The Hybrid portfolio of the Heart is growing. Cardiologists and Heart Surgeons bring the best of both worlds to the patient’s benefit.
What happens when interventional cardiology and cardiac surgery truly work as one? Hybrid cardiac surgery is redefining treatment strategies by combining the precision of transcatheter interventions with the durability of surgical repair. From same-stop hybrid revascularization to pioneering minimally invasive combinations, discover how this rapidly expanding field is delivering smarter, safer, and more personalized solutions for complex cardiac patients.
The term “Hybrid” delineates the joint treatment of a cardiac condition by Cardiologist AND Heart Surgeon. Hybrid therapies can be Same stop or Two-stage. Often, this combination of Transcatheter AND Surgical treatment offers the patient the best possible outcome, hence the best of both worlds, whereas a sole cardiological or heart surgical procedure may not yield the.
For the case of Hybrid Coronary revascularization, we note that while a LIMA on LAD bypass and perhaps a second artery on another culprit lesion of the left side of the heart may provide the best solution, the RCA may be best treated with a stent, which renders the best patency rate at 1 year. Hence, the combination of a Minimally invasive bypass procedure on the culprit lesion(s) and PCI on the rest, may indeed result in the best possible long-term outcome. The Hybrid procedure is not confined to Minimally invasive bypass surgery; it may as well be performed through a median sternotomy, whereby the PCI part is left for a later time.
In fact, the most common sequence for a hybrid coronary procedure is “Bypass first – PCI later” and not vice-versa. This holds the advantage that when the cardiologist is intervening a few weeks later, he has an anterolateral wall and LAD territory that is now protected by the bypass. Also, He can provide on-site quality assurance and eventually check the atrial or vein bypasses or even intervene in them, a capacity that does not exist intraoperatively during traditional bypass procedures. Unless the hybrid procedure is done same-stop, which means that Cardiologist and Heart Surgeon meet in the Hybrid operation theatre: the Heart surgeon starts with the minimally invasive bypass procedure, and when his grafts are done, the Cardiologist joins in (the patient still on Heparin) and performs the PCI. While the Heparin will be reversed by Protamine at the end of this procedure, the PCI result is still protected, due to a loading dose of Clopidogrel per mouth at the onset of the procedure, which now kicks in.
Our team not only has substantial experience with such procedures, including same stop, but also a pioneering contribution, with novel tools and stabilizers, which facilitate easier and faster execution.
Scan the QR code below to view video of a same-stop Hybrid coronary revascularization, with intraoperative quality control (Angiography) by the Cardiologist at the end.
Other forms of Hybrid procedures, usually 2-stage are:
- MIS bypass followed by TAVI
- PCI, followed by MIS Mitral valve repair
- MTEER followed by MIS CABG
Watch the Video HERE
and others, mostly to preserve a minimally invasive experience. Of note, such applications are not yet widely spread, subject to experience and Heart teamwork, and reported in literature empirically, at a level of evidence C.