ABC | Volume 110, Nº4, April 2018

Original Article Short-Term and Mid-Term Clinical Outcomes Following Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass: A Meta-Analysis Li Dong, * Yi-kun Kang, * Xiang-guang An Heart Center & Beijing Key Laboratory of Hypertension - Beijing Chaoyang Hospital - Capital Medical University, Beijng - China * Contributed equally to this paper, and should be regarded as co-first authors Mailing Address: Xiang-guang An • Heart Center & Beijing Key Laboratory of Hypertension - Beijing Chaoyang Hospital - Capital Medical University, Beijng 100020, China E-mail: anxiangguang@sina.com Manuscript received August 07, 2017, revised manuscript September 22, 2017, accepted October 06, 2017 DOI: 10.5935/abc.20180044 Abstract Background: Off-pump coronary artery bypass grafting (OPCAB) is one of the standard treatments for coronary artery disease (CAD) while hybrid coronary revascularization (HCR) represents an evolving revascularization strategy. However, the difference in outcomes between them remains unclear. Objective: We performed a meta-analysis to compare the short-term and mid-term outcomes of HCR versus OPCAB for the treatment of multivessel or left main CAD. Methods: We searched the PubMed, EMBASE, Web of Science and Cochrane databases to identify related studies and a routine meta-analysis was conducted. Results: Nine studies with 6121 patients were included in the analysis. There was no significant difference in short‑term major adverse cardiac and cerebrovascular event (MACCE) rate (RR: 0.55, 95% CI: 0.30–1.03, p = 0.06) or mortality (RR: 0.51, 95% CI: 0.17–1.48, p = 0.22). HCR required less ventilator time (SMD: -0.36, 95% CI: -0.55– -0.16, p < 0.001), ICU stay (SMD: -0.35, 95% CI: -0.58 – -0.13, p < 0.01), hospital stay (SMD: -0.29, 95% CI: -0.50– -0.07, p < 0.05) and blood transfusion rate (RR: 0.57, 95% CI: 0.49–0.67, p < 0.001), but needed more operation time (SMD: 1.29, 95% CI: 0.54–2.05, p < 0.001) and hospitalization costs (SMD: 1.06, 95% CI: 0.45–1.66, p < 0.001). The HCR group had lower mid-term MACCE rate (RR: 0.49, 95% CI: 0.26–0.92, p < 0.05) but higher rate in mid-term target vessel revascularization (TVR, RR: 2.20, 95% CI: 1.32–3.67, p < 0.01). Conclusions: HCR had similar short-term mortality and morbidity comparing to OPCAB. HCR decreased the ventilator time, ICU stay, hospital stay, blood transfusion rate and increased operation time and hospitalization costs. HCR has a lower mid-term MACCE rate while OPCAB shows better in mid-term TVR. (Arq Bras Cardiol. 2018; 110(4):321-330) Keywords: Coronary Artery Disease/surgery; Coronary Artery Bypass, Off-Pump; Myocardial Revascularization/ trends; Meta-Analysis; Database Bibliographic. Introduction Surgical revascularization still plays an essential role in the treatment of coronary artery disease (CAD) even in the era of widely prevalent percutaneous coronary intervention (PCI). As the most classical and widespread procedure for revascularization, coronary artery bypass grafting (CABG) has been considered the gold standard therapy in the past decades. 1 In order to be safe and less disruptive, hybrid coronary revascularization (HCR) and off-pump coronary artery bypass grafting (OPCAB) which combines an off-pump technique with total arterial grafting. Recent years, more and more cardiac centers in the world have adopted OPCAB and HCR. 2,3 It has been intensively discussed whether OPCAB is superior for CAD compared with on-pump CABG, but it remains uncertain. A recent randomized controlled trial (RCT) including 4752 patients found that the outcomes of death, stroke, myocardial infarction, renal failure or repeat revascularization at 5-year follow-up were similar among patients who underwent OPCAB or on-pump CABG. 4 Another research investigated 3445 patents with a 13-year follow-up and drew conclusions that both OPCAB and on-pump CABGwere safe and effective, and no significant difference was observed between them. 5 However, a meta-analysis including 12 studies detected a lower rate of death and adverse effects after OPCAB compared with conventional CABG. 6 Generally speaking, OPCAB is considered as lower incidence of neurological complications (including stroke, cognitive decline, etc.), 7 in addition to a comparable less mortality and morbidity, particularly in high-risk groups and elderly patients. 8,9 HCR combines minimally invasive CABG and PCI, offering a relatively atraumatic therapy for multivessel CAD. HCR utilizes a left internal mammary artery (LIMA) graft to the left anterior 321