The Comparison Of Mid-term Follow-up Between Two-stage Hybrid Coronary Revascularization And Conventional Off-pump Coronary Artery Bypass For Multivessel Coronary Artery Disease

Objectives1. To compare mid and long-term graft patency between two-stage HCR(Hybridcoronary revascularization) with robotic assistance and conventionalOPCAB(off-pump coronary artery bypass) to identify the operative effect anddifference of Hybrid technique.2. To compare first and sixth postoperative quality of life between HCR and OPCABto further demonstrate less injury, less pain and more quick recovery.Methods1. Materials: From January2007to May2013, a total of32patients acceptedtwo-stage HCR with robotic assistance. These were matched1:1to64patients FromJanuary2001to May2013treated with multivessel OPCAB by sternotomy using anoptimal matching algorithm with8preoperative variables: age, gender, BMI(bodymass index), smoke, preoperative Complications, PCI(percutaneous coronaryintervention), number of diseased vessels, left main coronary artery disease. A poorLAD target vessel, homodynamic instability, cardia failure or deadly arrhythmia notsuitable to off-pump surgery should be excluded. Severe lung disease with inabilityto tolerate single-lung ventilation, body mass index greater than40, or non-LADdisease not amenable to PCI should be excluded.2. Operative techque:Hybrid: The IMA was anastomosed completely to LAD with minimally invasivedirect coronary bypass graft (MIDCAB) or totally robotic coronary bypass graft onbeating heart (BHTECAB) under the assistant of da Vinci Surgical System. ThenPCI was performed within2weeks after robotic coronary bypass graft andsimultaneously check the patency of IMA-LAD. Pedicled internal mammaryartery was harvested by hand via median sternotomy. With the help of the Octopusstabilizer system, the anastomosis was performed on beating heart with hand sewn.3. Database collection: preoperative Baseline Characteristics, graft blood flow, blood lose, postoperative ventilation time, ICU stay, postoperative hospital stay,postoperative and follow-up complications.4. Graft patency assessment:①IMA-LAD patency of the first and third postoperative year between betweenHybrid and OPCAB.②SVG-non-LAD and DES(drug-eluting stent) patency of the first and thirdpostoperative year between between Hybrid and OPCAB.③64-MSCAT assess the graft patency with Fitzgibbon standard.5. Quality of life assessment: The SF-36Health Survey including9aspects:PF(Physical Functioning), RP(Role-Physical), BP(Bodily Pain), GH(GeneralHealth), VT(Vitality), SF(Social Functioning), RE(Role-Emotional), MH(MentalHealth), HT(Reported Health Transition).Results1. All the patients were alive after operation. The ventilation time of one patient inHybrid was more than24h. The ventilation time of three patients in OPCAB wasmore than24h and three patients have Transient atrial fibrillation after operation.2. All the internal mammary arteries were harvested successfully. The mean blood flowwas no statistical difference between Hybrid33.0(17.5-51.0)ml/min and OPCAB25.0(17.0-33.0ml/min. The IMA-LAD patency of the first and third postoperativeyear in Hybrid were96.9%and94.7%, compared with100%and96.4%in OPCAB,there was no statistical difference.3. DES(drug-eluting stent) patency of the first and third postoperative year in Hybridwere96.9%and89.4%, SVG-non-LAD of OPCAB were96.8%and92.8%, therewas no statistical difference.4. The average amounts of operative bleeding, postoperative drainage, red blood celluse, ICU stay, postoperative stay were less in Hybrid group(P<0.05), but there was nostatistical difference in the follow-up major adverse cardiac events of two groups.5. Quality of life on postoperative day30of the Hybrid was better than the OPCAB.The proportion of patients who return to work or exercise in Hybrid group wassignificantly higher than OPCAB group(P<0.05). The majority of patients in Hybridgroup were much more satisfaction with their operation incision(P<0.05). Conclusion1. To compared with OPCAB, The patency of Hybrid between mammary arteries orDES and saphenous veins in the first and third year were no difference.2. Patients in Hybrid will have less injury, less pain and more quick recovery.