Hybrid Coronary Revascularisation: Indications, Techniques, and Outcomes

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Technology

Background:

• Hybrid coronary revascularisation (HCR) merges coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
• It aims to leverage the benefits of minimally invasive surgery and advanced stent technology.
• HCR typically involves off-pump left internal mammary artery (LIMA) to left anterior descending artery (LAD) bypass (minimally invasive direct coronary artery bypass - MIDCAB), alongside PCI for non-LAD vessels.

Purpose of the Study:

• To review the surgical techniques, anticoagulation strategies, and procedural sequencing in HCR.
• To present real-world outcomes from observational studies and randomised trials of HCR.
• To assess the safety and feasibility of HCR in appropriately selected patients.

Main Methods:

• Review of existing literature, including observational studies and randomised trials.
• Analysis of surgical techniques for off-pump LIMA-to-LAD bypass (MIDCAB).
• Evaluation of percutaneous coronary intervention (PCI) for non-LAD lesions within the HCR strategy.

Main Results:

• Current evidence suggests HCR is safe and feasible in carefully selected patients.
• HCR integrates minimally invasive surgical revascularisation with PCI, avoiding sternotomy and cardiopulmonary bypass.
• Observational studies and trials provide initial data on HCR outcomes.

Conclusions:

• HCR offers a viable treatment option for patients with severe LAD disease and suitable non-LAD lesions for PCI.
• Multidisciplinary heart team decision-making is crucial for optimal patient selection.
• Further large-scale randomised trials are necessary to definitively establish HCR's role compared to standalone CABG or PCI.