Hybrid Coronary Revascularization Versus On-Pump Coronary Artery Bypass Grafting: The Dutch Experience

Objective: Hybrid coronary revascularization (HCR) is minimally invasive coronary artery bypass surgery in patients with multivessel disease. This study compared the clinical outcomes of robot-assisted HCR patients with those receiving conventional on-pump coronary artery bypass grafting (CABG) in the Netherlands. Methods: We included 117 HCR and 2,160 CABG patients between January 2015 and December 2021. We performed a 1:3 propensity score matching (PSM) analysis. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCE) at ≤30 days of follow-up. Secondary outcomes included red blood cell transfusions, length of stay, and the individual components of MACCE, which were mortality, perioperative myocardial infarction, revascularization of the target vessel (TVR), kidney failure, and in-hospital ischemic cerebrovascular accidents. Mortality and TVR at midterm follow-up were also included. Results: After PSM, 115 HCR and 342 on-pump CABG patients were included. HCR patients underwent a mean ± standard deviation of 1 ± 0 distal anastomosis, whereas CABG patients had a mean of 3.6 ± 1.1 distal anastomoses. At ≤30 days of follow-up, no differences in MACCE (odds ratio [OR] = 1.27, 95% confidence interval [CI]: 0.48 to 2.88, P = 0.57) or in the individual secondary outcomes were found. HCR resulted in a shorter hospital stay (OR = 0.99, 95% CI: 0.99 to 1.0, P = 0.02). At a median of 35 months (interquartile range [IQR], 23 to 45) of follow-up in the HCR group and 34 months (IQR, 22 to 45) in the CABG group, all-cause mortality and TVR did not differ. Conclusions: HCR provides excellent short-term and midterm outcomes, comparable to conventional CABG, while also offering faster recovery.