Background Hybrid coronary revascularization （HCR） is an altemative coronary revascularization strategy that combines a minimally invasive, survival advantage of the left internal mammary artery （LIMA） -left anter...Background Hybrid coronary revascularization （HCR） is an altemative coronary revascularization strategy that combines a minimally invasive, survival advantage of the left internal mammary artery （LIMA） -left anterior descending （LAD） coronary artery bypass with less-invasive percutaneous coronary intervention （PCI） to non-LAD coronary lesions by using drug-eluting stents. We report our experience of hybrid minimally invasive approach in 15 patients. Methods From December 2012 to October 2013, 15 patients underwent revascularization of the left anterior descending artery through minimally invasive coronary artery bypass grafting （MIDCAB）. All patients by endoscopic assist beating heart coronary artery bypass grafting. Seven patients were scheduled for a hybrid procedure. Percutaneous coronary intervention of non- LAD was performed 3 to 5 days preoperatively. Demographic data, perioperative outcome, and annual follow-up were obtained from all the patients. Results In-hospital mortality was 6.67%. The rate of conversion to full median sternotomy was 13.3%. Ventilation time was 6.9 ± 5.1 h. Blood loss volume was 241 ± 67.8 mL. ICU stay was 21.3 ± 10.8 h. Hospital postoperative stay lasted for 7.5 ± 1.3 days. Prior to PCI patients showed 100% patent LIMA （Tables 3 and 4）. A mean follow-up was 8.5 months. One year graft patency rate was 100% （8/8 patients for 254-slice tomography）. Two patients required reintervention. Conclusions Minimally invasive hybrid coronary revascularization is a safe, feasible and efficacious approach with good results and should be performed in selected patients by surgeons with experience in minimally invasive bypass surgery plus collaboration with cardiologists, eluting stents.展开更多
目的用meta分析方法对一站式杂交技术与非体外循环下冠脉搭桥术治疗冠心病疗效的临床研究进行综合性定量研究。方法使用Cochrane系统评价方法,计算机检索EMBASE,Cochrane图书馆、中国知网、万方数据库、CBM,web of Science,scopus,Googl...目的用meta分析方法对一站式杂交技术与非体外循环下冠脉搭桥术治疗冠心病疗效的临床研究进行综合性定量研究。方法使用Cochrane系统评价方法,计算机检索EMBASE,Cochrane图书馆、中国知网、万方数据库、CBM,web of Science,scopus,Google scholar and Controlled Trails metaRegister,Pubmed及Medline等数据库的文献,收集有关比较一站式杂交技术和非体外循环下冠脉搭桥术治疗冠心病的对照研究实验,评价入选研究的质量。结果共纳入符合标准的文献5篇,共409例患者。Meta分析结果显示:杂交组手术时间长于传统组住院费用多于传统组(P<0.05);机械通气时间、住ICU的时间住院时间失血量、输红细胞悬浮液量术后心肌梗死发生率明显低于传统组(P<0.05)。杂交组的非计划再次手术、术后新发房颤发生率及随访期死亡发生率与传统组无统计学差异(P>0.05),但是杂交组随访期主要心脏不良事件发生率低于传统组且重返工作或正常活动时间短于传统组(P<0.05)。结论一站式杂交治疗复杂冠心病的疗效可能优于非体外循环下冠脉搭桥术。展开更多
Background The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting （CABG） and percutaneous coronary intervention （PCI） and is an alternative to revascularization...Background The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting （CABG） and percutaneous coronary intervention （PCI） and is an alternative to revascularization treatment. We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events （MACCE） in patients with multivessel disease undergoing hybrid coronary revascularization. Methods The data of 120 patients were retrospectively collected and the SYNTAX score, EuroSCORE, SinoSCORE and the Global Risk Classification （GRC） calculated for each patient. The outcomes of interest were 2.7-year incidences of MACCE, including death, myocardial infarction, stroke, and any-vessel revascularization. Results During a mean of 2.7-year follow-up, actuarial survival was 99.17%, and no myocardial infarctions occurred. The discriminatory power （area under curve （AUC）） of the SYNTAX score, EuroSCORE, SinoSCORE and GRC for 2.7-year MACCE was 0.60 （95% confidence interval 0.42-0.77）, 0.65 （0.47-0.82）, 0.57 （0.39-0.75） and 0.65 （0.46-0.83）, respectively. The calibration characteristics of the SYNTAX score, EuroSCORE, SinoSCORE and GRC were 3.92 （P=0.86）, 5.39 （P=0.37）, 13.81 （P=0.32） and 0.02 （P=0.89）, respectively. Conclusions In patients with multivessel disease undergoing a hybrid procedure, the SYNTAX score, EuroSCORE, SinoSCORE and GRC were inaccurate in predicting MACCE. Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.展开更多
