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Hybrid coronary revascularization The right procedure for the right patient

Supporting your choice of surgical therapies for your patients with coronary artery disease (CAD).

Hybrid Coronary Revascularization Combines MICS CABG and PCI

Hybrid Coronary Revascularization (HCR) is a treatment plan that combines MICS CABG and Percutaneous Coronary Intervention (PCI). Partnering in either a staged or simultaneous approach, the cardiac surgeon performs the LIMA to LAD anastomosis (MICS CABG) and the interventional cardiologist stents the non-LAD territories. The procedure can be performed as a:

  • Staged PCI before MICS CABG
  • Staged MICS CABG before PCI
  • Simultaneous MICS CABG/PCI in a hybrid OR

Clinical Benefits

HCR may be an option for patients who ask for a less invasive cardiac therapy. It combines the durability of coronary artery bypass surgery (CABG with LIMA) to the critical LAD territory with the minimal invasiveness of PCI to non-LAD targets. Its advantages include:

  • Avoidance of aortic manipulation and CPB
  • LIMA to LAD survival advantage and durability1
  • SVG and DES appear comparable in non-LAD target revascularization2
  • Better cosmesis
  • Shorter hospital stay3

Benefits of a Hybrid Operating Room for HCR

The many benefits to clinicians who work together as a heart team to perform HCR, include:

  • Offers a single-stage HCR procedure
  • Enables cardiac surgeons, interventional cardiologists, anesthesiologists, nursing, and perfusionists to work as a team on a single table
  • Includes a percutaneous catheter-based approach
  • Allows for immediate evaluation of the treatment via completion angiogram
  • Optimizes surgical/interventional results with reduced trauma in a parallel setup

Patient Selection Criteria

Many patients may benefit from HCR. Consider the following criteria when deciding if your patients are eligible for the procedure.

Inclusion Criteria4

  • Young patients or those over 70 with comorbidities
  • Prior CVA
  • Calcified aorta
  • Renal dysfunction
  • Diabetes
  • PVD (may be performed via radial artery)
  • Disabled or deconditioned patients
  • Patients at high risk for conventional surgery

Good Candidates for HCR4

  • Ostial, complex or occluded LAD lesion with simple lesions of other coronary arteries.
  • Elderly patients with left main disease with low Syntax score
  • Overweight or diabetic patients
  • Comorbidities making sternotomy high risk
  • Younger patients with life expectancy over 10 years and who are not complete PCI candidates
  • Patients who require redo revascularization for multivessel disease and the LIMA is not utilized for the LAD

OUR Technologies ENABLE Direct Visualization

More than 20 years ago, when we introduced the Octopus™ tissue stabilizers for OPCAB, it changed the way cardiac surgeons could perform beating heart surgeries. For the first time, epicardial tissue could be stabilized using vacuum-assisted technology to complete anastomoses. Today, tissue stabilizers are seen as standard for beating heart therapies. The Octopus Nuvo tissue stabilizer, Starfish™ NS heart positioner, and ThoraTrak™ MICS retractor system are the technologies available from Medtronic to help you perform your HCR procedures.

Placement of Devices for HCR

The Medtronic Octopus Nuvo Tissue Stabilizer

New Ways of Working Together

Hybrid Coronary Revascularization (HCR) procedures are becoming more mainstream today. As the patient population changes, so do the demands on you, the cardiac surgeon. That’s why Medtronic is committed to supporting HCR. Together — with your skilled knowledge and our enabling technologies —  we can deliver the right therapies for each individual patient with coronary artery disease (CAD).

Learn new beating heart skills and gain hands-on experience with technologies that may be new to you. We offer a full range of training programs. Contact us to learn more.


Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 1985; Jan 2;Vol. 314 (1), pp.1-6.


Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary artery bypass grafting for severe coronary artery disease. New Eng J Med. 2009;360:961-972.


Poston RS, Trans R, Collins M, et al. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg. 2008;248:638-646.


Kiaii B, Teefy P, Sridhar K, Chu M. London Health Sciences Centre Hybrid Coronary Revascularization Technique Guide. April 2014.


Not all patients are candidates for beating heart procedures. Some patients would require cardiopulmonary support during surgery. 

See the device manual for detailed information regarding the instructions for use, the implant procedure, indications, contraindications, warnings, precautions, and potential adverse events.

For further information, contact your local Medtronic representative and/or consult the Medtronic website at www.medtronic.eu. For applicable products, consult instructions for use on manuals.medtronic.com. Manuals can be viewed using a current version of any major internet browser. For best results, use Adobe Acrobat® Reader with the browser.