title: Comparative study of same sitting hybrid coronary artery revascularization versus off-pump coronary artery bypass in multivessel coronary artery disease.
abstract: OBJECTIVE
  We compared the outcomes of same sitting robotic-assisted hybrid coronary artery revascularization (HCR) with off-pump coronary artery bypass grafting (OPCABG) in similar patients with multivessel coronary artery disease.
  
  
  BACKGROUND
  HCR is a novel procedure in selected patients with multivessel coronary artery disease (CAD). Although there are some data on staged HCR, the data on same sitting HCR are limited.
  
  
  METHODS
  We conducted a prospective study comparing same sitting robotic-assisted HCR patients (n = 25) to a group of consecutive low to moderate risk OPCABG patients (n = 27) during the study period. HCR patients underwent robotic internal mammary artery takedown followed by OPCABG via minithoracotomy. After confirming graft patency, immediate percutaneous coronary intervention on the nonbypass arteries was performed. Comparative analyses were performed on in-hospital and 30 day outcomes.
  
  
  RESULTS
  The baseline characteristics were similar for both groups including the severity of CAD (Syntax score 33.5+/-8.2 vs. 34.9+/-8.2, P = 0.556). Overall MACE was similar between both groups; however, the HCR group showed improved hospital outcomes with lower need for postoperative transfusions (12% vs. 67%, P < 0.001), and shorter length of hospital stay (5.1+/-2.8 vs. 8.2+/-5.4 days, P < 0.01). Despite lower postoperative costs, the HCR group had higher overall hospital costs due to higher procedural costs ($33,984 +/-$4,806 vs. $27,816+/-$11,172, P < 0.0001). Propensity model analysis showed similar findings. The HCR group showed improved quality of life measures with shorter time to return to work (5.3+/-3.0 vs. 8.2+/- 4.6 weeks, P = 0.01).
  
  
  CONCLUSIONS
  Same sitting HCR appears to be feasible and may offer superior outcomes to standard OPCABG, further studies are warranted.
authors: Writing Group on behalf of the Cardiac Surgery and Interventional Cardiology Groups, Pinnacle Health Cardiovascular Institute, Harrisburg Hospital, Harrisburg, Pennsylvania 17043, USA. bachinsky@comcast.net
authors: William B
authors: WB
authors: Bachinsky
authors: Murad
authors: M
authors: Abdelsalam
authors: Gouthami
authors: G
authors: Boga
authors: Lukasz
authors: L
authors: Kiljanek
authors: Mubashir
authors: M
authors: Mumtaz
authors: Christine
authors: C
authors: McCarty
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D013223:Statistics as Topic