Hybrid myocardial revascularization: an integrated approach to coronary revascularization

Coronary artery bypass surgery is beneficial in patients with complex coronary artery disease. The longevity of the left internal mammary artery (LIMA) placed to the left anterior descending (LAD) artery (LIMA-LAD) is between 92-99% at 15 years, and contributes substantially to the survival advantage in patients treated with surgical revascularization. The long-term patency of saphenous vein grafts (SVGs), commonly used (>95%) in surgical revascularization procedures, is less well-established, with up to 26% of SVGs failing in the first year. In selected patients, particularly in those patients with vessels poorly suited to SVGs, hybrid myocardial revascularization (HMR) has been used, combining a minimally invasive approach to the LIMA-LAD with drug-eluting stent placement of the non-LAD vessels. The advantages and disadvantages of hybrid myocardial revascularization are reviewed in this report.