Because most hospitals lack a hybrid operating room, staged procedures are usually performed. With the staged procedure, CABG before PCI is preferred, because this approach allows the interventional cardiologist to 1) verify the patency of the LIMA-to-LAD artery graft before attempting PCI of other vessels and 2) minimize the risk of perioperative bleeding that would occur if CABG were performed after PCI (ie, while the patient is receiving DAPT). Because minimally invasive CABG may be associated with lower graft patency rates compared with CABG performed through a midline sternotomy, it seems prudent to angio- graphically image all grafts performed through a minimally invasive approach to confirm graft patency.510 To date, no RCTs involving hybrid coronary revascular- ization have been published. Over the past 10 years, several small, retrospective series of hybrid revascularization using minimally invasive CABG and PCI have reported low mor- tality rates (0 to 2%) and event-free survival rates of 83% to 92% at 6 to 12 months of follow-up. The few series that have compared the outcomes of hybrid coronary revascularization with standard CABG report similar outcomes at 30 days and 4. Perioperative Management 4.1. Preoperative Antiplatelet Therapy: Recommendations Class I 1. Aspirin (100 mg to 325 mg daily) should be admin- istered to CABG patients preoperatively.517 519 (Level of Evidence: B) 2. In patients referred for elective CABG, clopidogrel and ticagrelor should be discontinued for at least 5 days before surgery520 522 (Level of Evidence: B) and prasugrel for at least 7 days (Level of Evidence: C) to limit blood transfusions. 3. In patients referred for urgent CABG, clopidogrel and ticagrelor should be discontinued for at least 24 hours to reduce major bleeding complications.521,523 525 (Level of Evidence: B) 4. 