Hybrid coronary revascularization versus coronary artery bypass surgery with bilateral or single internal mammary artery grafts.

This article is a propensity matched analysis comparing patients undergoing hybrid coronary revascularization (HCR) with minimally invasive left internal mammary artery to left anterior descending artery (LAD) bypass and percutaneous coronary intervention (PCI) to non-LAD arteries to patients undergoing conventional coronary artery bypass grafting (CABG) with either single (SIMA) or bilateral internal mammary arteries (BIMA).  A total of 306 patients underwent HCR from 2003 to 2013 compared with 8254 patients undergoing CABG.  In the HCR group LIMA harvest was performed endoscopically before 2009 and with robotic assistance thereafter.   In the matched study populations, cardiopulmonbary bypass was used in 0% of patients in HCR group, 21% in SIMA group and 7% in BIMA group.  Patient factors that were associated with HCR use were older age, lower body mass index, history of PCI, and 2-vessel coronary disease. In the HCR group, 84% of non-LAD lesions were treated with drug eluting stents.  At 30 days, there was no significant difference in major cerebrovascular and cardiac events between groups.  In hospital complications,  the need for blood transfusions, and hospital stay duration were lower for the HCR group.  There was no difference in survival between the matched groups at midterm followup (median follow-up 2.8 years).   The authors conclude that HCR in selected patients may be a safe and less invasive alternative to conventional CABG with similar short and midterm outcomes.