Do Hybrid Procedures Have Proven Clinical Utility and Are They the Wave of the Future?

Abstract

Both coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) have been shown to provide symptomatic relief and to increase long-term survival in patients with coronary artery disease.1–3 Hybrid coronary revascularization (HCR) seeks to combine the respective strengths of CABG and PCI in an attempt to offer a technique that is less invasive than conventional surgery without diminishing the efficaciousness of therapy offered. Response by Shannon et al on p 2510 The major therapeutic benefits of CABG arise from the graft from the left internal mammary artery (LIMA) to the left anterior descending artery (LAD). This can be attributed to the fact that the LIMA-to-LAD graft has excellent long-term patency, reaching as high as 95% to 98% at 10 years,1–3 as opposed to saphenous vein grafts (SVGs), which have high early failure rates, ranging from 6.2% to 30%, averaging ≈20% throughout the literature.4–6 The LIMA-to-LAD graft is also superior to PCI in terms of long-term patency, event-free survival, and relief of angina. The major benefits of multivessel PCI with drug-eluting stents (DES) to treat multivessel coronary artery disease are that it is less invasive, has shorter recovery times, and has lower stroke rates compared with CABG.2,7 It also has lower stent failure rates than SVG (defined as stent restenosis and thrombosis compared with SVG occlusion).2,7 Tables 1 and 2 present existing data on current outcomes with DES and SVGs in non-LAD territories.4,5,8–18 View this table: Table 1. Data From Randomized Trials on Drug-Eluting Stent Restenosis Rate and Stent Thrombosis for Non–Left Anterior Descending Artery Revascularization (n=3631) View this table: Table 2. Data From Studies of 12-Month Postoperative Saphenous Vein Graft Patency With Coronary Angiography for Non–Left Anterior Descending Artery Revascularization (n=7919) Hence, the logic underlying the …