Current state of integrated "hybrid" coronary revascularization.

The long-term benefits of a left internal mammary artery bypass graft to the left anterior descending artery (LAD) have been well described. As the patient population with multivessel coronary artery disease has grown older with greater comorbidities, less invasive approaches to revascularization have been explored. The use of drug-eluting stents has minimized the morbidity of revascularization but has failed to match the durability of coronary artery bypass grafting (CABG). Hybrid coronary revascularization (HCR) is the planned use of minimally invasive surgical techniques for left internal mammary artery-LAD grafting and the use of percutaneous coronary interventions (PCI) for non-LAD target revascularization. The optimal timing and order of revascularization in HCR remains unclear. Novel operating suites with surgical and fluoroscopic capabilities have begun to support the performance of simultaneous minimally invasive CABG and PCI. The role of HCR compared to both PCI and conventional CABG awaits the results of ongoing randomized clinical trials.