A Retrospective Analysis Of over 25 Years Single Institution Data Of Hybrid Coronary Artery Revascularization

BACKGROUND: Endoscopic atraumatic coronary artery bypass surgery (EndoACAB) is a relative new procedure performed in specialist centers. In our institution, this technique is often combined with percutaneous coronary intervention as part of a "hybrid" coronary revascularization approach to achieve complete revascularization for multivessel coronary artery disease. Here, we report our institution results of hybrid coronary revascularization.
METHODS: Retrospective review of single center cardiac surgery database over a period of 25 years and 6 months. Patient characteristics, post-operative complications and in hospital mortality are reported.
RESULTS: Between January 2000 to July 2025, a total of 1197 patients underwent Endoacab in our institution, in 484 of the cases (40.4%) in combination with PCI to non-LAD lesions to achieve complete revascularization. Within the hybrid group, 20.04% of the patients (n=97) underwent a “reverse hybrid” procedure, with PCI performed acutely to the culprit lesion followed by EndoACAB with a LIMA to LAD at a later date. In 295 patients (60.95%) 1 vessel was treated with PCI, in 189 patients 2 or more vessels were treated (39.05%).

In our series, there were 3.01% conversions to sternotomy(n=36), 3 procedure was abandoned and PCI was performed instead. Hospital mortality was 0.69% (n=8/1197) in a group of high risk patients. The most common complication was atrial fibrillation experienced by 10.60% of the patients (n=127/1197). 2.26% presented acute kidney injury (n=27/1197),  1.25% of the patients had significant wound infections (n= 15), all of this in female with high BMI and diabetes. In 0.75% (n=9) of the cases Lima to LAD anastomosis required required PCI for occlusion or irregularities. We had one case of emergency sternotomy during PCI as second part of  complete revascularization.
CONCLUSIONS: We demonstrated that hybrid coronary revascularization can effectively treat multivessels coronary disease with results from a large series. Mortality cases occurred in high risk cases subgroup.