A nationwide survey on perception, experience, and expectations of hybrid coronary revascularization among top-ranked US hospitals Ralf E. Harskamp, MD, a,f Michael E. Halkos, MD, MS, b Ying Xian, MD, PhD, a Molly A. Szerlip, MD, c Robert S. Poston, MD, d Stephanie L. Mick, MD, e Renato D. Lopes, MD, PhD, a Jan G. Tijssen, PhD, f Robbert J. de Winter, MD, PhD, f and Eric D. Peterson, MD, MPH a Durham, NC; Atlanta, GA; Plano, TX; Tucson, AZ; Cleveland, OH; and Amsterdam, The Netherlands Background Hybrid coronary revascularization (HCR) combines a surgical and percutaneous approach for treatment of multivessel coronary artery disease. Methods A survey was conducted among 200 cardiologists and cardiac surgeons from 100 top-ranked US hospitals. Questions were asked involving the perception, experience, and future expectations of HCR. Results Of physicians invited to the survey, 90 completed the survey (45.5%). Relative to nonresponders, responders were more often affiliated with an academic institution (80.0% vs 61.8%, P = .005), with higher patient volumes, and with the availability of a hybrid operating room (90.0% vs 67.3%, P b .001). Survey responders felt that HCR should be considered in an older and relatively healthy patient population without complex lesions. Cardiac surgeons were more favorable to use HCR in patients with chronic lung disease (42.0% vs 10.0%, P b .001) or renal failure (28.0% vs 15.0%, P = .06). Among responders with HCR experience (n = 54), 94% reported good to excellent results, and the learning curve differed depending on the surgical technique used. Inappropriate patient selection (41.2%) was the most common cause for complications. Three- quarter of responders believe that the future role for HCR will expand in the next decade. Important determinants of greater HCR use in the future were collaborative associations between cardiac surgeons and cardiologists (86.7%), appropriate patient selection (67.8%), and the outcomes of ongoing clinical trials (57.8%). Conclusion In this nationwide survey, cardiologists and cardiac surgeons felt that HCR is a reasonable alternative technique for coronary revascularization among suitable patients. Most felt that use of HCR would increase in the next decade. (Am Heart J 2015;0:1-7.e6.) Hybrid coronary revascularization (HCR) is a combined strategy of percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in the treatment of multivessel coronary artery disease. 1 The most common approach is when the left anterior descending (LAD) coronary artery is revascularized with a left internal mammary artery (LIMA) graft and ≥1 non-LAD vessels are revascularized with PCI. These procedures can be performed concurrently (in 1 setting) in a hybrid operating room or as a staged approach. HCR is in evolution, and current revascularization guidelines suggest its use as an alternative to conventional revascularization strategies in highly selected patient populations. 2,3 The rationale for HCR over CABG is that the morbidity of traditional CABG, including sternal wound complications, sequelae of cardiopulmonary bypass, aortic clamping, neurological complications, and the failure rate of saphenous vein grafts can be avoided. The rationale for HCR over multivessel PCI is the use of a LIMA-to-LAD graft, which is thought to provide better long-term outcomes due to its superior durability compared with percutaneous LAD intervention. 4-6 We conducted a survey to evaluate the attitudes, experiences, and expectations among cardiac surgeons and interventional cardiologists in top-ranked US hospitals and to compare the differences between physicians practicing at HCR and non–HCR-performing centers and differences between cardiac surgeons and interventional cardiologists. From the a Duke Clinical Research Institute, Durham, NC, b Emory University, Atlanta, GA, c The Heart Hospital Baylor, Plano, TX, d University of Arizona Medical Center, Tucson, AZ, e Cleveland Clinic, Cleveland, OH, and f Academic Medical Center–University of Amsterdam, Amsterdam, The Netherlands. David P. Faxon, MD, served as guest editor for this article. Submitted October 11, 2014; accepted January 4, 2015. Reprint requests: Ralf E. Harskamp, MD, Duke Clinical Research Institute, 2400 Pratt St, NC 27705, Durham, NC. E-mail: r.e.harskamp@gmail.com 0002-8703 © 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ahj.2015.01.003