Hybrid coronary revascularization - techniques and outcome

Background: Hybrid coronary revascularization combines minimally invasive coronary artery bypass grafting (CABG) and catheter-based coronary intervention for the treatment of multivessel coronary artery disease. This concept represents an alternative to open multivessel bypass surgery through sternotomy and to multivessel percutaneous intervention (PCI). The former is highly invasive but very effective in the long term; the latter is less invasive but results in more repeat revascularization procedures. Methods: The surgical part of hybrid coronary intervention can be performed through thoracic mini-incisions and in completely endoscopic fashion. Robotic technology such as the daVinci(R) surgical telemanipulation system is increasingly used. Percutaneous interventions in hybrid procedures include implantation of bare metal stents and drug eluting stents. Results: After 15 years of development, the literature reports mortality rates in the one percent range which may be lower than in open bypass surgery. Several studies demonstrate significantly earlier recovery and return to normal activities after hybrid intervention than after heart bypass surgery through sternotomy. Long-term follow-up studies show similar survival compared to survival after multivessel CABG and multivessel PCI. The rate of reinterventions and major adverse events, however, may be lower than after multivessel PCI, and closer to rates after open CABG. Conclusions: Hybrid revascularization represents a promising concept for treatment of coronary multivessel disease.