Abstract：
Myocardial revascularization in coronary artery disease via percutaneous coronary intervention or coronary artery bypass graft (CABG) surgery effectively relieves symptoms, significantly improves prognosis and quality of life when combined with guideline-directed medical therapy. Hybrid coronary revascularization is a promising alternative to percutaneous coronary intervention or CABG in selected patients and is defined as a planned and/or intended combination of consecutive CABG surgery using at least 1 internal mammary artery to the left anterior descending (LAD), and catheter-based coronary intervention to the non-LAD vessels for the treatment of multivessel disease. The main indications for hybrid coronary revascularization are (i) to achieve complete revascularization in patients who cannot undergo conventional CABG, (ii) to treat patients with acute coronary syndromes and multivessel disease with a non-LAD vessel as the culprit lesion that needs revascularization and (iii) in highly select patients with multivessel disease with complex LAD lesions and simple percutaneous coronary intervention targets for all other vessels. Hybrid coronary revascularization patients receive a left internal mammary artery graft to the LAD artery through a minimal incision along with percutaneous coronary intervention to the remaining diseased coronary vessels using latest generation drug-eluting stents. A collaborative environment with a dedicated heart team is the optimal platform to perform such interventions, which aim to improve the quality and outcome of myocardial revascularization. This position paper analyses the rationale of hybrid coronary revascularization and the currently available evidence on the various techniques and delves into the sequence of the interventions and pharmacological management during and after the procedure.
摘要：
通过经皮冠状动脉介入治疗或冠状动脉旁路移植术（CABG）手术治疗冠状动脉疾病的心肌血运重建可有效缓解症状，与指南指导的药物治疗相结合,可显著改善预后和生活质量.在选定的患者中，混合冠状动脉血运重建是经皮冠状动脉介入治疗或CABG的有希望的替代方法，被定义为计划和/或预期的连续CABG手术组合，使用至少一条乳内动脉至左前降支（LAD）。基于导管的非LAD血管冠状动脉介入治疗多支血管疾病。混合冠状动脉血运重建的主要适应症是（i）在不能进行常规CABG的患者中实现完全血运重建，（ii）治疗急性冠状动脉综合征和多支血管疾病的患者，其中非LAD血管作为需要进行血运重建的罪魁祸首；（iii）高度选择多支血管疾病的患者，具有复杂的LAD病变和所有其他血管的简单经皮冠状动脉介入治疗目标。混合冠状动脉血运重建患者通过最小切口接受左乳内动脉移植到LAD动脉，并使用最新一代的药物洗脱支架对剩余的患病冠状动脉进行经皮冠状动脉介入治疗。拥有专门的心脏团队的协作环境是执行此类干预措施的最佳平台，旨在提高心肌血运重建的质量和预后。这篇立场论文分析了混合冠状动脉血运重建的基本原理以及目前有关各种技术的可用证据，并深入研究了手术期间和之后的干预措施和药物管理的顺序。
