Simultaneous hybrid coronary revascularization versus off-pump coronary artery bypass grafting for diabetic patients with multivessel coronary artery disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHEN Liuzhong ¹ , SONG Zhizhao ² ,  HU Shengshou ¹ , XU Bo ³ , WU Yongjian ³ , LV Feng ¹ , XIONG Hui ¹ , LI Lihuan ⁴

1. Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;
2. Department of Cardiovascular Surgery, Nanjing Drum Tower Hospital, Nanjing, 210008, P.R.China;
3. Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;
4. Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding author：

HU Shengshou, Email: shengshouhu@yahoo.com

Keywords：

Hybrid coronary revascularization; coronary artery bypass grafting; diabetes

DOI：

10.7507/1007-4848.201707058

Video：

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Objective To compare the in-hospital and midterm outcomes after simultaneous hybrid coronary revascularization (HCR) with off-pump coronary artery bypass grafting (OPCAB) in diabetic patients with multivessel coronary artery disease. Methods One hundred thirty-two diabetic patients with multivessel coronary artery disease underwent one-stop HCR at Fuwai Hospital from January 2010 to January 2015. These patients were 1∶2 matched with those who underwent OPCAB using propensity score matching. Results Simultaneous HCR had less chest tube drainage (618 (420, 811) ml vs. 969 (711, 1 213)ml, P<0.001), lower transfusion rate (19.7%vs. 34.1%, P=0.026), shorter mechanical ventilation time (11.6 (8.2, 14.8) h vs. 16.0 (12.1, 18.7) h, P<0.001), and shorter stay in intensive care unit (21.5 (18.8, 42.0) hvs. 44.6 (23.7, 70.1) h, P<0.001) than OPCAB. During over median 40 months follow-up, simultaneous HCR offered similar major adverse cardiac or cerebrovascular events (MACCE) rate (6.8%vs 9.0%, P=0.826), but lower stroke rate (0% vs 3.0%, P=0.029), compared with OPCAB. Conclusion For selected patients with diabetes, simultaneous HCR provides a safe and effective revascularization alternative. It decreases perioperative invasiveness and incurred similar and favorable midterm outcomes with OPCAB.

Citation： SHEN Liuzhong, SONG Zhizhao, HU Shengshou, XU Bo, WU Yongjian, LV Feng, XIONG Hui, LI Lihuan. Simultaneous hybrid coronary revascularization versus off-pump coronary artery bypass grafting for diabetic patients with multivessel coronary artery disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(12): 916-922. doi: 10.7507/1007-4848.201707058 Copy

