Review ArticlesA Practical Approach to Hybrid Coronary RevascularizationSingh, Twinkle MD; Ayinapudi, Karnika MD; Motwani, Ayush MD; Hendel, Robert MD; Le Jemtel, Thierry H. MDAuthor Information From the Section of Cardiology, Department of Medicine, Tulane University School of Medicine; Tulane University Heart and Vascular Institute, New Orleans, LA. Disclosure: The authors have no conflicts of interest to report. Correspondence: Thierry H. Le Jemtel, MD, Tulane University Heart and Vascular Institute, 1415 Tulane Avenue, New Orleans, LA 70112. E-mail: [email protected]. Cardiology in Review: September/October 2020 - Volume 28 - Issue 5 - p 240-243 doi: 10.1097/CRD.0000000000000278 Buy Metrics Abstract Combined surgical and percutaneous coronary revascularization, ie, hybrid coronary revascularization (HCR) consists of surgical left internal mammary artery (LIMA) bypass to the left anterior descending artery (LAD) and percutaneous revascularization of other diseased coronary arteries. Developed as a 1-stage procedure, HCR has not been widely adopted by the cardiovascular community. The recommended minimally invasive approach through a small left thoracotomy incision is technically demanding, and same-day percutaneous revascularization requires a hybrid operating room that is not available in most hospitals. In this review, we consider present HCR protocols, barriers to widespread adoption of HCR, and we give special attention to the surgical approach for the LIMA graft to the LAD and the timing of percutaneous revascularization. We conclude that grafting the LIMA to the LAD through a median sternotomy approach and delaying the percutaneous revascularization may facilitate the widespread use of HCR in patients with multivessel coronary artery disease and a low to intermediate Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.