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Updated: Dec 14, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
The Hybrid Coronary Approach for Optimal Revascularization: JACC Review Topic of the Week
Pedro R Moreno1, Gregg W Stone1, Carlos A Gonzalez-Lengua1
1Mount Sinai Heart, Mount Sinai Hospital, Mount Sinai Morningside Hospital, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Hybrid coronary revascularization (HCR) combines surgical and minimally invasive techniques for heart சிகிச்ச. Further trials are needed to confirm if HCR offers better outcomes than traditional procedures.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary revascularization uses percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG).
- CABG with left internal mammary artery (LIMA) offers improved long-term survival.
- Hybrid coronary revascularization (HCR) integrates PCI and CABG benefits, using minimally invasive LIMA grafting.
Purpose of the Study:
- To evaluate if Hybrid Coronary Revascularization (HCR) is superior to multivessel PCI.
- To assess the benefits of HCR, including reduced complications and enhanced long-term survival.
Main Methods:
- The study initiated the National Heart, Lung, and Blood Institute-sponsored, randomized Hybrid Coronary Revascularization Trial.
- The trial aimed to compare HCR with multivessel PCI.
- Enrollment was suboptimal, leading to premature study discontinuation.
Main Results:
- The Hybrid Coronary Revascularization Trial was discontinued before completion due to insufficient enrollment.
- Preliminary data suggested HCR integrates advantages of both PCI and CABG.
- HCR may reduce bleeding, ventilator time, and hospital stay compared to traditional CABG.
Conclusions:
- HCR combines the advantages of PCI and CABG, potentially offering improved durability and survival.
- Larger, adequately powered randomized trials are necessary to definitively evaluate HCR's outcomes and cost-effectiveness against CABG and multivessel PCI.
Abstract:
Coronary revascularization is accomplished either by percutaneous coronary intervention (PCI), with low risk of immediate complications, or coronary artery bypass graft (CABG), with improved long-term, event-free survival attributable to use of the left internal mammary artery graft. Hybrid coronary revascularization (HCR) combines both. The left internal mammary artery graft is done by sternal-sparing approaches or by robotic-assisted, endoscopic surgery. HCR reduces bleeding, ventilator time, and length of stay compared with traditional CABG. Compared with PCI, HCR offers the durability and survival advantages of the left internal mammary artery. The large-scale National Heart, Lung, and Blood Institute-sponsored, randomized Hybrid Trial (Hybrid Coronary Revascularization Trial) was initiated to examine whether HCR is superior to multivessel PCI. However, enrollment was suboptimal, triggering premature study discontinuation. HCR integrates the positive features of both PCI and CABG, albeit requiring 2 procedures rather than 1. Adequately powered randomized trials are required to evaluate the outcomes and cost-effectiveness of HCR compared with CABG and multivessel PCI alone.
