Hybrid revascularization is a minimally invasive blend of coronary bypass surgery and stenting. It has been described as a "best of both worlds" strategy for treating multi-vessel coronary artery disease. Surgeons avoid opening the patient's sternum, which facilitates recovery, while keeping the durability of bypass surgery for the most important of the blocked coronary arteries.
John Puskas, MD, professor of surgery and associate chief of cardiothoracic surgery at Emory University School of Medicine, was national principal investigator for the study and is scheduled to present the results at the American College of Cardiology meeting in San Francisco.
Participating institutions included: Brigham and Women's, Columbia, Duke, Emory, Lankenau Hospital (Pennsylvania), Montefiore-Einstein Heart Center, Ohio State, University of Maryland, University of Pennsylvania, University of Virginia and Vanderbilt. The data coordinating center was housed in the Department of Health Evidence & Policy at the Icahn School of Medicine at Mount Sinai in New York. The study was funded by a Challenge grant – part of the 2009 American Recovery & Reinvestment Act – from the National Heart, Lung and Blood Institute, and was conducted in association with the NHLBI Cardiothoracic Surgery Trials Network.
The study was a prospective cohort study that enrolled 200 hybrid patients and 98 patients who would have been eligible for a hybrid procedure, but had multi-vessel percutaneous intervention (PCI) instead.
"We started by taking a snapshot of each participating center's catheterization lab over three months," Puskas says. "That was over 6,500 patients, but only a fraction were eligible. They had to have a pattern of coronary artery disease that could be reasonably treated with either hybrid techniques or multivessel percutaneous intervention: both an LAD (left anterior descending) lesion and a significant stenosis in at least one other non-LAD coronary artery. This was a group of patients with low to medium complexity coronary artery disease."
The primary measure of safety was the rate of major adverse coronary and cerebrovascular events (MACCE: includes death, heart attack, stroke or repeat revascularization procedure). Over the first year, hybrid patients had a MACCE rate of 11 percent (0.143 events per patient-year) while PCI patients had a rate of 10 percent (0.119 events per patient year), with hybrid revascularization displaying a trend toward a MACCE rate lower than PCI after the first year. Patients were followed for up to an average of 17.5 months and over that time, the MACCE rate for hybrid revascularization patients was 0.868 times that for PCI patients, adjusted for baseline risk.
"A question this study starts to address is, whether short-term outcomes and complications over the first year are comparable between these two alternative therapies," Puskas says. "These results suggest that hybrid revascularization is as safe in the first year, with a trend to benefit over the longer term. It would be a challenge to markedly out-perform PCI over the first year – we expect that if hybrid revascularization has an advantage, it will come out over the next few years."
He explains that multivessel coronary bypass surgery usually includes a left internal mammary artery (LIMA) graft for the blockage in the left anterior descending coronary artery (LAD), along with veins from the legs for the other blocked vessel(s). The LIMA graft has several advantages: most importantly, the LIMA graft stays open longer than vein grafts, because the LIMA is conditioned to higher blood pressures.
"We know the left internal mammary artery graft is the most durable treatment for that [LAD] blockage, so we expect there will be fewer repeat revascularizations in the hybrid group of patients," he says.
Hybrid revascularization keeps the LIMA graft for the LAD while using coronary stents for other non-LAD blockages, allowing a minimally invasive approach and avoiding use of the heart-lung machine.
"In light of the growing adoption of this treatment paradigm, a randomized trial of hybrid revascularization is now needed to rigorously evaluate its safety and efficacy relative to PCI," says Deborah D. Ascheim, MD, associate professor of health evidence & policy and cardiology at the Icahn School of Medicine at Mount Sinai, and principal investigator of the study's data coordinating center,
The results of the current study, Puskas agrees, support the Hybrid Observational Study Investigators' plans to conduct such a trial.
Co-author Michael Halkos, MD, assistant professor of surgery at Emory University School of Medicine, is giving a presentation Saturday, March 9 (6:45 pm ET), on the results of hybrid revascularization at Emory only.
2011 publication on hybrid revascularization and bypass surgery study at Emory: http://ats.ctsnetjournals.org/cgi/content/full/92/5/1695
Quinn Eastman | EurekAlert!
A sudden drop in outdoor temperature increases the risk of respiratory infections
11.01.2017 | University of Gothenburg
Urbanization to convert 300,000 km2 of prime croplands
27.12.2016 | Mercator Research Institute on Global Commons and Climate Change (MCC) gGmbH
Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.
As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...
At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).
Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...
Many pathogens use certain sugar compounds from their host to help conceal themselves against the immune system. Scientists at the University of Bonn have now, in cooperation with researchers at the University of York in the United Kingdom, analyzed the dynamics of a bacterial molecule that is involved in this process. They demonstrate that the protein grabs onto the sugar molecule with a Pac Man-like chewing motion and holds it until it can be used. Their results could help design therapeutics that could make the protein poorer at grabbing and holding and hence compromise the pathogen in the host. The study has now been published in “Biophysical Journal”.
The cells of the mouth, nose and intestinal mucosa produce large quantities of a chemical called sialic acid. Many bacteria possess a special transport system...
UMD, NOAA collaboration demonstrates suitability of in-orbit datasets for weather satellite calibration
"Traffic and weather, together on the hour!" blasts your local radio station, while your smartphone knows the weather halfway across the world. A network of...
Fiber-reinforced plastics (FRP) are frequently used in the aeronautic and automobile industry. However, the repair of workpieces made of these composite materials is often less profitable than exchanging the part. In order to increase the lifetime of FRP parts and to make them more eco-efficient, the Laser Zentrum Hannover e.V. (LZH) and the Apodius GmbH want to combine a new measuring device for fiber layer orientation with an innovative laser-based repair process.
Defects in FRP pieces may be production or operation-related. Whether or not repair is cost-effective depends on the geometry of the defective area, the tools...
10.01.2017 | Event News
09.01.2017 | Event News
05.01.2017 | Event News
16.01.2017 | Power and Electrical Engineering
16.01.2017 | Information Technology
16.01.2017 | Power and Electrical Engineering