Hybrid Coronary Revascularization: Insights Into Long-Term Clinical Outcomes From a Single-Center Experience

Abstract

Background: Hybrid coronary revascularization (HCR) combines minimally invasive direct coronary artery bypass (MIDCAB) to the left anterior descending artery (LAD) with percutaneous coronary intervention (PCI) for non-LAD lesions. HCR aims to balance the durability of surgical revascularization with the reduced invasiveness of PCI. This study evaluates 20 years of HCR experience at a single center, focusing on short- and long-term clinical outcomes.

Methods: A retrospective analysis was conducted on 2969 patients who underwent MIDCAB between 1996 and 2020 at the Heart Center Leipzig. A total of 177 patients met the inclusion criteria, defined as MIDCAB followed or preceded by PCI within 100 days. Exclusion criteria included emergency procedures, planned sternotomy, and delayed HCR beyond 100 days. Propensity score matching (PSM) compared outcomes between MIDCAB-first and PCI-first strategies.

Results: The median time interval between MIDCAB and PCI was 22 days. Early stent and graft failure rates were 2.8% and 2.2%, respectively. Kaplan–Meier estimated survival was 79.1% at 5 years, 64.2% at 10 years, 49.8% at 15 years, and 37.8% at 20 years. Freedom from repeat revascularization was 86.3% at 5 years and 73.6% at 10 years. PSM analysis showed no significant difference in 15-year survival (57.7% vs. 50.6%, p = 0.68) or 10-year freedom from repeat revascularization (88.9% vs. 86.1%, p = 0.39) between the MIDCAB-first and PCI-first groups.

Conclusion: HCR provides durable long-term survival and revascularization outcomes, with comparable results between MIDCAB-first and PCI-first strategies. These findings support HCR as a viable alternative to conventional CABG in selected patients.