文摘Background Hybrid coronary revascularization （HCR） is an altemative coronary revascularization strategy that combines a minimally invasive, survival advantage of the left internal mammary artery （LIMA） -left anterior descending （LAD） coronary artery bypass with less-invasive percutaneous coronary intervention （PCI） to non-LAD coronary lesions by using drug-eluting stents. We report our experience of hybrid minimally invasive approach in 15 patients. Methods From December 2012 to October 2013, 15 patients underwent revascularization of the left anterior descending artery through minimally invasive coronary artery bypass grafting （MIDCAB）. All patients by endoscopic assist beating heart coronary artery bypass grafting. Seven patients were scheduled for a hybrid procedure. Percutaneous coronary intervention of non- LAD was performed 3 to 5 days preoperatively. Demographic data, perioperative outcome, and annual follow-up were obtained from all the patients. Results In-hospital mortality was 6.67%. The rate of conversion to full median sternotomy was 13.3%. Ventilation time was 6.9 ± 5.1 h. Blood loss volume was 241 ± 67.8 mL. ICU stay was 21.3 ± 10.8 h. Hospital postoperative stay lasted for 7.5 ± 1.3 days. Prior to PCI patients showed 100% patent LIMA （Tables 3 and 4）. A mean follow-up was 8.5 months. One year graft patency rate was 100% （8/8 patients for 254-slice tomography）. Two patients required reintervention. Conclusions Minimally invasive hybrid coronary revascularization is a safe, feasible and efficacious approach with good results and should be performed in selected patients by surgeons with experience in minimally invasive bypass surgery plus collaboration with cardiologists, eluting stents.
文摘目的用meta分析方法对一站式杂交技术与非体外循环下冠脉搭桥术治疗冠心病疗效的临床研究进行综合性定量研究。方法使用Cochrane系统评价方法,计算机检索EMBASE,Cochrane图书馆、中国知网、万方数据库、CBM,web of Science,scopus,Google scholar and Controlled Trails metaRegister,Pubmed及Medline等数据库的文献,收集有关比较一站式杂交技术和非体外循环下冠脉搭桥术治疗冠心病的对照研究实验,评价入选研究的质量。结果共纳入符合标准的文献5篇,共409例患者。Meta分析结果显示:杂交组手术时间长于传统组住院费用多于传统组(P<0.05);机械通气时间、住ICU的时间住院时间失血量、输红细胞悬浮液量术后心肌梗死发生率明显低于传统组(P<0.05)。杂交组的非计划再次手术、术后新发房颤发生率及随访期死亡发生率与传统组无统计学差异(P>0.05),但是杂交组随访期主要心脏不良事件发生率低于传统组且重返工作或正常活动时间短于传统组(P<0.05)。结论一站式杂交治疗复杂冠心病的疗效可能优于非体外循环下冠脉搭桥术。
文摘Background The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting （CABG） and percutaneous coronary intervention （PCI） and is an alternative to revascularization treatment. We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events （MACCE） in patients with multivessel disease undergoing hybrid coronary revascularization. Methods The data of 120 patients were retrospectively collected and the SYNTAX score, EuroSCORE, SinoSCORE and the Global Risk Classification （GRC） calculated for each patient. The outcomes of interest were 2.7-year incidences of MACCE, including death, myocardial infarction, stroke, and any-vessel revascularization. Results During a mean of 2.7-year follow-up, actuarial survival was 99.17%, and no myocardial infarctions occurred. The discriminatory power （area under curve （AUC）） of the SYNTAX score, EuroSCORE, SinoSCORE and GRC for 2.7-year MACCE was 0.60 （95% confidence interval 0.42-0.77）, 0.65 （0.47-0.82）, 0.57 （0.39-0.75） and 0.65 （0.46-0.83）, respectively. The calibration characteristics of the SYNTAX score, EuroSCORE, SinoSCORE and GRC were 3.92 （P=0.86）, 5.39 （P=0.37）, 13.81 （P=0.32） and 0.02 （P=0.89）, respectively. Conclusions In patients with multivessel disease undergoing a hybrid procedure, the SYNTAX score, EuroSCORE, SinoSCORE and GRC were inaccurate in predicting MACCE. Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.
