Expanding indications: hybrid surgical-percutaneous coronary intervention (PCI) coronary revascularization of chronic total occlusions in patients with multivessel coronary artery disease (CAD)

Abstract

Hybrid revascularization of multivessel coronary artery disease by combining coronary artery bypass grafting (CABG) and chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is a relatively novel concept. Hybrid CABG-CTO PCI aims to combine the durable clinical benefits of a left internal mammary artery graft (ideally minimally invasively) with the durability of CTO PCI in non-left anterior descending vessels. This review assesses the current evidence for performing hybrid CTO PCI-CABG and pre-procedural planning considerations.

Keywords

Chronic total occlusion (CTO), percutaneous coronary intervention(PCI), coronary artery bypass grafting(CABG), hybrid revascularization / coronary artery disease

References

[1] Levine GN,Blankenship JC.American College of Cardiology Foundation, American Heart Association Task Force on Practice Guidelines., Society for Cardiovascular Angiography and Interventions. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American college of cardiology foundation/American heart association task force on practice guidelines and the society for cardiovascular angiography and interventions.J Am Coll Cardiol2011;58:e44-122

[2] Neumann FJ,Ahlsson A.ESC Scientific Document Group2018 ESC/EACTS guidelines on myocardial revascularization.Eur Heart J2019;40:87-165

[3] Serruys PW,Kappetein AP.SYNTAX InvestigatorsPercutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.N Engl J Med2009;360:961-72

[4] Velazquez EJ,Deja MA.STICH InvestigatorsCoronary-artery bypass surgery in patients with left ventricular dysfunction.N Engl J Med2011;364:1607-16 PMCID:PMC3415273

[5] Farkouh ME,Sleeper LA.FREEDOM Trial InvestigatorsStrategies for multivessel revascularization in patients with diabetes.N Engl J Med2012;367:2375-84

[6] Melina G,Refice S.Residual SYNTAX score following coronary artery bypass grafting.Eur J Cardiothorac Surg2017;51:547-53

[7] Farooq V,Bourantas CV.Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial validation of the residual SYNTAX score.Circulation2013;128:141-51

[8] Généreux P,Caixeta A.Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) score.J Am Coll Cardiol2012;59:2165-74 PMCID:PMC3725642

[9] Kahn JK.Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hospital setting.Amer Heart J1993;126:561-4

[10] Stone GW,Mehran R.Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part I.Circulation2005;112:2364-72

[11] Gaba P,Ali ZA,Stone GW.Complete versus incomplete coronary revascularization: definitions, assessment and outcomes.Nat Rev Cardiol2021;18:155-68

[12] Kleisli T,Jacobs MJ.In the current era, complete revascularization improves survival after coronary artery bypass surgery.J Thorac Cardiovasc Surg2005;129:1283-91

[13] Delacrétaz E.Therapeutic strategy with total coronary artery occlusions.Amer J Cardiol1997;79:185-7

[14] Weintraub WS.Should chronic total occlusion be treated with coronary artery bypass grafting?.Circulation2016;133:1818-25 PMCID:PMC5505506

[15] Farooq V,Garcia-Garcia HM.The negative impact of incomplete angiographic revascularization on clinical outcomes and its association with total occlusions: the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial.J Am Coll Cardiol2013;61:282-94

[16] Lin S,Yang L.Impact of coronary total occlusion on graft failure and outcomes of coronary artery bypass grafting.J Thorac Cardiovasc Surg2022;163:1349-1357.e5

[17] Wijeysundera HC,Fefer P.Relationship between initial treatment strategy and quality of life in patients with coronary chronic total occlusions.EuroIntervention2014;9:1165-72

[18] Xenogiannis I,Krestyaninov O.Impact of successful chronic total occlusion percutaneous coronary interventions on subsequent clinical outcomes.J Invasive Cardiol2020;32:433-9

[19] Michael TT,Brilakis ES.Procedural outcomes of revascularization of chronic total occlusion of native coronary arteries (from a multicenter United States registry).Am J Cardiol2013;112:488-92

[20] Sapontis J,Yeh RW.Early procedural and health status outcomes after chronic total occlusion angioplasty: a report from the OPEN-CTO registry (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures).JACC Cardiovasc Interv2017;10:1523-34

[21] Simsek B,Karacsonyi J.Predicting periprocedural complications in chronic total occlusion percutaneous coronary intervention: the PROGRESS-CTO complication scores.JACC Cardiovasc Interv2022;15:1413-22

[22] Escaned J,Ryan N.Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study.Eur Heart J2017;38:3124-34 PMCID:PMC5837643

[23] Obedinskiy AA,Boukhris M.The IMPACTOR-CTO trial.JACC Cardiovasc Interv2018;11:1309-11

[24] Werner GS,Hildick-Smith D.EUROCTO trial investigatorsA randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions.Eur Heart J2018;39:2484-93

[25] Henriques JP,Råmunddal T.EXPLORE Trial InvestigatorsPercutaneous intervention for concurrent chronic total occlusions in patients with STEMI: the EXPLORE trial.J Am Coll Cardiol2016;68:1622-32