1.	Castelvecchio S,Menicanti L, Garatti A, et al. Myocardial revascularization for patients with diabetes: coronary artery bypass grafting or percutaneous coronary intervention? Ann Thorac Surg, 2016, 102(3): 1012-1022.
2.	Holzmann MJ, Rathsman B, Eliasson B, et al. Long-term prognosis in patients with type 1 and 2 diabetes mellitus after coronary artery bypass grafting. J Am Coll Cardiol, 2015, 65(16): 1644-1652.
3.	Taggart DP. The FREEDOM trial: a definitive answer to coronary artery bypass grafting or stents in patients with diabetes and multivessel coronary artery disease. Eur J Cardiothorac Surg, 2013, 44(6): 978-979.
4.	Gaudino M, Taggart D, Suma H, et al. The choice of conduits in coronary artery bypass surgery. J Am Coll Cardiol, 2015, 66(15): 1729-1737.
5.	Magruder JT, Young A, Grimm JC, et al. Bilateral internal thoracic artery grafting: Does graft configuration affect outcome? J Thorac Cardiovasc Surg, 2016, 152(1): 120-127.
6.	Tranbaugh RF, Schwann TA, Swistel DG, et al. Coronary artery bypass graft surgery using the radial artery, right internal thoracic artery, or saphenous vein as the second conduit. Ann Thorac Surg, 2017, 104(2): 553-559.
7.	Yamasaki M, Deb S, Tsubota H, et al. Comparison of radial artery and saphenous vein graft stenosis more than 5 years after coronary artery bypass grafting. Ann Thorac Surg, 2016, 102(3): 712-719.
8.	Li P, Liu JP. Long-term risk of late and very late stent thrombosis in patients treated with everolimus against paclitaxel-eluting stents: an updated meta-analysis. Coron Artery Dis, 2014, 25(5): 369-377.
9.	Taniwaki M, Räber L, Magro M, et al. Long-term comparison of everolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for percutaneous coronary intervention of saphenous vein grafts. EuroIntervention, 2014, 9(12): 1432-1440.
10.	Puskas JD, Halkos ME, DeRose JJ, et al. Hybrid coronary revascularization for the treatment of multivessel coronary artery disease: a multicenter observational study. J Am Coll Cardiol, 2016, 68(4): 356-365.
11.	Angelini GD, Wilde P, Salerno TA, et al. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet, 1996, 347(9003): 757-758.
12.	Hu S, Li Q, Gao P, et al. Simultaneous hybrid revascularization versus off-pump coronary artery bypass for multivessel coronary artery disease. Ann Thorac Surg, 2011, 91(2): 432-438.
13.	Harskamp RE, Bagai A, Halkos ME, et al. Clinical outcomes after hybrid coronary revascularization versus coronary artery bypass surgery: a meta-analysis of 1,190 patients. Am Heart J, 2014, 167(4): 585-592.
14.	Shen L, Hu S, Wang H, et al. One-stop hybrid coronary revascularization versus coronary artery bypass grafting and percutaneous coronary intervention for the treatment of multivessel coronary artery disease: 3-year follow-up results from a single institution. J Am Coll Cardio, 2013, 61(25): 2525-2533.
15.	Zhou S, Fang Z, Xiong H, et al. Effect of one-stop hybrid coronary revascularization on postoperative renal function and bleeding: A comparison study with off-pump coronary artery bypass grafting surgery. J Thorac Cardiovasc Surg, 2014, 147(5): 1511-1516.
16.	Austin PC, Grootendorst P, Anderson GM. A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: A monte carlo study. Stat Med, 2007, 26(4): 734-753.
17.	Austin PC. Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: A systematic review and suggestions for improvement. J Thorac Cardiovasc Surg, 2007, 134(5): 1128-1135.
18.	Panoulas VF, Colombo A, Margonato A, et al. Hybrid coronary revascularization: Promising, but yet to take off. J Am Coll Cardio, 2015, 65(1): 85-97.
19.	Hu S, Gao R. Hybrid coronary revascularization for multivessel coronary artery disease. Coron Artery Dis, 2014, 25(3): 258-265.
20.	Altarabsheh SE, Deo SV, Rababa'h AM, et al. Off-pump coronary artery bypass reduces early stroke in octogenarians: a meta-analysis of 18,000 patients. Ann Thorac Surg, 2015, 99(5): 1568-1575.
21.	Domanski MJ, Farkouh ME, Zak V, et al. Predictors of stroke associated with coronary artery bypass grafting in patients with diabetes mellitus and multivessel coronary artery disease. Am J Cardiol, 2015, 115(10): 1382-1388.
22.	Davierwala PM, Leontyev S, Misfeld M, et al. No-touch aorta off-pump coronary bypass operation: arteriovenous composite grafts may be used as a last resort. Ann Thorac Surg, 2013, 95(3): 846-852.
23.	Davis KA, Miyares MA, Dietrich E. Dual antiplatelet therapy with clopidogrel and aspirin after ischemic stroke: A review of the evidence. Am J Health Syst Pharm, 2015, 72(19): 1623-1629.
24.	Head SJ, Borgermann J, Osnabrugge RL, et al. Coronary artery bypass grafting: Part 2--optimizing outcomes and future prospects. Euro Heart J, 2013, 34(37): 2873-2886.
25.	Dangas GD, Farkouh ME, Sleeper LA, et al. Long-term outcome of PCI versus CABG in insulin and non-insulin-treated diabetic patients: results from the FREEDOM trial. J Am Coll Cardiol, 2014, 64(12): 1189-1197.
26.	Gao P, Xiong H, Zheng Z, et al. Evaluation of antiplatelet effects of a modified protocol by platelet aggregation in patients undergoing "one-stop" hybrid coronary revascularization. Platelets, 2010, 21(3): 183-190.

