<International Circulation>: The one-stop hybrid procedure is a new branch of minimally invasive cardiac surgery with encouraging prospects. Could you introduce one-stop hybrid technology for us and how it fits into the current operating theatre and its potential for the future?

    Prof.Turina: There are two ways of doing hybrid procedures. One is to perform it simultaneously with coronary revascularization and interventional procedures. This requires an expensive operating room which has both two-arm angiography equipment and a fully equipped cardiac surgical suite. The other is the “poor man’s” procedure whereby coronary artery bypass grafting is performed first and once the patient has been stabilized， after a few hours to a couple of days， the patient is taken to the cardiac suite for additional stenting of the minor vessels. The latter technique never really took off because of its complexity and also the fact that once you had opened the chest and approached the heart， why leave diseased vessels for later treatment? There is the risk of events occurring between procedures. For example， the patient may experience a bout of high blood pressure and experience an infarct in the vessel which was not bypassed. There is definitely a place though for the former newer procedure as there are areas of the heart which are more difficult to approach such as the posterior wall， and arteries where the patency of the coronary bypass grafts is less optimal， such as in the moderately diseased main right coronary artery (instead of posterior descending)， or in the circumflex area. However， this procedure is only available to those who can afford it.

    <International Circulation>: The procedure is still in its initial stages and not yet perfected. What is the current state of play in terms of research and clinical work?

    Prof. Turina:The people who introduced the concept ten or so years ago are still working on it. On an international scale it has never really taken off and lived up to expectations. It is impossible to say to what degree it might replace conventional coronary artery bypass grafting so we are all closely watching the results and progress of the people who are performing these procedures to see if it can outperform conventional coronary bypass grafting. So there is work being done in the Cleveland Clinic in the US， some centers in the UK and Germany and some have been doing so for a long time， but currently nobody has produced convincing research results.

    <International Circulation>: one-stop hybrid technology requires greater demands on the cardiothoracic surgeon. What are the challenges facing surgeons?

    Prof. Turina: The overall challenge is to perform coronary artery bypass grafting with a minimally invasive procedure. Minimally invasive means a small left anterior thoracotomy or， no thoracotomy at all and using robots and endoscopy. Robots have not fulfilled their promise in cardiac surgery. Minimal invasive procedures using a small anterior thoracotomy， limit the surgeon to the left anterior descending coronary artery. There is a place， if you want to make a very small incision， to use endoscopic takedown of the left internal mammary artery and leave the rest of the field to the cardiologists. If it has advantages remains to be seen.