Hybrid Cardiovascular Procedures

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Abstract

A hybrid strategy is a combination of surgical therapy and a catheter-based intervention to treat any set of cardiovascular lesions. Such an approach can be used to treat coronary artery disease (CAD), combined CAD and valve disease, atrial fibrillation, congenital heart disease, cerebrovascular disease, and thoracic aortic disease. This strategy can be especially beneficial for high-risk patients who would benefit from less invasive forms of therapy. Co-operation between cardiac surgeons and cardiologists is vital when using a hybrid approach.

Disclosure
The authors have no conflicts of interest to declare.
Correspondence
John G Byrne, MD, Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-8802. E: john.byrne@vanderbilt.edu
Received date
07 July 2010
Accepted date
23 July 2010
Citation
US Cardiology - Volume 7 Issue 2;2010:7(2):65-68
Correspondence
John G Byrne, MD, Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-8802. E: john.byrne@vanderbilt.edu

Pages

Hybrid procedures integrate and combine endovascular intervention with surgical therapy. The goal of such an approach is to offer a less invasive therapeutic modality while optimizing patient care and minimizing peri-operative morbidity and mortality.
This review will discuss the different forms of hybrid therapy that are currently available and focus on the role they play in the treatment of cardiac and vascular disease. It will also focus on the data, outcomes, and potential uses of hybrid therapy.

Hybrid Coronary Revascularization

The SYNergy Between PCI With TAXUS and Cardiac Surgery (SYNTAX) trial has demonstrated that in patients with multivessel coronary artery disease (CAD), coronary artery bypass grafting (CABG) surgery is superior to percutaneous coronary intervention (PCI), with a lower need for repeat revascularization.1 PCI, however, offers a much less invasive revascularization modality with faster recovery and potentially a lower stroke rate compared with CABG alone.
Hybrid coronary revascularization (HCR) involves combining CABG surgery and PCI either in one setting or in a staged fashion. In this approach, the left internal mammary artery (LIMA) to left anterior descending (LAD) artery graft is combined with PCI of non-LAD coronary artery stenosis. The goal of HCR is to offer the patient the best of both techniques in a modality that is safe and less invasive than the standard surgical approach but does not compromise on long-term durability and survival. In HCR, saphenous vein grafts (SVGs) are substituted with coronary stents for the treatment of non-LAD coronary artery stenosis. The logic behind this is that SVGs have shown a high early failure rate of 6.2–30%, with an average of 20%,2–4 while 12-month restenosis rates with drug-eluting stents (DES) have been reported to be between 0 and 16% with an average of 4.58%.5–9 For treatment of the LAD system, the LIMA graft has superior long-term patency rates to PCI and SVGs, which translates into superior event-free survival and relief of angina,10,11 and contributes to the vast majority of the survival advantage observed in CABG surgery.12–14

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