1. Castelvecchio S,Menicanti L, Garatti A, et al. Myocardial revascularization for patients with diabetes: coronary artery bypass grafting or percutaneous coronary intervention? Ann Thorac Surg, 2016, 102(3): 1012-1022.
2. Holzmann MJ, Rathsman B, Eliasson B, et al. Long-term prognosis in patients with type 1 and 2 diabetes mellitus after coronary artery bypass grafting. J Am Coll Cardiol, 2015, 65(16): 1644-1652.
3. Taggart DP. The FREEDOM trial: a definitive answer to coronary artery bypass grafting or stents in patients with diabetes and multivessel coronary artery disease. Eur J Cardiothorac Surg, 2013, 44(6): 978-979.
4. Gaudino M, Taggart D, Suma H, et al. The choice of conduits in coronary artery bypass surgery. J Am Coll Cardiol, 2015, 66(15): 1729-1737.
5. Magruder JT, Young A, Grimm JC, et al. Bilateral internal thoracic artery grafting: Does graft configuration affect outcome? J Thorac Cardiovasc Surg, 2016, 152(1): 120-127.
6. Tranbaugh RF, Schwann TA, Swistel DG, et al. Coronary artery bypass graft surgery using the radial artery, right internal thoracic artery, or saphenous vein as the second conduit. Ann Thorac Surg, 2017, 104(2): 553-559.
7. Yamasaki M, Deb S, Tsubota H, et al. Comparison of radial artery and saphenous vein graft stenosis more than 5 years after coronary artery bypass grafting. Ann Thorac Surg, 2016, 102(3): 712-719.
8. Li P, Liu JP. Long-term risk of late and very late stent thrombosis in patients treated with everolimus against paclitaxel-eluting stents: an updated meta-analysis. Coron Artery Dis, 2014, 25(5): 369-377.
9. Taniwaki M, Räber L, Magro M, et al. Long-term comparison of everolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for percutaneous coronary intervention of saphenous vein grafts. EuroIntervention, 2014, 9(12): 1432-1440.
10. Puskas JD, Halkos ME, DeRose JJ, et al. Hybrid coronary revascularization for the treatment of multivessel coronary artery disease: a multicenter observational study. J Am Coll Cardiol, 2016, 68(4): 356-365.
11. Angelini GD, Wilde P, Salerno TA, et al. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet, 1996, 347(9003): 757-758.
12. Hu S, Li Q, Gao P, et al. Simultaneous hybrid revascularization versus off-pump coronary artery bypass for multivessel coronary artery disease. Ann Thorac Surg, 2011, 91(2): 432-438.
13. Harskamp RE, Bagai A, Halkos ME, et al. Clinical outcomes after hybrid coronary revascularization versus coronary artery bypass surgery: a meta-analysis of 1,190 patients. Am Heart J, 2014, 167(4): 585-592.
14. Shen L, Hu S, Wang H, et al. One-stop hybrid coronary revascularization versus coronary artery bypass grafting and percutaneous coronary intervention for the treatment of multivessel coronary artery disease: 3-year follow-up results from a single institution. J Am Coll Cardio, 2013, 61(25): 2525-2533.
15. Zhou S, Fang Z, Xiong H, et al. Effect of one-stop hybrid coronary revascularization on postoperative renal function and bleeding: A comparison study with off-pump coronary artery bypass grafting surgery. J Thorac Cardiovasc Surg, 2014, 147(5): 1511-1516.
16. Austin PC, Grootendorst P, Anderson GM. A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: A monte carlo study. Stat Med, 2007, 26(4): 734-753.
17. Austin PC. Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: A systematic review and suggestions for improvement. J Thorac Cardiovasc Surg, 2007, 134(5): 1128-1135.
18. Panoulas VF, Colombo A, Margonato A, et al. Hybrid coronary revascularization: Promising, but yet to take off. J Am Coll Cardio, 2015, 65(1): 85-97.
19. Hu S, Gao R. Hybrid coronary revascularization for multivessel coronary artery disease. Coron Artery Dis, 2014, 25(3): 258-265.
20. Altarabsheh SE, Deo SV, Rababa'h AM, et al. Off-pump coronary artery bypass reduces early stroke in octogenarians: a meta-analysis of 18,000 patients. Ann Thorac Surg, 2015, 99(5): 1568-1575.
21. Domanski MJ, Farkouh ME, Zak V, et al. Predictors of stroke associated with coronary artery bypass grafting in patients with diabetes mellitus and multivessel coronary artery disease. Am J Cardiol, 2015, 115(10): 1382-1388.
22. Davierwala PM, Leontyev S, Misfeld M, et al. No-touch aorta off-pump coronary bypass operation: arteriovenous composite grafts may be used as a last resort. Ann Thorac Surg, 2013, 95(3): 846-852.
23. Davis KA, Miyares MA, Dietrich E. Dual antiplatelet therapy with clopidogrel and aspirin after ischemic stroke: A review of the evidence. Am J Health Syst Pharm, 2015, 72(19): 1623-1629.
24. Head SJ, Borgermann J, Osnabrugge RL, et al. Coronary artery bypass grafting: Part 2--optimizing outcomes and future prospects. Euro Heart J, 2013, 34(37): 2873-2886.
25. Dangas GD, Farkouh ME, Sleeper LA, et al. Long-term outcome of PCI versus CABG in insulin and non-insulin-treated diabetic patients: results from the FREEDOM trial. J Am Coll Cardiol, 2014, 64(12): 1189-1197.
26. Gao P, Xiong H, Zheng Z, et al. Evaluation of antiplatelet effects of a modified protocol by platelet aggregation in patients undergoing "one-stop" hybrid coronary revascularization. Platelets, 2010, 21(3): 183-190.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Simultaneous hybrid coronary revascularization versus off-pump coronary artery bypass grafting for diabetic patients with multivessel coronary artery disease

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