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What is the state of hybrid coronary revascularization in 2018?

Yanagawa, Bobbya; Hong, Kathryna; Cheema, Asimb; Bagai, Akshayb; Verma, Subodha

doi: 10.1097/HCO.0000000000000548

Purpose of review Hybrid coronary revascularization (HCR) combines minimally invasive surgical bypass with percutaneous coronary intervention (PCI) using drug-eluting stents, the goal being to leverage the strengths of each approach. Here we provide an update on HCR from the past 12 months.

Recent findings HCR represents a minority of surgical revascularization cases from a small number of highly experienced surgical centers. Most single-center observational series show no differences in major cardiovascular outcomes comparing HCR and coronary artery bypass graft (CABG) or HCR and PCI. The 5-year results of the first randomized study comparing HCR to CABG reported no difference in all-cause mortality, myocardial infarction, and repeat revascularization. Comparing HCR with multivessel PCI, a large, prospective observational study reported no difference in risk-adjusted major adverse cardiovascular events at 12 months. The Hybrid Coronary Revascularization Trial is an international, multicenter, randomized controlled trial to compare HCR versus PCI for patients with proximal left anterior descending disease or left main disease. This trial is currently recruiting patients.

Summary HCR is a potentially attractive alternative to both surgical revascularization and multivessel PCI when performed in experienced centers for highly selected patients. The results of a large, multicenter, prospective trial will provide greater clarity on the clinical role and optimal coronary anatomy for this third revascularization option.

aDivisions of Cardiac Surgery

bCardiology, St Michael's Hospital, Toronto, Ontario, Canada

Correspondence to Bobby Yanagawa, MD, PhD, FRCSC, Assistant Professor, Division of Cardiac Surgery, Department of Surgery, University of Toronto, St. Michael's Hospital, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON M5B 1W8, Canada. Tel: +1 416 864 5706; fax: +1 416 864 5031; e-mail:

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