Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Results released for first multicenter study of hybrid revascularization

11.03.2013
The first multicenter study of hybrid revascularization shows that the emerging procedure for treating coronary artery disease has a similar rate of major adverse events in the first year, compared with percutaneous intervention (stenting).

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!
Further information:
http://www.emory.edu

More articles from Studies and Analyses:

nachricht Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT

nachricht Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Electron highway inside crystal

Physicists of the University of Würzburg have made an astonishing discovery in a specific type of topological insulators. The effect is due to the structure of the materials used. The researchers have now published their work in the journal Science.

Topological insulators are currently the hot topic in physics according to the newspaper Neue Zürcher Zeitung. Only a few weeks ago, their importance was...

Im Focus: Significantly more productivity in USP lasers

In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.

Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...

Im Focus: Shape matters when light meets atom

Mapping the interaction of a single atom with a single photon may inform design of quantum devices

Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

Researchers identify potentially druggable mutant p53 proteins that promote cancer growth

09.12.2016 | Life Sciences

Scientists produce a new roadmap for guiding development & conservation in the Amazon

09.12.2016 | Ecology, The Environment and Conservation

Satellites, airport visibility readings shed light on troops' exposure to air pollution

09.12.2016 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>