J Thorac Cardiovasc Surg 2008;136:238
© 2008 The American Association for Thoracic Surgery
Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass
Helmut Gulbins, MD
Department of Cardiovascular Surgery, University Hospital Eppendorf, University Heart Center, Hamburg, Germany
To the Editor:
This study describes a single-center experience with hybrid procedures in a small patient group of 15 hybrid patients compared with a group of 30 matched off-pump patients. The study has 2 major shortcomings I want to address. First, the grafts used differed between the patients because vein grafts, bilateral internal thoracic arteries, and radial arteries were used. The choice of graft influences patency, as well as potential blood loss. Second, the blood loss in their off-pump group was rather high (>1000 mL). Third, and most important, the quality of revascularization remains an issue in stent implantation. Although the authors tried to address this, they used the wrong method because computed tomographic angiography does not allow for sufficient detection of in-stent restenosis. Additionally, the group sizes are too small to allow for a determination of a trend toward better 1-year graft patency; a single stent occlusion would turn the whole trend. Finally, off-pump coronary artery bypass does not require occlusion of coronary arteries for 8 to 12 minutes for each anastomosis; by inserting a shunt, which is standard in most centers, this occlusion can be reduced to less than 1 minute. For these reasons, the conclusions drawn from the results of this study are that the hybrid procedure is possible, even with good clinical long-term results. The study does not provide sufficient data to prove any superiority of the hybrid approach compared with the off-pump coronary artery bypass procedure with complete surgical revascularization.
