A nationwide survey on perception, experience, and expectations of hybrid coronary revascularization among top-ranked US hospitals

• Published in: The American heart journal 2015-04, Vol.169 (4), p.557-563.e6
• Main Authors: Harskamp, Ralf E., MD, Halkos, Michael E., MD, MS, Xian, Ying, MD, PhD, Szerlip, Molly A., MD, Poston, Robert S., MD, Mick, Stephanie L., MD, Lopes, Renato D., MD, PhD, Tijssen, Jan G., PhD, de Winter, Robbert J., MD, PhD, Peterson, Eric D., MD, MPH
• Format: Article
• Language: English
• Subjects: Attitudes; Cardiology; Cardiovascular; Cardiovascular disease; Chronic obstructive pulmonary disease; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary Artery Disease - surgery; Coronary vessels; Female; Hospitals; Hospitals - statistics & numerical data; Humans; Male; Medical equipment; Middle Aged; Monetary incentives; Morbidity - trends; Myocardial Revascularization - methods; Physicians; Polls & surveys; Population Surveillance - methods; Studies; Surgery; Treatment Outcome; United States - epidemiology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2015.01.003

Background Hybrid coronary revascularization (HCR) combines a surgical and percutaneous approach for treatment of multivessel coronary artery disease. Methods A survey was conducted among 200 cardiologists and cardiac surgeons from 100 top-ranked US hospitals. Questions were asked involving the perception, experience, and future expectations of HCR. Results Of physicians invited to the survey, 90 completed the survey (45.5%). Relative to nonresponders, responders were more often affiliated with an academic institution (80.0% vs 61.8%, P = .005), with higher patient volumes, and with the availability of a hybrid operating room (90.0% vs 67.3%, P < .001). Survey responders felt that HCR should be considered in an older and relatively healthy patient population without complex lesions. Cardiac surgeons were more favorable to use HCR in patients with chronic lung disease (42.0% vs 10.0%, P < .001) or renal failure (28.0% vs 15.0%, P = .06). Among responders with HCR experience (n = 54), 94% reported good to excellent results, and the learning curve differed depending on the surgical technique used. Inappropriate patient selection (41.2%) was the most common cause for complications. Three-quarter of responders believe that the future role for HCR will expand in the next decade. Important determinants of greater HCR use in the future were collaborative associations between cardiac surgeons and cardiologists (86.7%), appropriate patient selection (67.8%), and the outcomes of ongoing clinical trials (57.8%). Conclusion In this nationwide survey, cardiologists and cardiac surgeons felt that HCR is a reasonable alternative technique for coronary revascularization among suitable patients. Most felt that use of HCR would increase in the next decade.