Residual SYNTAX Score After Advanced Hybrid Robotic Totally Endoscopic Coronary Revascularization

Abstract

Background: Advanced hybrid coronary revascularization (AHCR) combines multivessel robotic beating-heart totally endoscopic coronary artery bypass with percutaneous coronary intervention. The aim of this study was to quantify the remaining coronary artery disease after AHCR using the residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) study score.

Methods: From July 2013 to September 2017, patients who had postoperative angiography after AHCR were reviewed. The cohort was divided into two groups: group 1, complete or near-complete revascularization (residual SYNTAX score of 8 or less); and group 2, incomplete revascularization (residual SYNTAX score more than 8).

Results: Among 308 patients who underwent totally endoscopic coronary artery bypass, 57 patients received AHCR and 51 patients had postoperative angiograms that allowed calculations of residual SYNTAX score. Mean baseline and residual SYNTAX scores were 33.1 ± 11.0 and 4.6 ± 6.5 respectively. There were 44 patients (86%) in the complete or near-complete revascularization group, and of these, 16 patients (31%) achieved true complete revascularization (residual SYNTAX score = 0). Overall graft patency was 96.2%. There were no differences in preoperative characteristics or postoperative outcomes between the two groups. Two-year survival rate and freedom from major adverse cardiac events (death, myocardial infarction, and repeat revascularization) were significantly higher in the complete or near-complete revascularization group compared with the incomplete revascularization group.

Conclusions: Advanced hybrid coronary revascularization at our institution was safely performed with excellent early outcomes, graft patency, and high achievement of complete or near-complete revascularization. Residual SYNTAX score might predict long-term ischemic events after hybrid coronary revascularization.