Hybrid revascularisation methodology
To maximise blood flow with patients who have multivessel disease again, the hybrid procedure can be used. This is the intentional combination of:
- PCI
- CABG
Some facts
Both techniques – the surgical procedure (bypass surgery) and the interventional procedure (balloon angioplasty/stent implantation) – have their own advantages and disadvantages in the treatment of patients with multivessel disease. The combination of both ensures an optimal result to normalise the blood supply again.
Several studies (Syntax and Freedom) have shown that the gold standard for patients with multivessel disease – including an affected LAD with or without main stem lesions – is the placement of a bypass graft between the LAD and the mammary artery.
The left internal mammary artery will therefore be anastomosed to the LAD in a surgical operation.
In surgical treatment using venous grafts, the patency of these bypass grafts is about 70% after one year. The frequency of restenosis after the use of stents (PCI) is 3% after 1 year and 4% after 2 years.
Advantages and disadvantages of the different procedures: Multivessel disease with affected LAD
| PCI (balloon angioplasty / stent implantation) | CABG (bypass surgery) |
| Advantages | Disadvantages | Advantages | Disadvantages |
| Minimally invasive | Higher need for re-intervention | LIMA best result | Sternotomy |
| Patency ~ venous graft | Survival inferior to LIMA->LAD | Lowest need for re-intervention | Heart-lung machine |
| Patients choose PCI | Low-risk procedure | Venous graft PCI ~ |
Why hybrid revascularisation?
Hybrid revascularisation offers the best of both worlds:
- Minimally invasive surgery (endo-ACAB) : LIMA -> LAD
- PCI for “non LAD lesion”
Benefits of the hybrid procedure:
- Best LIMA -> LAD revascularisation technique
- Minimal surgical trauma
- No sternotomy
- No heart-lung machine
- No manipulation of the aorta
- Less or no need of transfusion
- (Short) stay in the intensive care unit
- Shorter hospital stay
- Patient satisfaction
Who is a candidate for hybrid revascularisation?
Suitable candidates are patients with multivessel disease with one or several significant lesions in the anterior coronary artery and other lesions in the other two coronary arteries.
Conclusion
Some patients receive good treatment with PCI
Some patients receive good treatment with CABG
Many patients’ treatment would be improved by combining PCI and endo-ACAB