Hybrid Coronary Revascularization

Hybrid coronary revascularization (HCR) is a treatment strategy for revascularization of multi-vessel coronary artery disease that utilizes minimally invasive coronary artery bypass grafting (CABG) techniques in conjunction with percutaneous coronary intervention (PCI), integrating the advantages of both. The long-term symptom relief and survival benefit of an internal mammary artery (IMA) graft to the left anterior descending (LAD) artery are attained in this approach, as well as the durability of PCI with drug-eluting stents (DES) to non-LAD targets. This chapter will review the range of minimally invasive surgical techniques that form the basis of the surgical leg of HCR, address pharmacologic issues unique to HCR, and finally to review logistical considerations in the sequencing of each leg of HCR, surgical and percutaneous.