Ten-Year Outcomes of Off-Pump Bilateral IMA Grafting Versus Hybrid Coronary Revascularization

Background The study compared long-term outcomes between off-pump coronary artery bypass grafting (OPCAB) using bilateral internal mammary arteries (BIMA) and hybrid coronary revascularization (HCR). Methods We included patients who underwent OPCAB with BIMA (2002 - 2012) and HCR (2002 - 2020). Emergency procedures, patients in critical preoperative condition, and on-pump surgery cases were excluded. Propensity score matching with a 2:1 ratio was performed to minimize confounding factors. The primary outcome was 10-year survival. Results Of 687 patients, 552 patients underwent OPCAB with BIMA and 135 patients received HCR. HCR patients were older (62 vs. 69 years, p<0.001), had lower left ventricular ejection fraction (60% vs. 54%, p<0.001), and a lower incidence of left-main disease (25% vs. 10%, p<0.001) and three-vessel disease (62.5% vs. 47.4%, p=0.002). In-hospital mortality was comparable between groups (BIMA 1.1% vs. HCR 3.0%, p=0.11). The HCR group had higher rates of incomplete revascularization (27.2% vs. 15.2%, p=0.001) and revision for bleeding (6.7% vs. 1.8%, p=0.005). After propensity score matching, 10-year survival (BIMA 71.2% vs. HCR 69.7%, p=0.81) was similar between groups, while freedom from repeat revascularization was higher in the BIMA group (89.7% vs. 76.3%, p=0.003). Conclusion Complete surgical revascularization using BIMA should be preferred when feasible. However, HCR offers comparable survival and represents a viable option for select patients.