Hybrid coronary revascularization versus coronary artery bypass surgery with bilateral or single internal mammary artery grafts.

J Thorac Cardiovasc Surg. 2016 Apr;151(4):1081-9

https://www.ctsnet.org/jans/hybrid-coronary-revascularization-versus-coronary-artery-bypass-surgery-bilateral-or-single?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=JANS+1%2F20%2F2017

Suprise!!
We surgeon believe that BIMA is superior to SIMA and hybrid coronary revascularization (HCR= LIMA-LAD + PCI)


The authors also sought to better delineate preoperative patient selection criteria predictive of the use of HCR and found that older patients, patients with lower body mass index or prior percutaneous coronary intervention, and patients with stable 2-vessel disease were more likely to undergo HCR and that patients who underwent CABG with a single arterial conduit, compared with bilateral arterial conduits and HCR, had significantly higher Society of Thoracic Surgeons predicted risk of mortality with the highest rates of diabetes, peripheral arterial disease, prior myocardial infarction, and heart failure.

In light of these findings and with data showing that drugeluting stents are equivalent if not better than saphenous vein grafts,8 should we not be pushing the envelope and greatly expanding our use of HCR at the expense of traditional left internal thoracic artery–left anterior descending þ saphenous vein graft CABG regardless of whether or not they slot nicely into historical patient selection brackets?

 Although this study provides an excellent proofof-concept and suggests a change in clinical practice, it also highlights our need for aggressive multicenter randomized controlled trials to determine the optimal surgical coronary revascularization and patient-selection strategies in an all-comers fashion. Initial randomized control trial forays into HCR10 are a good start.