What is hybrid coronary bypass?

Hybrid coronary bypass is surgery that combines minimally invasive robot-assisted bypass with coronary angioplasty and stenting. Your surgeon may recommend this surgery if you have a major blockage in the left anterior descending (LAD) coronary artery and smaller blockages in other coronary arteries. Some hospitals are equipped to provide both procedures at the same time, while others provide the procedures in two stages.

Your coronary arteries are the vessels that supply the heart muscle with blood. Bypass surgery uses a graft to create a new route for blood to flow around a narrowed or blocked coronary artery. A graft is a healthy vessel taken from other places in your body.

Coronary angioplasty widens or opens a blocked or narrowed coronary artery. Stenting involves inserting a mesh tube inside your coronary artery and expanding it to keep it open after angioplasty. Stents remain in place to keep your coronary artery open.

Hybrid coronary bypass is major surgery that has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having hybrid coronary bypass. 

Why is hybrid coronary bypass performed? 

Your surgeon may recommend this surgery if you have a major blockage in the left anterior descending (LAD) coronary artery, along with other non-LAD partial blockages. Your doctor will only consider hybrid coronary bypass if less invasive treatments are ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend hybrid coronary bypass under the following conditions: 

  • You have multi-vessel blockages with a major blockage of the LAD and partial blockages in other vessels. 
  • Your LAD blockage is graftable and the other vessel blockages are candidates for angioplasty.
  • You would benefit from a minimally invasive procedure over a traditional open-heart surgery.
  • You have not had previous heart or chest surgery, are not obese, do not have poor lung function, and are not in an emergency situation. 

Who performs hybrid coronary bypass?

A cardiac surgeon and an interventional cardiologist often work as a team to perform hybrid coronary bypass. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons. Interventional cardiologists specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging.

How is hybrid coronary bypass performed?

Your doctors will perform your hybrid coronary bypass in a hospital. The bypass portion of the surgery treats the more seriously blocked coronary artery. It involves making four or five tiny porthole incisions between your ribs. Your cardiac surgeon will use a robot and insert special instruments and a thoracoscope through these very small incisions in your chest. 

A thoracoscope is a thin, lighted instrument with a small camera. The camera sends pictures of the inside of your body to a video screen viewed by the surgeon while performing surgery. This part of the surgery involves placing a graft to create a new route for blood to flow around the narrowed or blocked coronary artery.

The coronary angioplasty and stenting portion of the surgery treats less seriously blocked or narrowed coronary arteries. It involves inserting a catheter and guide wire through an incision in your groin. The doctor feeds the catheter into the coronary artery that needs angioplasty. X-rays help guide the wire to the exact location.

Your doctor will inject a contrast agent through the catheter to help improve the quality of the X-ray images. Still using X-ray guidance, your doctor will open or widen your artery and place a stent to keep it open.

Types of anesthesia 

Your doctors will perform your hybrid coronary bypass using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain.