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Hybrid Cardiovascular Procedures

Vanderbilt Heart and Vascular Institute, Nashville, Tennessee

^_* Reprint requests and correspondence: Dr. John G. Byrne, Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8802 (Email: john.byrne{at}vanderbilt.edu).

A hybrid strategy combines the treatments traditionally available only in the catheterization laboratory with those traditionally available only in the operating room to offer patients the best available therapies for any given set of cardiovascular lesions. Examples include hybrid coronary revascularization (coronary artery bypass grafting [CABG]/percutaneous coronary intervention [PCI]) wherein a left internal mammary artery graft is placed on the left anterior descending artery (left anterior descending coronary artery [LAD]) either by minimally invasive or open technique and combined with PCI of non-LAD vessels. Other examples include minimally invasive valve surgery combined with PCI to coronary lesions (valve/PCI), to convert a high-risk valve/CABG into a lower-risk isolated minimally invasive valve procedure. Several questions remain unresolved, such as the order in which surgery and PCI should be performed, the duration of the staging of the 2 procedures, antiplatelet strategies, the costs, and the logistics. Other areas in which hybrid approaches are being developed include hybrid endomyocardial/epicardial atrial fibrillation procedures and hybrid aortic arch debranching combined with endovascular grafting for thoracic aortic procedures. The key requirement in all of these approaches is the need for collaboration between cardiac surgeons, vascular surgeons, and interventional cardiologists to obtain optimal patient outcomes.

Key Words: hybrid procedures • minimally invasive cardiac surgery • percutaneous coronary intervention

Abbreviations and Acronyms   AF = atrial fibrillation   BMS = bare-metal stent(s)   CABG = coronary artery bypass grafting   DES = drug-eluting stent(s)   LAD = left anterior descending coronary artery   LIMA = left internal mammary artery   MIDCAB = minimally invasive direct coronary artery bypass grafting   OPCAB = off-pump coronary artery bypass   PCI = percutaneous coronary intervention   SVG = saphenous vein graft   TECAB = totally endoscopic coronary artery bypass grafting   TLR = target lesion revascularization

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