Hybrid approach to multivessel coronary artery disease: a commentary

Hybrid coronary revascularization (HCR) intends to combine the advantages of both minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI). Thus, HCR is a sternal-sparing, off-pump, minimally invasive, hand-sewn left internal mammary artery (LIMA) to left anterior descending (LAD) bypass graft though a 4–6 cm anterolateral minithoracotomy with PCI to non-LAD lesions, in order to achieve a functional complete revascularization. HCR should, in theory, provide the perfect revascularization: stents replace the need for the saphenous vein graft (SVG), and MIDCAB provides a minimally invasive approach to reduce surgical morbidity