Related Experiment Video
Updated: Mar 28, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Hybrid coronary revascularization versus coronary artery bypass surgery with bilateral or single internal mammary
Joshua M Rosenblum1, Ralf E Harskamp2, Niels Hoedemaker3
1Divisions of Cardiothoracic Surgery and Cardiology, Clinical Research Unit, Emory University School of Medicine, Atlanta Ga.
Insights
Hybrid coronary revascularization (HCR) offers a safe, less invasive alternative to traditional coronary artery bypass graft (CABG) surgery. This study found HCR comparable to CABG with single or bilateral internal mammary artery grafting in short- and midterm outcomes.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Interventional Cardiology
Background:
- Hybrid coronary revascularization (HCR) integrates minimally invasive left internal mammary artery (LIMA)-left anterior descending artery (LAD) bypass with percutaneous coronary intervention for non-LAD vessels.
- Conventional coronary artery bypass graft (CABG) surgery utilizes single internal mammary artery (SIMA) or bilateral internal mammary artery (BIMA) grafting.
Purpose of the Study:
- To compare the clinical outcomes of HCR with conventional CABG using SIMA or BIMA grafting.
- To evaluate the safety and efficacy of HCR as an alternative surgical approach.
Main Methods:
- A retrospective comparison of 306 HCR patients versus 8254 CABG patients (SIMA or BIMA) from October 2003 to September 2013.
- Primary outcome: composite of 30-day death, myocardial infarction, and stroke (MACCE).
- Propensity score-matched analysis was employed to compare outcomes between HCR and CABG groups.
Main Results:
- Thirty-day MACCE rates were comparable between HCR and matched SIMA/BIMA groups.
- HCR was associated with significantly lower in-hospital complications and reduced need for blood transfusion compared to both SIMA and BIMA.
- HCR patients experienced shorter hospital stays than those undergoing SIMA or BIMA grafting.
- No significant difference in midterm survival was observed between HCR and either SIMA or BIMA groups.
Conclusions:
- HCR presents a safe and less invasive option for carefully selected patients requiring coronary revascularization.
- Outcomes for HCR are comparable to conventional CABG with SIMA or BIMA grafting in the short and midterm follow-up periods.
Objective:
Hybrid coronary revascularization (HCR) combines minimally invasive left internal mammary artery (LIMA)-left anterior descending artery (LAD) bypass with percutaneous intervention of non-LAD vessels. The purpose of this study was to compare outcomes of HCR to conventional coronary artery bypass graft (CABG) surgery with single internal mammary artery (SIMA) or bilateral internal mammary artery (BIMA) grafting.
Methods:
Between October 2003 and September 2013, 306 consecutive patients who underwent HCR were compared with 8254 patients who underwent CABG with SIMA (7381; 89.4%) or BIMA (873; 10.6%) at a US academic center. The primary outcome was a composite of 30-day death, myocardial infarction, and stroke (major cerebrovascular and cardiac event [MACCE]). In addition to multiple logistic and linear regression analysis, a propensity score-matched analysis was used to compare HCR with SIMA and with BIMA.
Results:
The Society of Thoracic Surgeons-predicted risk of mortality was 1.6% for HCR, 2.1% for SIMA, and 1.1% for BIMA (P < .001). Factors associated with HCR use were older age, lower body mass index, history of percutaneous coronary intervention, and 2-vessel disease. In propensity-matched groups, 30-day MACCE rates were comparable (3.3% for HCR vs 1.3% for BIMA [odds ratio (OR), 2.50; P = .12] and vs 3.6% for SIMA [OR, 1.00; P = 1.00]). In-hospital complications were lower after HCR versus SIMA or BIMA (OR, 0.59; P = .033 and OR, 0.55; P = .015, respectively), as was the need for blood transfusion (OR, 0.44; P < .001 and OR, 0.57; P < .001). HCR was associated with shorter hospital stay compared with SIMA (OR, 1.28; P = .038) or BIMA (OR, 1.40; P = .006). No survival difference between matched groups was found at midterm follow-up (HCR vs SIMA: hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.32-1.38; P = .66; HCR vs BIMA: HR, 1.05; 95% CI, 0.48-2.29; P = .91).
Conclusions:
HCR may represent a safe, less invasive alternative to conventional CABG in carefully selected patients, with similar short-term and midterm outcomes as CABG performed with either SIMA or BIMA grafting.
More Related Videos
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
Published on: April 24, 2017
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...