Nationwide Short-Term and Midterm Clinical Outcome Comparison of Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Surgery

Abstract

OBJECTIVE: Hybrid coronary revascularization (HCR) has emerged as a minimally invasive alternative to conventional coronary artery bypass techniques for patients with multivessel coronary artery disease. This study aimed to compare the clinical outcomes of HCR versus off-pump coronary artery bypass (OPCAB) in patients with multivessel disease in The Netherlands. METHODS: This study analyzed 117 HCR patients and 313 OPCAB patients after propensity score matching. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCE) at 30 days after the procedure. Secondary outcomes included mortality, myocardial infarction, repeat revascularization, and ischemic cerebrovascular accidents. Midterm survival and repeat target vessel revascularization (TVR) were evaluated over a median follow-up of 36 months. RESULTS: At 30 days, MACCE rates were similar between the HCR group (5.1%) and the OPCAB group (4.1%; P = 0.62). Secondary outcomes were also comparable between the groups. The incidence of myocardial infarction in the HCR group was numerically higher (3.4% vs 1.6%), but this difference was not statistically significant ( P = 0.17). Midterm survival rates showed no significant difference between the groups, although numerically the HCR showed a higher rate of TVR (5.1% vs 4.1%, P = 0.62). No significant differences were found in blood transfusion requirements or postoperative hospital stay duration. CONCLUSIONS: HCR demonstrated comparable short-term and midterm outcomes to OPCAB, suggesting it is a viable alternative for multivessel coronary artery disease treatment. However, further research is necessary to assess long-term effectiveness and to identify specific patient populations who may benefit most from HCR.