Revascularización coronaria híbrida alternativa en pacientes no candidatos a cirugía convencional una cohorte simple en la Fundación Cardioinfantil

Abstract

Introduction: The present study was carried out to evaluate the frequency of short and long-term major cardiac events (MACE) in a group of patients who underwent a hybrid coronary revascurization due to intraoperative findings. Methods: Between 2008 and 2016, 49 patients underwent HCR at Fundación Cardioinfantil-Cardiology Institute. Patients were discussed by the heart team. In 75% of the cases the decision to perform a hybrid revascularization was taken during surgery due to intraoperative findings. The left internal mammary artery was bypassed to the left anterior descendent artery, then the patients were taken to the catheterization laboratory were the circumflex or right coronary artery were intervened. Endpoints were short and long-term frequency of MACE, coronary re-intervention or death. Results: Follow-up was 87% completed with a median time of 1.8 years. The most common indication for a hybrid procedure was severe atheromatous disease of the aorta (43%). In 29% of the cases cardiopulmonary bypass was used. The median SYNTAX score was 32. 30-day MACE events were reported in six patients (two died, one had a myocardial infarction, one suffered a stroke, and two required a coronary re-intervention). At the last follow-up two patients underwent a coronary re-intervention due to intrastent thrombosis, two died, and two suffered a myocardial infarction. Conclusion: In the intraoperative scenario of severe atheromatous disease of the aorta, poor target vessels, and poor conduits, the use of hybrid techniques can be a considerable choice of treatment.