A new horizon for coronary surgery: Hybrid coronary revascularization and routine intra-operative completion angiography

Hybrid coronary revascularization combines coronary artery bypass grafting (CABG) surgery with percutaneous coronary intervention (PCI) for coronary artery disease. Surgical grafting is reserved for revascularization of the left anterior descending (LAD) artery, usually performed with the left internal mammary artery (LIMA) through either a limited thoracotomy or an endoscopic approach, while PCI with stenting is reserved for revascularization of non-LAD lesions. This combines the benefits of each technique-namely, the superiority of the LIMA to LAD graft and the improved patency rate of stent placement in non-LAD vessels. For non-LAD vessels, the higher one-year failure rate for saphenous vein grafts (SVG, averages 20%) compared to drug-eluting stents (DES, average 9%) supports this hybrid approach. The hybrid procedure can be performed as a staged procedure-with PCI followed by CABG or CABG followed by PCI. However, hybrid coronary revascularization is increasingly performed as a combined ("one stop") procedure in a dedicated suite-the "hybrid operating room". The hybrid room has the capability of serving both as a complete surgical operating room and as a catheterization laboratory. The hybrid operating room also allows for routine completion angiography following CABG surgery. This facilitates early identification of graft failure thereby providing the opportunity to correct technical errors within the same surgical period and thus may improve graft patency rate, especially of SVG to non-LAD vessels. This chapter reviews the advantages of and the logistics required for performing hybrid procedures and completion angiography-a new horizon for coronary surgery.

Duke Scholars

Author Annemarie Thompson Anesthesiology, Cardiothoracic