Singh Twinkle, Ayinapudi Karnika, Motwani Ayush, Hendel Robert, Le Jemtel Thierry H
From the Section of Cardiology, Department of Medicine, Tulane University School of Medicine; Tulane University Heart and Vascular Institute, New Orleans, LA.
Cardiol Rev. 2020 Sep/Oct;28(5):240-243. doi: 10.1097/CRD.0000000000000278.
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.
外科手术与经皮冠状动脉血运重建相结合，即杂交冠状动脉血运重建术（HCR），包括将左乳内动脉（LIMA）外科搭桥至左前降支动脉（LAD）以及对其他病变冠状动脉进行经皮血运重建。作为一种一期手术开展的HCR，尚未被心血管领域广泛采用。推荐的经左胸小切口的微创方法技术要求较高，且同日经皮血运重建需要杂交手术室，而大多数医院并不具备。在本综述中，我们探讨了当前的HCR方案、HCR广泛应用的障碍，并特别关注LIMA移植至LAD的手术方法以及经皮血运重建的时机。我们得出结论，通过正中胸骨切开术将LIMA移植至LAD并延迟经皮血运重建，可能有助于HCR在多支冠状动脉疾病且经皮冠状动脉介入治疗与心脏手术协作（SYNTAX）评分低至中等的患者中广泛应用。
