Hybrid Coronary Revascularisation – Niche or Final Destination?

In selected patients, coronary artery bypass grafting (CABG) offers superior long-term benefit to percutaneous coronary intervention (PCI) in the treatment of coronary artery disease (CAD). This is largely due to the effectiveness of the left internal thoracic artery (LITA) to left anterior descending (LAD) artery bypass. Patients, however, frequently prefer PCI because of its less invasive nature, faster recovery, and comparable short-term outcomes. Hybrid coronary revascularisation (HCR) combines minimally invasive bypass with PCI using contemporary techniques and modern drug-eluting stents. It aims to unite the prognostic benefit of the LITA + /- RITA graft(s) with PCI’s recovery profile and comparable outcomes in non-LAD saphenous vein bypasses. In this article, we review the biological rationale for LITA and bilateral ITA use, the historical evolution of HCR, current guideline recommendations and practical issues around the timing and sequencing of interventions. In addition, we discuss how the integration of robotic technology facilitates sternal-sparing, multi-arterial approaches that may enable HCR to evolve from a niche to the final destination therapy.