Abstract:

Optimal revascularization strategy in patients with multi-vessel coronary artery disease remains a matter of debate, with advantages and disadvantages in both surgical and percutaneous procedures. A combined approach to achieve coronary revascularization, termed “hybrid coronary revascularization” (HCR), has been recently introduced in clinical practice. HCR is defined as a scheduled combination of surgical left internal mammary artery to left anterior descending (LIMA-LAD) grafting and percutaneous treatment of at least one non-LAD coronary arteries, with both procedures planned and performed within a defined time limit. HCR is indicated in case of both proximal LAD disease eligible to surgical LIMA-LAD grafting and non-LAD disease amenable to percutaneous procedures. Reviews and metanalysis of the literature showed that HCR is non-inferior to conventional surgical myocardial revascularization, and in case of high-risk patients, HCR can be the ideal option. However, the various technical approaches and time-related steps need to be further evaluated. Present and future research in interventional cardiology and cardiac surgery will turn into parallel improvements in HCR procedures. Surgical revascularization with off-pump techniques and minimally-invasive approaches, scoring systems such as SYNTAX II, tools evaluating the hemodynamic significance of atherosclerotic plaques with physiology-based approaches such as fractional flow reserve and instantaneous wave-free ratio, newer generation drug eluting stents, newer antiplatelet agents, and therapies might improve indications and clinical outcomes after HCR procedures. This article reviews the current literature on HCR and aims to provide an overview about future developments.

Authors:

Antonio Nenna, MD, Resident in Cardiac Surgery, Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy, Cristiano Spadaccio, MD, PhD, Consultant Cardiac Surgeon, Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK, Mario Lusini, MD, PhD, Consultant Cardiac Surgeon, Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy, Raffaele Barbato, MD, Consultant Cardiac Surgeon, Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy, Massimo Chello, MD, Consultant Cardiac Surgeon, Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy, Francesco Nappi, MD, Consultant Cardiac Surgeon, Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France

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