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This article needs more reliable medical references for verification or relies too heavily on primary sources. Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. Find sources: "Hybrid coronary revascularization" – news · newspapers · books · scholar · JSTOR (September 2016)

Hybrid coronary revascularization (HCR) or hybrid coronary bypass is a relatively new type of heart surgery that provides an alternative to traditional coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI or PTCA) by combining the two into one operation. It is this combining aspect that "hybrid" refers to. HCR is one of several types of hybrid cardiac surgery; it is not to be confused with a MIDCAB (minimally invasive direct coronary artery bypass) procedure, which uses the smaller thoracotomy incision but does not involve coronary stenting.

Benefits

Hybrid bypass offers all the benefits of a MIDCAB, although there are some disadvantages.

1. A much smaller incision (made through the rib cage as opposed to cutting the sternum and opening the rib cage) than with traditional bypass surgery.
2. Less pain for the patient and quicker recovery time. Particularly in high risk patients, morbidity and mortality decreases in comparison to conventional surgery. A study from FuWai Hospital in Beijing reports on 104 patients with multivessel coronary artery disease who were compared with the same sized group of patients undergoing off pump surgery using propensity score matching. The patients treated with the hybrid approach had a significantly lower ICU stay and intubation time and experienced less complications in terms of bleeding and transfusions needs. At a median follow up of 18 months, patients undergoing the hybrid procedure also had a significantly higher freedom from major adverse cardiac or cerebrovascular events (99% vs. 90.4%; p = 0.03). HCR is also associated with a significant decrease in the need for blood transfusion and a significant reduction in the duration of intubation.
3. Less risk of complications, infections etc. and also decreases the necessity for two separate cardiac procedures (bypass and stenting). However, it requires the implementation of suitable X-ray equipment in the OR, i.e. a hybrid operating room. Helpful in this regard is the regular use of completion angiography. In a study designed and published by the Vanderbilt Heart and Vascular Institute, routine intraoperative completion angiography performed in a fully functional hybrid operation room detected important defects in 97 of 796 (12% of the grafts) venous coronary artery bypass grafts in 366 adult patients (14% of the patients) with complex coronary artery disease. Their findings in completion angiography at the end of the operation included suboptimal anastomoses, poor lie of the venous bypass graft, and bypasses to not diseased vessels. The angiography findings led to a change in the management, including minor adjustments of the graft, traditional surgical revision or percutaneous coronary interventions, resulting in optimal bypass outcomes. However, early perioperative angiography is not recommended nor it is a standard practice; therefore, in the case of suspected early postoperative myocardial ischemia, immediate angiography should be performed to verify patency of the grafts.
4. In the study from FuWai, the hybrid procedure was also less costly than an exclusively percutaneous strategy.

A 2018 Meta Analysis with over 4000 patient cases found HCR to have significant advantages compared with conventional CABG. Reduced incidence of Blood Transfusion, reduced hospital stay duration and reduced intubation duration were all reported. In contrast, HCR was found to be significantly more expensive compared to CABG. However, 2018 guidelines recommend (Level 2B recommendation) that hybrid coronary revascularization may be considered in specific patient subsets at experienced centres.

