Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center, University Hospital Essen, Essen, Germany.
Department of Cardiac Surgery, Medical University of Innsbruck, Austria.
Eur J Cardiothorac Surg. 2024 Aug 2;66(2). doi: 10.1093/ejcts/ezae271.
Myocardial revascularization in coronary artery disease via percutaneous coronary intervention or coronary artery bypass graft (CABG) surgery effectively relieves symptoms, significantly improves prognosis and quality of life when combined with guideline-directed medical therapy. Hybrid coronary revascularization is a promising alternative to percutaneous coronary intervention or CABG in selected patients and is defined as a planned and/or intended combination of consecutive CABG surgery using at least 1 internal mammary artery to the left anterior descending (LAD), and catheter-based coronary intervention to the non-LAD vessels for the treatment of multivessel disease. The main indications for hybrid coronary revascularization are (i) to achieve complete revascularization in patients who cannot undergo conventional CABG, (ii) to treat patients with acute coronary syndromes and multivessel disease with a non-LAD vessel as the culprit lesion that needs revascularization and (iii) in highly select patients with multivessel disease with complex LAD lesions and simple percutaneous coronary intervention targets for all other vessels. Hybrid coronary revascularization patients receive a left internal mammary artery graft to the LAD artery through a minimal incision along with percutaneous coronary intervention to the remaining diseased coronary vessels using latest generation drug-eluting stents. A collaborative environment with a dedicated heart team is the optimal platform to perform such interventions, which aim to improve the quality and outcome of myocardial revascularization. This position paper analyses the rationale of hybrid coronary revascularization and the currently available evidence on the various techniques and delves into the sequence of the interventions and pharmacological management during and after the procedure.
经皮冠状动脉介入治疗或冠状动脉旁路移植术（CABG）在联合指南指导的药物治疗时，可有效缓解症状，显著改善预后和生活质量。在某些特定患者中，杂交冠状动脉血运重建术是经皮冠状动脉介入治疗或 CABG 的一种很有前途的替代方法，它被定义为计划和/或打算连续进行 CABG 手术，至少使用 1 根内乳动脉到左前降支（LAD），以及经导管冠状动脉介入治疗非 LAD 血管，以治疗多支血管疾病。杂交冠状动脉血运重建术的主要适应证为：（i）在不能进行常规 CABG 的患者中实现完全血运重建；（ii）治疗急性冠状动脉综合征和多支血管疾病患者，其中非 LAD 血管为罪犯病变，需要血运重建；（iii）在多支血管疾病患者中，选择高度特定的患者，其 LAD 病变复杂，而其他所有血管的经皮冠状动脉介入治疗目标简单。杂交冠状动脉血运重建患者通过微创切口接受左内乳动脉向 LAD 动脉移植，并对其余病变冠状动脉血管进行最新一代药物洗脱支架的经皮冠状动脉介入治疗。一个拥有专门心脏团队的协作环境是进行此类干预的最佳平台，旨在改善心肌血运重建的质量和结果。本立场文件分析了杂交冠状动脉血运重建的基本原理以及目前关于各种技术的证据，并深入探讨了介入期间和之后的干预顺序和药物管理。
