Hybrid coronary revascularization: the future of coronary artery bypass surgery or an unfulfilled promise?

Abstract

Advancement in technique and technology over the past 2 decades has helped improve clinical outcomes in both surgical and interventional percutaneous coronary revascularization. Hybrid coronary revascularization (HCR) procedures introduced in 2011 by the American Heart Association/American College of Cardiology Foundation updated guidelines for coronary artery bypass grafting (CABG) surgery,1 combine the superiority of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) revascularization2,3 with percutaneous coronary intervention (PCI) by means of drug-eluting stents (DES) for non-LAD vessels.4 Various minimally invasive surgical approaches are used to perform the LIMA to LAD graft. These approaches and techniques include off-pump coronary revascularization, robotically assisted procedures, small left thoracotomy, and partial sternotomy. Article see p 872 In the current issue of Circulation , Harskamp and colleagues5 describe contemporary practice patterns and clinical outcomes after hybrid coronary artery revascularization in the United States. Isolated CABG in patients who underwent HCR in the Society of Thoracic Surgeons Adult Database between July 2011 and March 2013 were the subject of the study. The authors found only 0.48% (n=950) of 198 622 CABG patients had HCR with 809 of 950 patients (85%) having a staged procedure, whereas a small number of patients (141 of 950; 15%) had HCR done concurrently. Only one third of the centers performing CABG procedures participated in the HCR cohort. Patients with HCR had higher cardiovascular risk profiles than CABG patients, whereas CABG patients had more complex coronary anatomy. HCR patients had more off-pump procedures performed and more nonsternotomy approaches. HCR patients also had a higher incidence of robotic assistance. …