Original title: Clinical Outcomes after Hybrid Coronary Revascularization versus Coronary Artery Bypass Surgery: A Meta-Analysis of 1,190 Patients. Reference: Ralf E. Harskamp et al. American Heart Journal (2014), epub ahead of print.

Hybrid revascularization combines long-term patency of the mammary artery connected to the left anterior descending with minimally invasive drug-eluting stents to other injuries. This in theory would lead to a faster recovery and shorter hospital stay and avoid using venous grafts with a reduced patency when compared with the new drug-eluting stents. This meta-analysis included 6 works with 1190 patients comparing hybrid revascularization versus conventional surgery. From the total 366 (30.8 %) underwent hybrid revascularization (185 in phases and 181 in the same procedure) and 824 (69.2 %) received conventional surgery (786 without cardiopulmonary bypass pump and 38 with pump). Anti-aggregation and anticoagulation schemes varied widely between different studies but none reported the use of glycoprotein inhibitors or bivalirudin.

The composite of death, myocardial infarction, stroke and repeat revascularization in the inpatient period was similar between the two strategies (1.4 % hybrid revascularization versus 2.9 % for conventional surgery, P = 0.33). If they differ in a shorter hospital stay and less time in critical areas was for the hybrid revascularization. Next year the combined end point was not different       (4.1 % versus 9.1 %, P = 0.13), however, considering each component separately, revascularization was more frequent in the hybrid group. Most repeat revascularization included both the left anterior descending artery as those treated with stents and other untreated injuries that progressed over time. 

Conclusion

In this meta-analysis of patients with multivessel coronary disease, hybrid revascularization was associated with a similar rate of death, myocardial infarction, and stroke both during hospitalization and at follow-up at one year compared with conventional surgery. There was a higher rate of repeat revascularization with the hybrid strategy and this was independent that procedure has been performed in one time or stages. 

Editorial comment

This study is the first meta-analysis on hybrid revascularization and their findings support the current recommendation of the guide (recommendation IIa / IIb level of evidence B). The biggest advantage undoubtedly is happening due to the less invasive of the technique, however the price of this could be a lower quality of mammary artery anastomosis to the left anterior descending, reason why it is suggested to test the anastomosis before starting angioplasty. Most of the defects found in the anterior mammary anastomosis / descending were asymptomatic and were observed in the context of routine follow-up angiography that was not performed in patients who received conventional surgery.

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