Hybrid coronary revascularization (HCR) or hybrid coronary bypass is a relatively new type of

heart surgery Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to corr ...

that provides an alternative to traditional coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI or PTCA) by combining the two into one operation. It is this combining aspect that "

hybrid Hybrid may refer to: Science * Hybrid (biology), an offspring resulting from cross-breeding ** Hybrid grape, grape varieties produced by cross-breeding two ''Vitis'' species ** Hybridity, the property of a hybrid plant which is a union of two dif ...

" refers to. HCR is one of several types of hybrid cardiac surgery; it is not to be confused with a MIDCAB (minimally invasive direct coronary artery bypass) procedure, which uses the smaller

thoracotomy A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the hea ...

incision but does not involve

coronary stent A coronary stent is a tube-shaped device placed in the coronary arteries that supply blood to the heart, to keep the arteries open in the treatment of coronary heart disease. It is used in a procedure called percutaneous coronary intervention (PC ...

ing. __TOC__

Benefits

Hybrid bypass offers all the benefits of a MIDCAB # A much smaller incision (made through the

rib cage The rib cage, as an enclosure that comprises the ribs, vertebral column and sternum in the thorax of most vertebrates, protects vital organs such as the heart, lungs and great vessels. The sternum, together known as the thoracic cage, is a sem ...

as opposed to cutting the

sternum The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Sha ...

and opening the rib cage) than with traditional bypass surgery. # Less pain for the patient and quicker recovery time. Particularly in high risk patients, morbidity and mortality decreases in comparison to conventional surgery. A study from FuWai Hospital in Beijing reports on 104 patients with multivessel coronary artery disease who were compared with the same sized group of patients undergoing off pump surgery using

propensity score matching In the statistical analysis of observational data, propensity score matching (PSM) is a statistical matching technique that attempts to estimate the effect of a treatment, policy, or other intervention by accounting for the covariates that predic ...

. The patients treated with the hybrid approach had a significantly lower ICU stay and intubation time and experienced less complications in terms of bleeding and transfusions needs. At a median follow up of 18 months, patients undergoing the hybrid procedure also had a significantly higher freedom from major adverse cardiac or cerebrovascular events (99% vs. 90.4%; p = 0.03). HCR is also associated with a significant decrease in the need for blood transfusion and a significant reduction in the duration of intubation. # Less risk of complications, infections etc. and also decreases the necessity for two separate cardiac procedures (bypass and stenting). However, it requires the implementation of suitable X-ray equipment in the OR, i.e. a hybrid operating room. Helpful in this regard is the regular use of completion angiography. In a study designed and published by the Vanderbilt Heart and Vascular Institute, routine intraoperative completion angiography performed in a fully functional hybrid operation room detected important defects in 97 of 796 (12% of the grafts) venous coronary artery bypass grafts in 366 adult patients (14% of the patients) with complex coronary artery disease. Their findings in completion angiography at the end of the operation included suboptimal anastomoses, poor lie of the venous bypass graft, and bypasses to not diseased vessels. The angiography findings led to a change in the management, including minor adjustments of the graft, traditional surgical revision or percutaneous coronary interventions, resulting in optimal bypass outcomes. # In the study from FuWai, the hybrid procedure was also less costly than an exclusively percutaneous strategy. A 2018 Meta Analysis with over 4000 patient cases found HCR to have significant advantages compared with conventional CABG. Reduced incidence of

Blood Transfusion Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but mo ...

, reduced hospital stay duration and reduced

intubation Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blake ...

duration were all reported. In contrast, HCR was found to be significantly more expensive compared to CABG. Reynolds AC, King N. (2018) Hybrid coronary revascularization versus conventional coronary artery bypass grafting: Systematic review and meta-analysis. Medicine (Baltimore). 2018 Aug;97(33):e11941

References

{{Cardiac surgery procedures Cardiac procedures

Benefits

See also

References