Hybrid coronary revascularization combines arterial coronary artery bypass grafting surgery and percutaneous coronary artery stenting. This is a sophisticated procedure for the treatment of multivessel coronary artery disease. What are the indications for hybrid coronary revascularization in your practice?
It’s a very interesting question. A few years ago, I wrote an editorial together with Dr. Antonio Colombo. We are convinced that we should do more of this procedure, Hybrid coronary revascularization. So, the main issue here is that the data available is too little to create a standard. We have more of a philosophy behind the evidence. The philosophy is the following. The only prognostic data on the coronary artery bypass grafting is the graft of the mammary artery on the LAD coronary artery. Everything else has a less prognostic impact. We can do mammary artery LAD grafting in a very minimally invasive fashion. This graft has been shown superior to PCI [percutaneous coronary intervention]. So, if we do this prognostic procedure first [CABG with mammary artery grafted to LAD coronary artery] and then we let all the rest of coronary artery lesions be treated by PCI, we combine the best of the two worlds. We act on the prognosis with the bypass grafting, and we act on symptoms and quality of life with PCI. PCI will be done under protection by the first graft. So it will be a low-risk procedure. So, what are the indications for Hybrid coronary revascularization? Basically, in theory, it may be every patient with coronary artery disease who needs intervention. This should be demonstrated by a clinical trial, which has not been done yet appropriately. But in principle, it could be a solution for everyone to improve also the acceptance of CABG surgery. Because, obviously, if you look at the current scenario of coronary artery disease intervention, you have two options. One option is that you come to the hospital, and within one day, you have your solution [PCI], and you can walk out with treated coronary arteries. Or you go to the operating room, you get your chest cracked open, and it will take three months before you are fully back into your lifestyle practice. Obviously, most of us, including probably myself, would tend to get the easiest solution. Obviously, we know that in the long term, CABG surgery is much better. But I always think that to reach the long term, I need to reach the short term. So the mortality and morbidity risk of a surgery over time is blunted by the risks of the PCI associated with PCI. But still, the early risk is higher for surgery than PCI. So today, we drive our decisions based on the anatomy of coronary arteries. We know that complex coronary anatomy can be better treated by surgery. PCI is less of an option in diabetic patients. And, the opposite is true. If the patient is a very high risk, we like to do PCI regardless of the anatomy. So we follow this kind of rule. But if we move forward, I also think in this field. Once there will be more interaction between cardiac surgeons and interventional cardiologists, I can predict Hybrid coronary revascularization becoming more and more of an option. And actually, this will be done soon. I am here in my new position as a heart valve center leader. I like to incorporate different technologies for patient treatment. And today, I focus on heart valves. I’ve been very much working on coronary arteries. I performed many coronary artery surgery in the past years. Even today, if needed, I can do that. I do it, I think, reasonably well. But I like to have, under my guidance, a team of people who are highly specialized, who are doing minimally invasive coronary artery treatments. We are adopting hybrid coronary revascularization procedures in many patients because I really believe it’s the way to go.