Integrated Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Grafting and Angioplasty for Coronary Artery Revascularization

(#2001-6827 ... June 27, 2001)

Marek Cisowski,¹ Wodzimierz Morawski,¹ Janusz Drzewiecki, ² Andrzej Bochenek¹

¹Department of Cardiac Surgery, Silesian School of Medicine, Katowice, Poland
² Department of Cardiology, Silesian School of Medicine, Katowice, Poland

Presented at the Fourth Annual Scientific Meeting of the International Society for Minimally Invasive Cardiac Surgery, June 27-30, 2001, Munich, Germany.

ABSTRACT

Introduction: Minimally invasive direct coronary artery bypass through an anterolateral minithoracotomy has become a promising therapeutic option in patients (pts) with single vessel disease (especially in elderly and reoperative pts with type C or B lesions). To expand the benefits of MIDCAB concept to patients with multivessel disease, a hybrid procedure combining surgical revascularization of the left anterior descending (LAD) artery with interventional procedures for additional coronary lesions has recently been introduced.

Materials and Methods: Between April 1998 and December 2000, 35 pts (26 male, 9 female, mean age 54.8 ± 20.1 years) underwent a ÒhybridÓ revascularization. MIDCAB procedure with endoscopic left internal mammary artery (LIMA) harvesting followed by staged angioplasty and stenting of additional coronary lesions. Follow-up period was up to 28 months. Control coronary angiography was performed in all the patients.

Results: Angiographic studies showed patent LIMA-LAD graft in 35 pts (100%). We showed good quality of anastomosis in 34 pts (97.2%). There was significant stenosis of the LIMA-LAD anastomosis in one patient (2.8%) and the PTCA of the anastomosis with good result was performed. Five pts (14.3%) developed restenosis after PTCA &emdash; redo PTCA was performed successfully. The early and mid-term results were excellent in terms of all endpoints of this study.

Conclusion: The hybrid procedures are safe and effective method for complete revascularization in selected pts with multivessel coronary artery disease (pts with type C lesion in the proximal LAD). This method allows performing complete revascularization with minimization of surgical trauma.