Hybrid Coronary Revascularization as a Safe, Feasible, and Viable Alternative to Conventional Coronary Artery Bypass Grafting: What Is the Current Evidence?
The “hybrid” approach to multivessel coronary artery disease combines surgical left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) bypass grafting and percutaneous coronary intervention of the remaining lesions. Ideally, the LITA to LAD bypass graft is performed in a minimally invasive fashion. This review aims to clarify the place of hybrid coronary revascularization (HCR) in the current therapeutic armamentarium against multivessel coronary artery disease. Eighteen studies including 970 patients were included for analysis. The postoperative LITA patency varied between 93.0% and 100.0%. The mean overall survival rate in hybrid treated patients was 98.1%. Hybrid treated patients showed statistically significant shorter hospital length of stay (LOS), intensive care unit (ICU) LOS, and intubation time, less packed red blood cell (PRBC) transfusion requirements, and lower in-hospital major adverse cardiac and cerebrovascular event (MACCE) rates compared with patients treated by on-pump and off-pump coronary artery bypass grafting (CABG). This resulted in a significant reduction in costs for hybrid treated patients in the postoperative period. In studies completed to date, HCR appears to be a promising and cost-effective alternative for CABG in the treatment of multivessel coronary artery disease in a selected patient population. 1. Introduction Coronary artery bypass grafting (CABG) is considered to be the “gold standard” in patients with multivessel disease and remains the treatment of choice for patients with severe coronary artery disease, including three-vessel or left main coronary artery disease [1]. The use of CABG, as compared with both percutaneous coronary intervention (PCI) and medical therapy, is superior with regard to long-term symptom relief, major adverse cardiac or cerebrovascular events and survival benefit [1–4]. However, because of the use of cardiopulmonary bypass and median sternotomy, CABG is associated with significant surgical trauma leading to a long rehabilitation period and delayed postoperative improvement of quality of life [5]. An alternative “hybrid” approach to multivessel coronary artery disease combines surgical left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) bypass grafting and percutaneous coronary intervention of the remaining lesions [3, 6–8]. Ideally, the LITA to LAD bypass graft is performed in a minimally invasive fashion through minimally invasive direct coronary artery bypass grafting (MIDCAB) [9]. This hybrid approach takes advantage of
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