• Ralf E Harskamp, J Matthew Brennan, Ying Xian, Michael E Halkos, John D Puskas, Vinod H Thourani, James S Gammie, Bradley S Taylor, Robbert J de Winter, Sunghee Kim, Sean O'Brien, Eric D Peterson, and Jeffrey G Gaca.
• From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.). r.e.harskamp@gmail.com.
• Circulation. 2014 Sep 9; 130 (11): 872-9.

BackgroundHybrid coronary revascularization (HCR) involves a combination of surgical and percutaneous techniques, which in selected patients may present an alternative to conventional coronary artery bypass grafting (CABG).Methods And ResultsPatients were included who underwent HCR (staged/concurrent) or isolated CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database (July 2011 to March 2013). HCR represented 0.48% (n=950; staged=809, concurrent=141) of the total CABG volume (n=198,622) during the study period, and was performed in one-third of participating centers (n=361). Patients who underwent HCR had higher cardiovascular risk profiles in comparison with patients undergoing CABG. In comparison with CABG, median sternotomy (98.5% for CABG, 61.1% for staged HCR, and 52.5% for concurrent HCR), direct vision harvesting (98.9%, 66.0%, and 68.1%) and cardiopulmonary bypass (83.4%, 45%, and 36.9%) were less frequently used for staged and concurrent HCR, whereas robotic assistance (0.7%, 33.0%, and 30.5%) was more common. After adjustment, no differences were observed for the composite of in-hospital mortality and major morbidity (odds ratio, 0.93; 95% confidence interval, 0.75-1.16; P=0.53 for staged HCR, and odds ratio, 0.94; 95% confidence interval, 0.56-1.56; P=0.80 for concurrent HCR in comparison with CABG). There was no statistically significant association between operative mortality and either treatment group (odds ratio, 0.74; 95% confidence interval, 0.42-1.30; P=0.29 for staged HCR, and odds ratio, 2.26; 95% confidence interval, 0.99-5.17; P=0.053 for concurrent HCR in comparison with CABG).ConclusionHCR, either as a staged or concurrent procedure, is performed in one-third of US hospitals and is reserved for a highly selected patient population. Although HCR may appear to be an equally safe alternative for CABG surgery, further randomized study is warranted.© 2014 American Heart Association, Inc.

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