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What is hybrid heart bypass surgery?

Hybrid heart bypass is a procedure combining stenting techniques with either minimally invasive direct coronary artery bypass (MIDCAB) or totally endoscopic coronary bypass (TECAB). Your surgeon may recommend a hybrid heart bypass procedure if you have multiple blockages in your arteries and are not a suitable candidate to have all blockages addressed by minimally invasive surgery. These combined procedures allow your surgeon to perform heart surgery through small incisions and guide catheters, a balloon, a stent and other devices through your arteries.

Bypass surgery creates a new pathway through which blood can flow by bypassing a blocked area in your vein or artery resulting from atherosclerosis. Atherosclerosis is a hardening, narrowing, or blockage of the arteries due to widespread build-up of plaque in the arteries, commonly caused by too much cholesterol. This condition also may reduce blood flow to the heart and brain.

Peripheral artery disease (PAD), also referred to as peripheral vascular disease (PVD), may be a sign of atherosclerosis. It is a common but serious condition in which narrowed arteries and veins outside of the heart — such as those in the arms, legs, neck or near the kidneys or intestines — reduce blood flow to the limbs, most often the legs. Left untreated, PVD can lead to heart attack, stroke, high blood pressure, kidney failure, heart disease, heart failure or even amputation. 


Northwell offers a full range of the most advanced diagnostic technologies, including ultrasounds, pulse volume recording, computed tomography (CT) scans and magnetic resonance imaging (MRI). Our vascular specialists use these technologies to diagnose PVD in the arteries, such as:

  • Brachiocephalic artery (leading from the heart to the head)
  • Iliac and femoral artery (supplies the arms and legs)
  • Mesenteric artery (supplies the intestines with blood)
  • Renal artery (supplies the kidneys)


There are two types of hybrid heart bypass surgery: 

  • MIDCAB (minimally invasive direct coronary artery bypass) - MIDCAB is a less-invasive version of coronary artery bypass surgery that avoids the need for a sternotomy, or the cracking open of the sternum. It is a very good option for single-vessel LAD (left anterior descending) coronary artery disease.
  • TECAB (totally endoscopic coronary artery bypass surgery) - This minimally invasive approach uses the daVinci robot system, allowing the surgeon to use precise movements with an excellent view of the coronary arteries. Both on-pump and off-pump coronary artery bypass (OPCAB) can be performed to treat single and multivessel diseases.

How to prepare

Coronary artery bypass surgery requires an in-hospital stay of several days or longer, depending on your condition. Your doctor will explain the procedure to you and offer you the opportunity to ask any questions you might have. In addition to getting your complete medical history, your doctor may perform a complete physical examination to ensure that you are in good health before undergoing the procedure.

Notify your doctor if you:

  • Are pregnant or suspect that you are pregnant
  • Are sensitive to or allergic to any medications, iodine, latex, tape or anesthetic agents (local and general)
  • Are taking prescription or over-the-counter medications or herbal supplements
  • Are a smoker
  • Have a history of bleeding disorders or are taking any anticoagulant (blood-thinning) medications, aspirin or other medications that affect blood clotting
  • Have a pacemaker

You will be asked to fast for eight hours before the procedure, generally after midnight. Before surgery begins, you will be asked to remove any jewelry or other objects that may interfere with the procedure, and will be asked to remove your clothing and put on a hospital gown. You will also be asked to empty your bladder before surgery. 


This newer approach offers you the long-term benefits of surgery and stenting, as well as reduced stress on your body by having two procedures performed at the same time rather than on different days. Other benefits of hybrid procedures include reduced blood loss, smaller incisions, a shorter hospital stay and quicker recovery time.

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