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Optimizing Revascularization of Complex, Proximal Left Anterior
Descending Coronary Stenoses: The Clinical and Financial Impacts
of Catheter-Based, Median Sternotomy, and Port-Access Approaches
(#2001-93224 ... October 19, 2001)
Daniel R. Watson, MD, Janice A. Taylor, MS
Riverside Methodist Hospital, Columbus, OH
INTRODUCTION
As technology advances and the general population of the
world ages, there is a pronounced increase in the call for more
efficient and less invasive coronary artery bypass grafting
(CABG) procedures. Considering the significant role that
managed health care organizations play in the financial aspect
of medicine, more emphasis is also placed on the cost effectiveness
of coronary artery therapy. Within this realm of interventional
medicine, type C stenoses of the left anterior
descending (LAD) coronary artery present a particular dilemma
with regard to therapeutic options. Whether catheterbased,
median sternotomy, or port-access approaches are
appropriate to restore the LAD to its previous level of functioning
is continuously debated: treatment by one method
may result in re-intervention by another. Depending on the
balance of the patient's and the surgeon's perspectives, it is
necessary to prioritize a myriad of factors not limited to shortterm
and long-term outcome, cost, pain, and quality of life.
Comparing qualitative outcomes to quantitative outcomes
becomes exceedingly important when one considers that the
average age of patients undergoing cardiac surgery is steadily
increasing. This retrospective study evaluates the clinical and
financial consequences of the approaches available at a community
hospital to complete revascularization of single LAD
lesions, and focuses on where improvements can be made.
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