PURPOSE: Surgical and PCI revascularization are considered isolated options. A simultaneous hybrid approach (HYBRID) may exploit advantages of each and allow an opportunity to apply the best strategy for a particular lesion. Despite theoretical appeal, concerns about perioperative bleeding and inadequate platelet inhibition for safe use of DES has limited widespread acceptance. We sought to assess perioperative platelet function and bleeding parameters in consecutive patients treated with HYBRID compared to matched set of controls who underwent standard off pump multi-vessel CABG (OPCAB).
METHODS: Twenty patients with multi-vessel CAD revascularized by HYBRID were prospectively studied. PCI and MIDCAB were done in one sitting in an OR. A matched group of 20 patients treated with OPCAB were compared. All patients received pre-procedure aspirin (325mgpo). Intraoperative heparin was titrated to ACT>300sec. Hybrid patients received Clopidogrel 300mg one hour after procedure followed by 75mg daily. Platelet function and coagulation were assessed at hour 1 and days 1 and 3 utilizing: Thromboelastography (TEG), whole blood aggregometry, PT, INR and PTT. All patients underwent post-grafting LIMA angiography and predischarge CT angiography to assess graft patency.
RESULTS: With the exception of ADP response, there was no significant difference between the two groups. Administration of Clopidogrel postoperatively to patients in the HYBRID group resulted in a significant reduction in platelet responsiveness to ADP in whole blood aggregometry assays, compared to pre op, on days 1 (3.69 ± 2.49 vs. 7.81 ± 3.41, p <0.0001) and day 3 ( 7.81 ± 3.41 vs. 5.37 ± 2.09, p<0.001). Postoperative blood loss in hybrid patients was significantly lower compared to OPCAB group (317± 182cc vs. 717±267cc, p<0.0001. All hybrid patients were successfully treated with DES and no in-hospital mortality occurred in either group. All grafts were patent at discharge.
CONCLUSION: Despite antithrombotic protocol that resulted in suppression of ADP induced platelet aggregation, there was less bleeding in HYBRID revascularized group compared to OPCAB controls.
CLINICAL IMPLICATIONS: These findings suggest that HYBRID revascularization is a viable strategy for patients with suitable coronary anatomy.
DISCLOSURE: Jason Levine, None.