From operating room to outcome: Revisiting hybrid coronary revascularization vs. CABG in multivessel disease

Background: Hybrid coronary revascularization (HCR) has emerged as an alternative to conventional coronary artery bypass grafting (CABG) for multivessel coronary artery disease (MVCAD), combining the durability of surgical grafting with the less invasive nature of percutaneous intervention. However, its long-term safety and efficacy remain debated. Objective: To compare the incidence of major adverse cardiac and cerebrovascular events (MACCE), length of stay, and transfusion needs between HCR and CABG. Methods: We conducted a systematic review and meta-analysis of randomized and observational studies comparing HCR and CABG in MVCAD patients. Outcomes included composite MACCE, its components, length of stay (hospital and ICU), and post-operative transfusion. Subgroup and sensitivity analyses were performed to evaluate heterogeneity. Results: Thirteen studies (5 RCTs, 8 observational) involving 6,039 patients were included. Short-term MACCE rates did not differ significantly between HCR and CABG (OR = 1.14, p = 0.46), while long-term MACCE favored CABG (OR = 1.22, p ≤ 0.05). Repeat revascularization significantly contributed to the difference. HCR was associated with shorter ICU stay (mean diff = –0.48 h, p < 0.05) and lower transfusion rates (OR = 0.41, p < 0.00001). Conclusion: HCR offers advantages in recovery and perioperative outcomes, though CABG remains superior in long-term MACCE, mainly due to lower repeat revascularization. Further trials are needed to refine patient selection and procedural strategies.