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A Practical Approach to Hybrid Coronary Revascularization.
Twinkle Singh1, Karnika Ayinapudi, Ayush Motwani
1From the Section of Cardiology, Department of Medicine, Tulane University School of Medicine; Tulane University Heart and Vascular Institute, New Orleans, LA.
Cardiology in Review
|January 28, 2020
Summary
Hybrid coronary revascularization (HCR) combines surgical bypass and percutaneous procedures. Modifying the surgical approach and timing of percutaneous intervention can increase HCR adoption for multivessel coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Hybrid coronary revascularization (HCR) integrates surgical and percutaneous coronary revascularization but faces limited adoption.
- Current HCR protocols often involve technically demanding minimally invasive surgery and specialized hybrid operating rooms.
Purpose of the Study:
- To review current Hybrid coronary revascularization protocols.
- To identify barriers to widespread Hybrid coronary revascularization adoption.
- To propose modifications to facilitate Hybrid coronary revascularization use.
Main Methods:
- Review of existing Hybrid coronary revascularization protocols and literature.
- Analysis of surgical approaches, specifically the left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD).
- Evaluation of the timing of percutaneous coronary revascularization relative to surgical intervention.
Main Results:
- The minimally invasive surgical approach for Hybrid coronary revascularization is technically challenging.
- Limited availability of hybrid operating rooms restricts same-day percutaneous coronary revascularization.
- A median sternotomy approach for LIMA-LAD grafting combined with delayed percutaneous revascularization is suggested.
Conclusions:
- Modifying the surgical approach to median sternotomy for LIMA-LAD grafting can simplify the procedure.
- Delaying percutaneous coronary revascularization may overcome logistical barriers.
- These modifications could promote wider adoption of Hybrid coronary revascularization for suitable patients with multivessel coronary artery disease.
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