Hybrid Coronary Revascularization in High-risk Patients Over 75 With Non-valvular Disease: a Case Study Approach
Year: 2025
Type: article
Abstract: Coronary artery disease (CAD) is one of the most prevalent conditions affecting elderly patients, particularly those aged 75 and above. The study involved 18 patients with the following characteristics: Age: All patients were over the age of 75, with a mean age of 79.2 years. Non-Valvular Disease: None of the patients had significant valvular heart disease, which allowed the focus of treatment on coronary lesions. High EU Scores: All patients had high EU scores, indicating high perioperative risk. The mean EU score for this cohort was 6.3 ± 1.2, which corresponds to a high risk of surgical mortality and morbidity. The study aimed to evaluate the feasibility, safety, and clinical outcomes of hybrid coronary revascularization in elderly patients with complex coronary disease and high surgical risk. The results were as follows: Successful Hybrid Revascularization: All 18 patients underwent successful hybrid coronary revascularization. In 12 patients, both the LIMA graft and PCI were performed simultaneously. In 6 patients, PCI was staged, occurring 1 to 3 weeks after the CABG procedure. Technical Success: The use of the middle 3-costal LIMA graft allowed for excellent graft patency and adequate revascularization of the LAD in all patients. PCI on the non-LAD lesions was successfully performed with high technical success (100%).Postoperative Recovery: The average ICU stay was 2.3 days, and the average hospital stay was 7.1 days. Most patients were discharged within one week following surgery.Clinical Improvement: At a median follow-up of 18 months (range 12-24 months), 15 patients (83%) reported significant improvement in symptoms, including a reduction in angina and an increase in functional capacity.Major Adverse Cardiac Events (MACE): The 1-year MACE rate was 5.5%, with 1 patient experiencing a non-fatal MI and 1 requiring re-intervention via PCI due to restenosis of a non-LAD lesion.Graft Patency: The patency rate of the LIMA graft at 12 months was 100%, and PCI-treated lesions also showed favorable outcomes, with only 1 case of restenosis (in the RCA) requiring re-intervention. Improved Functional Status: 16 patients (89%) showed marked improvement in quality of life, with better functional status and reduced need for medications to control symptoms of heart failure or angina.Overall Survival: No patients died during the follow-up period, and overall survival at 1 year was 100%. The results of this observational study underscore the safety and efficacy of hybrid coronary revascularization for high-risk elderly patients with non-valvular disease. Specifically, the use of a middle 3-costal LIMA graft for the LAD in combination with PCI for other coronary lesions offers a tailored approach to revascularization, which minimizes surgical risk while providing optimal revascularization for critical coronary territories. The low perioperative complication rates, excellent graft patency, and favorable long-term outcomes suggest that HCR is a viable option for elderly patients over 75 years of age, even with a high EU score. The hybrid approach offers significant advantages over traditional CABG in this population by reducing the extent of surgery, limiting the need for multiple grafts, and allowing for PCI of less complex lesions. Hybrid coronary revascularization represents a promising strategy for elderly patients with complex coronary artery disease, particularly those with high EU scores and non-valvular heart disease. The combination of middle 3-costal LIMA grafting to the LAD and PCI for other lesions provides a durable, safe, and effective solution that optimizes outcomes in high-risk patients. Given the encouraging results from this observational study, HCR should be considered a valuable treatment option in the management of elderly patients with high-risk coronary anatomy. Further studies with larger patient populations and longer follow-up are necessary to confirm these findings and refine the technique.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7122554935