What is hybrid myocardial revascularization? vWhich patients with coronary artery disease benefit most from hybrid myocardial revascularization procedures? Dr. Jeffrey Popma, MD. The concept of a hybrid myocardial procedure is important. It comes from this fact. The left internal mammary artery to the left anterior descending artery is a fairly durable operation. Dr. Anton Titov, MD. It potentially and oftentimes does last the patient's lifetime. The number of graft failures that we have with the LIMAs is much much much less than what we have with veins. In contrast, in patients that have disease of the left circumflex or of the right coronary artery, oftentimes veins are placed as grafts. Dr. Jeffrey Popma, MD. Veins are used as grafts if there are no arterial conduits available. Those veins may last 10 years in a patin with coronary artery disease. Vein grafts also may occlude after 10 years and sometimes even before that time. Because of degeneration of the vein graft itself. The concept of a hybrid myocardial revascularization is this. The surgeon would do bypass surgery with the left internal mammary artery, with the LIMA. Other coronary arteries in a patient with coronary artery disease would be stented with drug-eluting stents. We know that the long-term durability of the drug-eluting stents is pretty good. It is better than revascularization with vein grafts. Dr. Jeffrey Popma, MD. The hybrid myocardial revascularization concept would give the patient's the most durable long term results. It will treat coronary artery disease much better. The problem is always reimbursement. Dr. Anton Titov, MD. How do you pay for the stenting procedure? How do you pay for the surgical procedure? Because they are all done at the same time. We haven't really worked that out. The fact that it takes a little bit more coordination, a little bit more time to do. Do you do coronary artery stenting before the patient goes to the operating room? Do you do the stenting afterwards? Dr. Jeffrey Popma, MD. We have done it both ways. But it is a very very important topic. It is a topic that we will think about more. We think about how we are going to effectively treat patients with aortic valve disease as well. Who benefits from a combination of open heart surgery and coronary artery stent placement? Coronary artery bypass grafting, CABG. Leading expert explains.