Hybrid Revascularization Strategies in Complex Coronary Artery Disease (CAD): Integrating Surgical and Percutaneous Approaches for Optimal Outcomes

doi:N/A

Bangaldesh Journal of Cardivascular Medicine

2023, Volume 1, Issue 4 : 1-5

Research Article

Hybrid Revascularization Strategies in Complex Coronary Artery Disease (CAD): Integrating Surgical and Percutaneous Approaches for Optimal Outcomes

Jonathan R. Mitchell

Sarah L. Thompson

Ahmed K. Rahman

Emily J. Foster

⁴

Department of Cardiothoracic Surgery, Heart Institute of America, Boston, USA

Division of Interventional Cardiology, University Medical Center, London, UK

Department of Cardiovascular Sciences, National Heart Center, Dubai, UAE

⁴

Department of Clinical Research and Outcomes, Global Cardiac Research Institute, Sydney, Australia

Abstract

Background

Complex coronary artery disease (CAD), including multivessel disease, left main coronary artery disease, and diffuse coronary atherosclerosis, remains a major contributor to cardiovascular morbidity and mortality worldwide. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have traditionally been viewed as competing treatment modalities. Hybrid Coronary Revascularization (HCR) combines the durability of surgical grafting with the minimally invasive advantages of PCI, potentially offering optimal revascularization for selected patients.

Objective

To evaluate procedural success, clinical outcomes, safety, and long-term effectiveness of hybrid revascularization strategies in patients with complex CAD.

Methods

A prospective multicenter observational study enrolled 320 patients with complex CAD undergoing hybrid revascularization between January 2019 and December 2024. Patients underwent minimally invasive left internal mammary artery (LIMA) grafting to the left anterior descending artery (LAD) combined with PCI of non-LAD lesions. Clinical outcomes were assessed at 30 days, 1 year, and 3 years.

Results

Procedural success was achieved in 97.8% of patients. Major adverse cardiovascular and cerebrovascular events (MACCE) occurred in 9.7% at one year and 16.2% at three years. Repeat revascularization was required in 4.1% of patients. LIMA-LAD graft patency remained 96.8% at three years.

Conclusion

Hybrid coronary revascularization offers excellent procedural success and favorable long-term outcomes in selected patients with complex CAD. The combination of minimally invasive surgery and PCI may represent an effective alternative to conventional CABG in appropriately selected patients.

Keywords

Hybrid Coronary Revascularization

Complex CAD

PCI

CABG

LIMA-LAD

Multivessel Disease

License

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