[26] Lee SW,Ahn JM.Randomized trial evaluating percutaneous coronary intervention for the treatment of chronic total occlusion.Circulation2019;139:1674-83

[27] Galassi AR,Toma A.Percutaneous coronary intervention of chronic total occlusions in patients with low left ventricular ejection fraction.JACC Cardiovasc Interv2017;10:2158-70

[28] Megaly M,Tajti P.Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling.J Interv Cardiol2018;31:562-71

[29] Goel PK,Pandey CM.Long-term outcomes post chronic total occlusion intervention-implications of completeness of revascularization.J Interv Cardiol2018;31:293-301

[30] Gong X,Ding X,Li H.The impact of successful chronic total occlusion percutaneous coronary intervention on long-term clinical outcomes in real world.BMC Cardiovasc Disord2021;21:182 PMCID:PMC8048230

[31] Azzalini L,Puskas JD.Percutaneous revascularization of chronic total occlusions: Rationale, indications, techniques, and the cardiac surgeon's point of view.Int J Cardiol2017;231:90-6

[32] Shen L,Wang H.One-stop hybrid coronary revascularization versus coronary artery bypass grafting and percutaneous coronary intervention for the treatment of multivessel coronary artery disease: 3-year follow-up results from a single institution.J Am Coll Cardiol2013;61:2525-33

[33] Puskas JD,DeRose JJ.Hybrid coronary revascularization for the treatment of multivessel coronary artery disease: a multicenter observational study.J Am Coll Cardiol2016;68:356-65 PMCID:PMC5142519

[34] Loulmet D,d'Attellis N.Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments.J Thorac Cardiov Surg1999;118:4-10

[35] McGinn JT Jr,Lapierre H,Mesana TG.Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients.Circulation2009;120:S78-84

[36] Davierwala PM,Bergien L.Twenty-year outcomes of minimally invasive direct coronary artery bypass surgery: the Leipzig experience.J Thorac Cardiovasc Surg2021:S0022-5223(21)00343

[37] Raza S,Bakaeen FG.Long-term patency of individual segments of different internal thoracic artery graft configurations.Ann Thorac Surg2019;107:740-6

[38] Raza S,Houghtaling PL.Influence of diabetes on long-term coronary artery bypass graft patency.J Am Coll Cardiol2017;70:515-24

[39] Hillis LD,Anderson JL.American College of Cardiology Foundation, American Heart Association Task Force on Practice Guidelines., American Association for Thoracic Surgery., Society of Cardiovascular Anesthesiologists., Society of Thoracic Surgeons. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American college of cardiology foundation/American heart association task force on practice guidelines. Developed in collaboration with the American association for thoracic surgery, society of cardiovascular anesthesiologists, and society of thoracic surgeons.J Am Coll Cardiol2011;58:e123-210

[40] Widimsky P,Stros P.One-year coronary bypass graft patency: a randomized comparison between off-pump and on-pump surgery angiographic results of the PRAGUE-4 trial.Circulation2004;110:3418-23

[41] Goldman S,Moritz T.VA Cooperative Study Group #207/297/364Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study.J Am Coll Cardiol2004;44:2149-56

[42] Kosmidou I,Zhang Y.Long-term outcomes in women and men following percutaneous coronary intervention.J Am Coll Cardiol2020;75:1631-40

[43] Kandzari DE,Doros G.BIOFLOW V InvestigatorsUltrathin bioresorbable-polymer sirolimus-eluting stents versus thin durable-polymer everolimus-eluting stents for coronary revascularization: 3-year outcomes from the randomized BIOFLOW V trial.JACC Cardiovasc Interv2020;13:1343-53

[44] Kitahara H,McCrorey M.Hybrid coronary revascularization: Midterm outcomes of robotic multivessel bypass and percutaneous interventions.J Thorac Cardiovasc Surg2019;157:1829-36.e1

[45] Hirai T,Balkhy HH.Advanced Hybrid Complete Revascularization with TECAB and Impella-Assisted PCI of CTO.Cardiovasc Revasc Med2019;20:51-4

[46] Byrne JG,Unic D.Staged initial percutaneous coronary intervention followed by valve surgery (“hybrid approach”) for patients with complex coronary and valve disease.J Am Coll Cardiol2005;45:14-8

[47] Young MN,Cadigan ME.Multidisciplinary heart team approach for complex coronary artery disease: single center clinical presentation.J Am Heart Assoc2020;9:e014738 PMCID:PMC7428540

[48] Xenogiannis I,Karmpaliotis D,Jaffer FA,Patel M,Choi JW.Temporal trends in chronic total occlusion percutaneous coronary interventions: insights from the PROGRESS-CTO registry.J Invasive Cardiol2020; 32:153-160

[49] Young MN,Kaltenbach LA.Examining the operator learning curve for percutaneous coronary intervention of chronic total occlusions.Circ Cardiovasc Interv2019;12:e007877