Hybrid coronary revascularization offers a minimally invasive strategy that combines the survival benefit of LIMA-LAD grafting with the reduced morbidity of PCI for multivessel coronary artery disease.
May support hybrid strategies in selected multivessel CAD; leaves open need for randomized trials before practice change.
Surgical and percutaneous treatments of coronary artery disease (CAD) have evolved in parallel over the last several decades. Both modalities now offer safe and effective relief from severe CAD, each with unique advantages and disadvantages. Hybrid coronary revascularization (HCR) provides a minimally invasive strategy that exploits the strengths of both traditional coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). HCR entails non-sternotomy left internal mammary artery (LIMA) harvest and grafting to the left anterior descending (LAD) artery, combined with percutaneous coronary intervention (PCI) to non-LAD vessels. The result is a complete revascularization, including the survival benefit of a LIMA-LAD graft, while avoiding the morbidity and convalescence associated with a sternotomy. This review will describe the methods of sternal sparing LIMA-LAD grafting in practice today andexplore the various strategies and current evidence for HCR.
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Emmanuel Moss (2013) studied this question.
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