See also

• Heart disease

References

1. ^ Murphy, Gavin J; Bryan, Alan J; Angelini, Gianni D (2004). "Hybrid Coronary Revascularization in the Era of Drug-Eluting Stents". The Annals of Thoracic Surgery. 78 (5): 1861–7. doi:10.1016/j.athoracsur.2004.07.024. PMID 15511503.
2. Kon, Zachary N; Brown, Emile N; Tran, Richard; Joshi, Ashish; Reicher, Barry; Grant, Michael C; Kallam, Seeta; Burris, Nicholas; Connerney, Ingrid; Zimrin, David; Poston, Robert S (2008). "Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass". The Journal of Thoracic and Cardiovascular Surgery. 135 (2): 367–75. doi:10.1016/j.jtcvs.2007.09.025. PMC 2962576. PMID 18242270.
3. Bonatti, J; Schachner, T; Bonaros, N; Jonetzko, P; Ohlinger, A; Ruetzler, E; Kolbitsch, C; Feuchtner, G; Laufer, G; Pachinger, O; Friedrich, G (2008). "Simultaneous hybrid coronary revascularization using totally endoscopic left internal mammary artery bypass grafting and placement of rapamycin eluting stents in the same interventional session. The COMBINATION pilot study". Cardiology. 110 (2): 92–5. doi:10.1159/000110486. PMID 17971657. S2CID 32152844.
4. ^ Hu, Shengshou; Li, Qi; Gao, Peixian; Xiong, Hui; Zheng, Zhe; Li, Lihuan; Xu, Bo; Gao, Runlin (2011). "Simultaneous Hybrid Revascularization Versus Off-Pump Coronary Artery Bypass for Multivessel Coronary Artery Disease". The Annals of Thoracic Surgery. 91 (2): 432–8. doi:10.1016/j.athoracsur.2010.10.020. PMID 21256284.
5. Reynolds, AC; King, N (August 2018). "Hybrid coronary revascularization versus conventional coronary artery bypass grafting: Systematic review and meta-analysis". Medicine (Baltimore). 97 (33): e11941. doi:10.1097/MD.0000000000011941. PMC 6112891. PMID 30113498.
6. Zhao, David X; Leacche, Marzia; Balaguer, Jorge M; Boudoulas, Konstantinos D; Damp, Julie A; Greelish, James P; Byrne, John G (2009). "Routine Intraoperative Completion Angiography After Coronary Artery Bypass Grafting and 1-Stop Hybrid Revascularization". Journal of the American College of Cardiology. 53 (3): 232–41. doi:10.1016/j.jacc.2008.10.011. PMID 19147039. S2CID 39700219.
7. Robinson, NB; Sef, D; Gaudino, M; Taggart, DP (February 2023). "Postcardiac surgery myocardial ischemia: Why, when, and how to intervene". The Journal of Thoracic and Cardiovascular Surgery. 165 (2): 687–695. doi:10.1016/j.jtcvs.2021.05.052. PMID 34556355.
8. Reynolds AC, King N. (2018) Hybrid coronary revascularization versus conventional coronary artery bypass grafting: Systematic review and meta-analysis. Medicine (Baltimore). 2018 Aug;97(33):e11941
9. Sousa-Uva, M; Neumann, FJ; Ahlsson, A; Alfonso, F; Banning, AP; Benedetto, U; Byrne, RA; Collet, JP; Falk, V; Head, SJ; Jüni, P; Kastrati, A; Koller, A; Kristensen, SD; Niebauer, J; Richter, DJ; Seferovic, PM; Sibbing, D; Stefanini, GG; Windecker, S; Yadav, R; Zembala, MO; ESC Scientific Document, Group (1 January 2019). "2018 ESC/EACTS Guidelines on myocardial revascularization". European Journal of Cardio-Thoracic Surgery. 55 (1): 4–90. doi:10.1093/ejcts/ezy289. PMID 30165632. {{cite journal}}: |first23= has generic name (help)

v t e Tests and procedures involving the heart
Cardiac surgery Interventional cardiology Cardiology diagnostic tests and procedures Cardiac imaging
Surgery	Heart valves and septa Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross procedure Transcatheter Mitral valve replacement Transcatheter pulmonary valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock–Hanlon procedure shunt from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of the great vessels Arterial switch operation Mustard procedure Senning procedure for univentricular defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock–Taussig shunt SVC to the right PA Glenn procedure Cardiac vessels CHD Angioplasty Bypass/Coronary artery bypass MIDCAB Off-pump CAB TECAB Coronary stent Bare-metal stent Drug-eluting stent Obstacle removal Endarterectomy Atherectomy Bentall procedure Valve-sparing aortic root replacement LeCompte maneuver Other Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure (Cox maze and minimaze) Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion S-ICD implantation ICD implantation Cardiac resynchronization therapy Left atrial appendage occlusion Cardiotomy Heart transplantation
Tests	Electrophysiology Electrocardiography Vectorcardiography Holter monitor Implantable loop recorder Cardiac stress test Bruce protocol Electrophysiology study Cardiac imaging Angiocardiography Echocardiography TTE TEE Myocardial perfusion imaging Cardiovascular MRI Ventriculography Radionuclide ventriculography Cardiac catheterization/Coronary catheterization Cardiac CT Cardiac PET sound Phonocardiogram
Function tests	Impedance cardiography Ballistocardiography Cardiotocography
Pacing	Cardioversion Transcutaneous pacing
Category

• Cardiac procedures