title: Practice patterns and clinical outcomes after hybrid coronary revascularization in the United States: an analysis from the society of thoracic surgeons adult cardiac database.
abstract: BACKGROUND
  Hybrid coronary revascularization (HCR) involves a combination of surgical and percutaneous techniques, which in selected patients may present an alternative to conventional coronary artery bypass grafting (CABG).
  
  
  RESULTS
  Patients were included who underwent HCR (staged/concurrent) or isolated CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database (July 2011 to March 2013). HCR represented 0.48% (n=950; staged=809, concurrent=141) of the total CABG volume (n=198,622) during the study period, and was performed in one-third of participating centers (n=361). Patients who underwent HCR had higher cardiovascular risk profiles in comparison with patients undergoing CABG. In comparison with CABG, median sternotomy (98.5% for CABG, 61.1% for staged HCR, and 52.5% for concurrent HCR), direct vision harvesting (98.9%, 66.0%, and 68.1%) and cardiopulmonary bypass (83.4%, 45%, and 36.9%) were less frequently used for staged and concurrent HCR, whereas robotic assistance (0.7%, 33.0%, and 30.5%) was more common. After adjustment, no differences were observed for the composite of in-hospital mortality and major morbidity (odds ratio, 0.93; 95% confidence interval, 0.75-1.16; P=0.53 for staged HCR, and odds ratio, 0.94; 95% confidence interval, 0.56-1.56; P=0.80 for concurrent HCR in comparison with CABG). There was no statistically significant association between operative mortality and either treatment group (odds ratio, 0.74; 95% confidence interval, 0.42-1.30; P=0.29 for staged HCR, and odds ratio, 2.26; 95% confidence interval, 0.99-5.17; P=0.053 for concurrent HCR in comparison with CABG).
  
  
  CONCLUSIONS
  HCR, either as a staged or concurrent procedure, is performed in one-third of US hospitals and is reserved for a highly selected patient population. Although HCR may appear to be an equally safe alternative for CABG surgery, further randomized study is warranted.
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.). r.e.harskamp@gmail.com.
authors: Ralf E
authors: RE
authors: Harskamp
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: J Matthew
authors: JM
authors: Brennan
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: Ying
authors: Y
authors: Xian
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: Michael E
authors: ME
authors: Halkos
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: John D
authors: JD
authors: Puskas
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: Vinod H
authors: VH
authors: Thourani
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: James S
authors: JS
authors: Gammie
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: Bradley S
authors: BS
authors: Taylor
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: Robbert J
authors: RJ
authors: de Winter
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: Sunghee
authors: S
authors: Kim
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: Sean
authors: S
authors: O'Brien
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: Eric D
authors: ED
authors: Peterson
authors: From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
authors: Jeffrey G
authors: JG
authors: Gaca
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D011364:Professional Practice / Q000706:statistics & numerical data*; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology
keywords: coronary artery bypass; coronary disease; stents; thoracic surgery