COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Bobby Yanagawa and Subodh VermaA comparison of surgical, total percutaneous, and hybrid approaches to treatment of combined coronary artery and valvular heart diseaseEL-Andari, Ryaana; Bozso, Sabin J.b; Kang, Jimmya; Nagendran, JeevanbAuthor Information aFaculty of Medicine and Dentistry bDepartment of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada Correspondence to Jeevan Nagendran, MD, PhD, FRCSC, Cardiac Surgeon, Minimally Invasive and Transcatheter Valve Surgery, University of Alberta, Mazankowski Alberta Heart Institute, 4-108A Li Ka Shing Health Research Centre, 8602 – 112 Street, Edmonton, AB, Canada T6G 2E1. Tel: +1 780 492 7605; fax: +1 780 492 6037; e-mail: [email protected] Current Opinion in Cardiology: September 2020 - Volume 35 - Issue 5 - p 559-565 doi: 10.1097/HCO.0000000000000764 Buy Metrics Abstract Purpose of review The purpose of this review is to compare outcomes of surgical valve replacement (SVR) and coronary artery bypass grafting (CABG), minimally invasive cardiac surgery (MICS) SVR and percutaneous coronary intervention (PCI), and transcatheter aortic valve replacement and PCI for the treatment of combined coronary artery disease (CAD) and valvular heart disease (VHD). Recent findings Several studies have attempted to identify key differences in outcomes with hybrid MICS SVR and PCI approaches to combined CAD and VHD. Recent studies have demonstrated that MICS SVR and PCI, when compared with conventional open SVR and CABG, demonstrate reduced or unchanged morbidity and mortality. However, the rate of bleeding in MICS SVR and PCI is consistently higher likely because of the effects of antiplatelet therapy. Summary A shift toward MICS has occurred in the preceding decades, with outcomes improving in recent years. With limited ability to perform CABG through MICS approaches, attempts have been made at hybrid procedures to address multiple presenting concerns while allowing for the benefits of MICS approaches. Hybrid MICS SVR and PCI approaches may provide suitable alternatives to traditional surgical approaches with reduced intra and postoperative morbidity and mortality, with the notable exception of bleeding complications. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.