Michael Halkos Receives Funding as AATS Graham Surgical Investigator to Evaluate HCR

May 2016

The Graham Foundation of the American Association for Thoracic Surgery (AATS) has designated Michael Halkos, MD, to receive its Intuitive Surgical Investigator Award for 2016-2017. Dr. Halkos is associate professor of surgery of the Division of Cardiothoracic Surgery, Emory University School of Medicine, and scientific director of the Emory Cardiothoracic Surgery Center for Clinical Research.

The award will fund Dr. Halkos' prospective observational study comparing hybrid coronary revascularization (HCR) with coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease involving the left anterior descending (LAD) and/or left main (LM) coronary arteries. The primary aim is to determine whether HCR is associated with a reduction in major adverse coronary and cerebrovascular events (MACCE) in these patients compared to CABG. Secondary objectives are to determine the impact of HCR compared to CABG on neurocognitive function, hospital readmission, functional status, major morbidity after surgery, and quality of life.

Dr. Halkos routinely performs both procedures, and is considered an expert in the robotic approach to HCR.

In CABG, a healthy artery or vein from the body is connected to the blocked coronary artery. HCR combines CABG with percutaneous coronary intervention (PCI), a nonsurgical technique that uses a catheter to place a stent to open clogged blood vessels. In HCR, the left anterior descending artery (LAD), the most important artery of the three coronary branches, is grafted, while any remaining, non-LAD coronary stenoses are treated with PCI. PCI alone is generally considered to be less durable than CABG, while CABG by itself is associated with longer hospitalization and recovery time and a higher risk of stroke.

"I suppose HCR could be considered as combining the best qualities of CABG and PCI while minimizing their downsides," says Dr. Halkos. "HCR is being used more often across the country for what is perceived as lower in-hospital morbidity and mortality, very good patency rates, higher patient satisfaction, and other reasons, but in fact, there has been no randomized controlled trial to date to demonstrate whether HCR indeed achieves these results over time."

With this study, Dr. Halkos hopes to change this lack of foundational confirmation. The initial focus will be to generate pilot data to inform a randomized controlled trial examining whether HCR is associated with a reduction in MACCE compared to CABG in patients with multi-vessel coronary artery disease. The patient population for the study will be tracked for one year after receiving one or the other procedure. The one-year follow-up will include comparing individual components of MACCE, ischemia-driven repeat revascularization, hospital readmission, and health status outcomes (angina, physical function, and quality of life). Neurocognitive function will also be measured at 30 days postoperatively.

"This type of study is long overdue, and ideally will begin providing the kind of hard data that can give physicians and patients the confidence to know they are choosing the best surgical option according to the patient's particular circumstances," says Dr. Halkos.

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