title: Clinical and angiographic results after hybrid coronary revascularization.
abstract: BACKGROUND
  With hybrid coronary revascularization (HCR), minimally invasive left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) grafting is combined with percutaneous coronary intervention (PCI) of non-LAD vessels. The purpose of this study was to examine the short-term clinical and angiographic results in one of the largest HCR series to date.
  
  
  METHODS
  From 2003 to 2012, 300 consecutive patients (aged 64±12 years, female 31.7%, predicted risk of mortality 1.6%±2.1%) underwent HCR on an intent-to-treat basis at a single institution. After robotic or thoracoscopic LIMA harvest, off-pump LIMA to LAD grafting was performed through a 3- to 4-cm sternal-sparing, non-rib-spreading thoracotomy. PCI was utilized to treat non-LAD lesions either before, after, or concomitant with the surgical procedure.
  
  
  RESULTS
  Of the 300 patients undergoing HCR on an intent-to-treat basis, HCR was performed with surgery first in 192 patients (64.0%), PCI first in 56 (18.7%), and as a concomitant procedure in 21 (7.0%). Of the 31 patients (10.1%) who did not undergo HCR, 24 patients (8.0%) did not have PCI and thus were incompletely revascularized. For all patients, 30-day mortality, stroke, and nonfatal myocardial infarction occurred in 4 (1.3%), 3 (1.0%), and 4 (1.3%), respectively. Angiographic LIMA evaluation was performed in 248 patients and revealed a FitzGibbon A LIMA patency rate of 97.6% (242 of 248 patients). Repeat revascularization was required in 13 of 300 patients (4.3%).
  
  
  CONCLUSIONS
  Hybrid coronary revascularization represents an alternative approach for patients with multivessel coronary disease with excellent short-term outcomes. It provides a minimally invasive alternative to traditional coronary artery bypass graft surgery and may prove more durable than multivessel PCI.
authors.affiliation: Division of Cardiothoracic Surgery, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia. Electronic address: mhalkos@emory.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Halkos
authors.affiliation: Division of Cardiothoracic Surgery, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Walker
authors.affiliation: Division of Cardiothoracic Surgery, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Vassiliades
authors.affiliation: Division of Cardiology, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: John S
authors.initials: JS
authors.lastname: Douglas
authors.affiliation: Division of Cardiology, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Chandan
authors.initials: C
authors.lastname: Devireddy
authors.affiliation: Division of Cardiothoracic Surgery, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.affiliation: Division of Cardiology, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Aloke V
authors.initials: AV
authors.lastname: Finn
authors.affiliation: Division of Cardiology, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: S Tanveer
authors.initials: ST
authors.lastname: Rab
authors.affiliation: Division of Cardiothoracic Surgery, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.affiliation: Division of Cardiology, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Liberman
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*
keywords: 23; CABG; DES; HCR; IMA; LAD; LIMA; OR; PCI; STS; The Society of Thoracic Surgeons; coronary artery bypass graft surgery; drug-eluting stent; hybrid coronary revascularization; internal mammary artery; left anterior descending coronary artery; left internal mammary artery; operating room; percutaneous coronary intervention