Immediate and long-term results of hybrid myocardial revascularization.

Aim: to evaluate the immediate and long-term results of using the HRM technique in patients with multivessel coronary lesions.

Material and methods: The retrospective single-center study included 865 patients, of which 522 (60.3%) were men; the average age of the patients was 65.8±11.5 years. 749 (86.5%) had angina pectoris; the average number of affected coronary arteries (CA) was 2.8. Post-infarction cardiosclerosis was present in 326 (37.6%), the number of patients with atherosclerotic lesions of the arteries of the lower extremities was 122 (14.1%) and the carotid system - 104 (13.5%). The risk of patients was stratified according to the Euroscore II scale - 1.9±1.5%. The first stage was predominantly coronary bypass surgery - 729 (84.2%) patients; while 671 (92%) underwent anterolateral left thoracotomy, 58 (8%) patients underwent median sternotomy (surgeries, history of chest trauma). 136 (15.7%) patients underwent PCI at the first stage for emergency indications due to the development of acute coronary syndrome (ACS). The second stage (mainly PCI) was performed within a period of up to 60 days, usually in one hospitalization.

Results: All patients who underwent hybrid intervention underwent complete myocardial revascularization. The average length of stay in intensive care after CABG was 1.1, hospital stay 6.6 beds/days. The early postoperative period (after the first stage) in 7 (2.2%) patients was complicated by bleeding, which required revision of the wound. In 31 (4.2%), a rhythm disturbance such as atrial fibrillation (AF) occurred, which was treated with medication. Superficial suppuration of the postoperative wound occurred in 5 (0.6%) cases. The second stage (mainly PCI) was carried out as planned - 729 (84.2%) patients. There were no cases of postoperative AMI. 136 patients underwent CABG using a sternotomy approach. The overall mortality rate of HRM was 6 (0.6%), which was observed mainly in patients with ACS. The long-term results of breastfeeding were analyzed at an average follow-up period of 65.1±5 months. According to the results of the Kaplan– Meier analysis, the probability of patient survival was 99.4% at 12 months, 94.9% at 36 months, and 89.7% at 60 months. The probability of repeat revascularization rates during the same follow-up period was 12 months – 0.3%, 36 months – 1.7%, 60 months – 8.4%.

Conclusion: Hybrid interventions have good immediate and long-term results in older patients with multivessel coronary disease, patients with severe comorbidities, and in patients with previous cardiac surgery. Prospective randomized studies are required to definitively evaluate the method.

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