Hybrid coronary revascularization – techniques and outcome

Abstract

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 + 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.

Comparative Study of Same Sitting Hybrid Coronary Artery Revascularization versus Off‐Pump Coronary Artery Bypass in Multivessel Coronary Artery Disease

“…Patients benefit with smaller incisions, less morbidity, and possibly improved outcomes including earlier hospital discharge and recovery. 6 However, patients often require 2 separate procedures and/or hospitalizations using this stage hybrid method adding to patient inconvenience, potential safety of delaying revascularization, lack of immediate confirmation of graft patency, and hospital/procedural costs. Same sitting HCR procedures offer patients a single intervention with reduced hospital stay compared to a staged HCR during a single hospital stay or a staged HCR procedure requiring 2 hospital stays.…”

“…Patients benefit with smaller incisions, less morbidity, and possibly improved outcomes including earlier hospital discharge and recovery. 6 However, patients often require 2 separate procedures and/or hospitalizations using this stage hybrid method adding to patient inconvenience and hospital/procedural costs. The advent of hybrid operating suites in recent years has allowed for same sitting surgical and endovascular procedures.…”

Robotic Coronary Artery Bypass Grafting Decreases 30-Day Complication Rate, Length of Stay, and Acute Care Facility Discharge Rate Compared with Conventional Surgery

“…The data was extracted from a de-identified prospective, cardiac surgery database, which was populated with data elements from both the New York State and Society of Thoracic Surgeons (STS) databases (7). The surgical technique of robotic CABG has been published previously (8, 9). …”

Robotic Totally Endoscopic Multivessel Coronary Artery Bypass Grafting Procedure Development, Challenges, Results

“…3,4 It can be anticipated that combinations of robotic endoscopic mvTECAB and (multivessel) PCI will be an integral part of integrated approaches to treatment of complex multivessel disease with high SYNTAX scores. Jansens et al 18 described the first case of such a complex intervention.…”