Document Detail


Perioperative outcomes in hybrid versus conventional surgical coronary artery revascularisation.
MedLine Citation:
PMID:  20573651     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A best evidence topic was written on perioperative outcomes in hybrid coronary revascularisation according to a structured protocol. The question addressed was 'In patients with stable multivessel coronary artery disease, does the use of hybrid coronary revascularisation compared to conventional and off-pump coronary artery bypass grafting (CABG) reduce perioperative morbidity and mortality?' Six hundred and twenty-three papers were found in the literature search. From these results, six comparative studies and one review paper appeared to be relevant. The authors, journal, date and country of publication, patient group studied, study type, relevant results and weaknesses of these papers were compiled and tabulated. Critical appraisal ruled out three of the six comparative studies identified by the search. Therefore, the following papers constituted best evidence. de Cannière et al. reported a non-randomised retrospective comparison of staged hybrid revascularisation with conventional CABG, showing an association with shorter intensive care unit and total hospital stays, as well as shorter time to return to work. Kon et al. reported a non-randomised retrospective comparison of simultaneous hybrid revascularisation with off-pump CABG, showing that fewer blood transfusions were required in addition to shorter intensive care and hospital stays. Vassiliades et al. reported a non-randomised retrospective comparison of staged hybrid revascularisation with off-pump CABG, which failed to show a difference between 30-day major adverse cardiac events in the two patient groups. DeRose reviewed 13 published series of hybrid revascularisation cases, concluding that experienced centres should consider hybrid revascularisation as an appropriate alternative to conventional CABG for selected patients. In summary, these papers provide limited evidence of improved perioperative outcomes in both staged and simultaneous hybrid revascularisation compared to CABG. Weaknesses of the comparative studies include the lack of mid-term and long-term follow-up and the difficulty of generalising results from specialist units to general cardiac surgical practice. A large randomised control trial comparing hybrid revascularisation and coronary artery bypass with mid-term follow-up will be required to establish the clinical effectiveness of this procedure.
Authors:
Michael-Luke Jones; Shengyang Qiu; Catherine Sudarshan
Publication Detail:
Type:  Journal Article; Review     Date:  2010-06-23
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  11     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-19     Completed Date:  2010-12-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  292-6     Citation Subset:  IM    
Affiliation:
Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, UK. jonesml@me.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary* / adverse effects,  mortality
Benchmarking
Blood Transfusion
Coronary Artery Bypass* / adverse effects,  mortality
Coronary Artery Bypass, Off-Pump* / adverse effects,  mortality
Coronary Artery Disease / mortality,  physiopathology,  surgery,  therapy*
Evidence-Based Medicine
Female
Humans
Length of Stay
Myocardial Revascularization / adverse effects,  methods*,  mortality
Patient Selection
Recovery of Function
Risk Assessment
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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