Long-term Outcomes of Coronary Artery Bypass Grafting and Staged Hybrid Myocardial Revascularization in Patients With Ischemic Heart Disease

Ischemic Heart Disease (IHD) remains a critical health concern both in Russia and globally. Surgical interventions, such as Coronary Artery Bypass Grafting (CABG) and coronary stenting, are commonly used to address IHD. However, in certain cases, single-stage complete revascularization may not be feasible. Hybrid Coronary Revascularization (HCR), a technique combining CABG with subsequent endovascular interventions, offers a potential solution to this challenge.

This study aims to compare the efficacy and safety of surgical myocardial revascularization using CABG vs. staged HCR.

This retrospective, single-center, cohort, non-randomized study included 95 patients with IHD who underwent myocardial revascularization at the Pirogov National Medical and Surgical Center between 2017 and 2021. Group I (n=45) consisted of patients who received complete myocardial revascularization through CABG. Group II (n=50) comprised patients who underwent Hybrid Myocardial Revascularization (HMR), with CABG followed by Percutaneous Coronary Intervention (PCI). The median interval between CABG and PCI in Group II was 32.1±15.7 days.

Intraoperatively, the total procedure duration significantly differed between the groups, with Group I (CABG) having a mean duration of 242.8±45.9 min compared with 310±55.8 min in Group II (HMR) P<0.001). During the perioperative period, the need for inotropic support differed significantly between the groups (24.4% in group I, 8.0% in group II P=0.028). No significant differences were observed between the groups regarding the length of stay in the intensive care unit, the number of blood transfusions required, or the incidence of Myocardial Infarctions (MI), postoperative bleeding, or strokes. With a mean follow-up period of 755±286 days, the frequency of Major Adverse Cardiovascular Events (MACEs) did not differ significantly between the two groups. The rate of Venous Graft Failure (VGF) was also comparable, with 18 cases (22.8%) in Group I and 6 cases (18.8%) in Group II (P=NS). Meanwhile, group II demonstrated a higher incidence of restenosis with 2 cases [10.5%] vs. 10 cases [16.1%], P=0.023) over the 24-month follow-up. Early and long-term postoperative mortality rates were similar between the groups, with no statistically significant differences.

The efficacy and safety of standard CABG with extensive myocardial revascularization possible and the staged hybrid approach are comparable in the surgical treatment of patients with diffuse Coronary Artery Disease (CAD).