Hybrid Revasculerisation allows surgeons to work on the three main arteries of the heart using a combination of bypass and angioplasty (stent) procedures. Using this procedure, there is no need to stop your heart and place you on a heart/lung bypass machine as there would be in a full heart bypass operation in which a bypass procedure would be used for all three arteries.
Instead, your surgeon will only bypass the artery that is easiest to get to at the front of the heart, allowing for a less invasive procedure, and would insert stents or balloons into the other two arteries running at the back of the heart.
WHAT DOES HYBRID REVASCULARISATION INVOLVE?
This surgery is performed while your heart is beating. Your surgeon will graft the left internal mammary artery (LIMA) to the left anterior descending artery (LAD), which lies on the front surface of the heart so is easy to access. Your surgeon will then insert drug-coated stents into the other two arteries to stop narrowing. Clots that form in stents in these arteries are less dangerous than in the LAD artery.
The benefits of this surgery are that scars are much smaller and there is no need to take veins from your legs.
WHY NOT PERFORM ANGIOPLASTY ON ALL THREE ARTERIES?
Grafting the LIMA artery, taken from the breast, onto the LAD artery has been proven over time to provide a longer life span than angioplasty alone. Also, inserting a stent in the LAD artery rather than doing a bypass creates a higher risk of death if the stent clots.
WHY NOT PERFORM A TRADITIONAL HEART BYPASS?
A traditional heart bypass carries extra risk as all three arteries are operated on invasively and surgeons need to stop and move the heart to get to the two arteries that lie underneath the heart. There is also risk in placing you on a heart/lung bypass machine because small showers of debris can cause small strokes that may result in memory loss and forgetfulness. Additionally, veins used to bypass the two arteries under the heart are taken from the leg and these are not as robust as the LIMA artery that is used to bypass the front artery and there is a 20% likelihood of blockage in these weaker veins within a year of the operation.
WHO SHOULD GO FOR HYBRID REVASCULARISATION?
Your cardiologist will only recommend this hybrid procedure if the more traditional heart bypass surgery or angioplasty procedures are considered too risky for you and if it is thought you could benefit from hybrid revascularisation. Discuss the benefits and risks with your cardiologist.