Hybrid Coronary Revascularization Versus On-Pump Coronary Artery Bypass Grafting.

BACKGROUND: Hybrid coronary revascularization (HCR) is an evolving coronary revascularization strategy for the treatment of multivessel coronary artery disease. We provide a comparative analysis to conventional on-pump coronary artery bypass graft surgery (CABG) with long-term follow-up. METHODS: We included all double on-pump CABG (n = 682) and HCR (147 robotic-assisted minimally invasive bypass grafts of the left internal thoracic artery to the left anterior descending coronary artery and percutaneous coronary intervention to one of the non-left anterior descending coronary artery vessels) performed in our institution between March 2004 and November 2015. We performed an adjusted analysis using inverse-probability weighting based on the propensity score of receiving either on-pump CABG or HCR. RESULTS: In the adjusted analysis, there was no statistically significant difference in the incidence of reexploration for bleeding, perioperative myocardial infarction, stroke, need for hemodialysis, blood transfusion rate, prolonged mechanical ventilation, and intensive care unit length of stay. Hybrid coronary revascularization was associated with lower inhospital mortality (CABG 1.3%, HCR 0%, p = 0.008), and shorter mean (± SD) hospital length of stay (CABG 6.7 ± 4.7 days, HCR 4.5 ± 2.1 days, p < 0.001). After a median follow-up period of 70 months (range, 37 to 106) for the CABG group and 96 months (range, 53 to 114) for the HCR group, there was no significant difference in survival (CABG 92%, HCR 97%, p = 0.13) or freedom from any form of revascularization (CABG 93%, HCR 91%, p = 0.27). Hybrid coronary revascularization was superior in freedom from angina (CABG 70%, HCR 91%, p < 0.001). CONCLUSIONS: For selected patients, HCR is associated with a faster postoperative recovery as well as similar short-term and long-term outcomes when compared with standard on-pump CABG.

Alternative Surgical Approach to Repairing a Giant Sinus of Valsalva Aneurysm.

We report our method of surgically repairing an unruptured giant aneurysm of the right coronary sinus of Valsalva, a lesion that caused moderate aortic regurgitation but no symptoms in a 61-year-old woman. We excised the aneurysm, reconstructed the right sinus of Valsalva with use of a patch, performed mechanical aortic valve replacement directly through the excised aneurysm's cavity, and constructed a single bypass graft to the right coronary artery. The patient was discharged from the hospital after 5 days. Twelve months postoperatively, her clinical and echocardiographic results were normal, and she was doing well. To our knowledge, our surgical approach to this repair has not been described previously.