Hybrid Coronary Revascularisation: Indications, Techniques, and Outcomes
Ibrahim T. Fazmin, Jason M. Ali
Abstract
Hybrid coronary revascularisation (HCR) integrates coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) to combine the benefits of minimally invasive surgery and advanced stent technology. Typically, HCR involves off-pump left internal mammary artery (LIMA) to left anterior descending artery (LAD) bypass via minimally invasive direct coronary artery bypass (MIDCAB), complemented by PCI to non-LAD vessels. This approach avoids a full sternotomy and cardiopulmonary bypass while preserving the advantages of surgical revascularisation. Patient selection for HCR should be guided by a multidisciplinary heart team, targeting those with severe LAD disease and suitable non-LAD lesions for PCI. This review outlines the surgical techniques, anticoagulation strategies, and procedural sequencing employed in HCR, along with real-world outcomes from observational studies and randomised trials. While current evidence supports the safety and feasibility of HCR in appropriately selected patients, further large-scale randomised trials are needed to clarify its role in comparison to standalone CABG or PCI.