Methods: Patients with equivalent number of coronary lesions (2.7±0.7) underwent either HYB (n=15), MVST (n=15), or OPCAB (n=30). Postoperative hospital and ICU lengths of stay, intraoperative blood loss and blood transfusions were compared between groups. Blood samples were obtained from the aorta and coronary sinus at the beginning and completion of each case to analyze the activation of coagulation (prothrombin fragment 1.2, F1.2; activated factor XII, FXII-a), myocardial injury (myoglobin), and inflammation (IL-8) using ELISA.

Results: Compared to the other groups, HYB was associated with a significant improvement in all clinical outcome variables as well as reduced coagulation, myocardial injury and inflammation within the heart as defined by transcardiac analysis of F1.2, myoglobin and IL-8 (see Table). After adjusting for potential confounders (age, sex, BMI, diabetes and number of diseased territories), group assignment was shown to be an independent predictor of postoperative hospital stay (t=2.39, p=0.02).

Conclusion: Perhaps due to reduced activation of coagulation, inflammation and/or myocardial injury, the HYB group showed significantly less time of intubation, less blood loss, and required fewer blood transfusions and was an independent predictor of less hospital stay. These promising early findings may warrant greater adoption of this procedure.