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Practice patterns and clinical outcomes after hybrid coronary revascularization in the United States: an analysis from the society of thoracic surgeons adult cardiac database.

Publication ,  Journal Article
Harskamp, RE; Brennan, JM; Xian, Y; Halkos, ME; Puskas, JD; Thourani, VH; Gammie, JS; Taylor, BS; de Winter, RJ; Kim, S; O'Brien, S; Gaca, JG ...
Published in: Circulation
September 9, 2014

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). METHODS AND 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). CONCLUSION: 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.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

September 9, 2014

Volume

130

Issue

11

Start / End Page

872 / 879

Location

United States

Related Subject Headings

  • United States
  • Stroke
  • Stents
  • Risk Factors
  • Professional Practice
  • Percutaneous Coronary Intervention
  • Outcome and Process Assessment, Health Care
  • Middle Aged
  • Male
  • Length of Stay
 

Citation

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Harskamp, R. E., Brennan, J. M., Xian, Y., Halkos, M. E., Puskas, J. D., Thourani, V. H., … Gaca, J. G. (2014). Practice patterns and clinical outcomes after hybrid coronary revascularization in the United States: an analysis from the society of thoracic surgeons adult cardiac database. Circulation, 130(11), 872–879. https://doi.org/10.1161/CIRCULATIONAHA.114.009479
Harskamp, Ralf E., J Matthew Brennan, Ying Xian, Michael E. Halkos, John D. Puskas, Vinod H. Thourani, James S. Gammie, et al. “Practice patterns and clinical outcomes after hybrid coronary revascularization in the United States: an analysis from the society of thoracic surgeons adult cardiac database.Circulation 130, no. 11 (September 9, 2014): 872–79. https://doi.org/10.1161/CIRCULATIONAHA.114.009479.
Harskamp, Ralf E., et al. “Practice patterns and clinical outcomes after hybrid coronary revascularization in the United States: an analysis from the society of thoracic surgeons adult cardiac database.Circulation, vol. 130, no. 11, Sept. 2014, pp. 872–79. Pubmed, doi:10.1161/CIRCULATIONAHA.114.009479.
Harskamp RE, Brennan JM, Xian Y, Halkos ME, Puskas JD, Thourani VH, Gammie JS, Taylor BS, de Winter RJ, Kim S, O’Brien S, Peterson ED, Gaca JG. Practice patterns and clinical outcomes after hybrid coronary revascularization in the United States: an analysis from the society of thoracic surgeons adult cardiac database. Circulation. 2014 Sep 9;130(11):872–879.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

September 9, 2014

Volume

130

Issue

11

Start / End Page

872 / 879

Location

United States

Related Subject Headings

  • United States
  • Stroke
  • Stents
  • Risk Factors
  • Professional Practice
  • Percutaneous Coronary Intervention
  • Outcome and Process Assessment, Health Care
  • Middle Aged
  • Male
  • Length of Stay