What is the state of hybrid coronary revascularization in 2018?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Minimally Invasive Surgery

Background:

• Hybrid coronary revascularization (HCR) integrates minimally invasive surgical bypass with percutaneous coronary intervention (PCI).
• This approach aims to combine the benefits of surgical and interventional strategies for coronary artery disease.

Purpose of the Study:

• To provide an update on hybrid coronary revascularization (HCR) developments over the past 12 months.
• To review recent findings and ongoing trials evaluating HCR outcomes.

Main Methods:

• Review of single-center observational series comparing HCR with coronary artery bypass graft (CABG) and PCI.
• Analysis of the 5-year results from the first randomized study comparing HCR to CABG.
• Examination of a prospective observational study comparing HCR with multivessel PCI.
• Highlighting the ongoing Hybrid Coronary Revascularization Trial, a multicenter randomized controlled trial.

Main Results:

• Most observational studies show no significant differences in major cardiovascular outcomes between HCR and CABG or HCR and PCI.
• The first randomized trial reported no difference in mortality, myocardial infarction, or repeat revascularization at 5 years between HCR and CABG.
• A large observational study found no difference in risk-adjusted major adverse cardiovascular events at 12 months between HCR and multivessel PCI.

Conclusions:

• HCR is a potentially valuable option for selected patients with complex coronary artery disease, particularly when performed at experienced centers.
• Ongoing large-scale trials are expected to provide further insights into the clinical role and optimal patient selection for HCR.
• The results suggest HCR may offer comparable outcomes to traditional revascularization methods, warranting further investigation.