Purpose: Hybrid coronary revascularization (HCR) combines the strengths of coronary artery bypass grafting (CABG) using the minimally invasive direct (MIDCAB), or the minimally invasive multivessel CABG (MICS CABG) with percutaneous coronary intervention (PCI) for selected patients with multivessel coronary artery disease (MV CAD). This study evaluates the mid- and long-term follow-up results of these patients. Methods: Study evaluated all patients (n=138) with planned HCR between 2007-2018. Major adverse cardiac and cerebral events (MACCE), freedom from angina and health status were collected by a questionnaire. Long-term follow-up (mean 57.7 ± 29.7 months) was available for 121 patients (87.7%). Results: The patients were 69.6 ± 11.2 years old, predominantly male109 (79%). The mean EuroSCORE II was 7.2 ± 10.0. There were 97 MIDCAB and 41 MICS CABG procedures with no conversions, neither to sternotomy nor to cardio-pulmonary bypass. 36.2% (n=50) underwent PCI prior to surgery. A planned postoperative PCI was performed in only 18 patients (13%) during the follow-up. Consecutively, 70 patients did not receive the planned PCI.

The 30-day mortality was 2.1% (3/138). At 3- and 5-year the survival rate was 89% and 80%, respectively, and MACCE-free survival was 87% and 75%, respectively. The survival rate was higher in the group of patients receiving a PCI, median survival 10 versus 8.6 years, without reaching statistical significance (log-rank test P = 0.85).

Conclusion: Current evidences suggest that HCR is a safe and effective coronary artery revascularization strategy for selected patients with MVCAD. In the future the focus has to be directed on to the organization of the PCI step after coronary surgery.