From the Divisions of Cardiology and Cardiovascular Surgery, The
University of Pittsburgh Medical Center, Presbyterian University Hospital,
Pittsburgh, Pa.
Abstract
Background—Angioplasty has become an accepted treatment of
patients with coronary artery disease and is now commonly used
to treat patients with multivessel disease. The major disadvantage of
angioplasty has been restenosis requiring repeat interventions
with resultant loss of initial cost savings. Compared with the right
and the circumflex coronary arteries, the left anterior
descending artery (LAD) has been more adversely affected by
restenosis. Recently, minimally invasive direct
coronary artery bypass (MIDCAB) to the LAD through a small left
anterior thoracotomy using the left internal mammary artery has been
performed in some centers with excellent early results and with reduced
costs compared with standard bypass
surgery.
Methods and Results—We retrospectively reviewed the first 31
consecutive patients treated in our institution with integrated
coronary revascularization (ICR): MIDCAB to
the LAD combined with PTCA of the other diseased vessels in patients
with multivessel disease. Postoperative angiography in 84% of patients
revealed a patent anastomosis and normal flow in the graft and bypassed
vessel. Thirty-eight (97%) of 39 vessels were successfully treated
percutaneously. At a mean follow-up of 7 months, all
patients are currently asymptomatic. There have been 2
adverse clinical events, both related to angioplasty and not to MIDCAB.
The average length of stay at the hospital after MIDCAB was 2.79±1.05
days.
Conclusions—These preliminary results with ICR are encouraging
and suggest that a randomized, prospective clinical trial comparing ICR
with standard coronary artery bypass surgery for the
revascularization of symptomatic
patients with multivessel disease involving the LAD is warranted.
© 1998 American Heart Association, Inc.
Brief Rapid Communication
Feasibility of Combined Percutaneous Transluminal Angioplasty and Minimally Invasive Direct Coronary Artery Bypass in Patients With Multivessel Coronary Artery Disease
Key Words: bypass • revascularization • angioplasty
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