Comparison of minimally invasive direct coronary artery bypass and drug-eluting stents for management of isolated left anterior descending artery disease: a systematic review and meta-analysis of 7,710 patients

Raja, Shahzad G.; Uzzaman, Mohammed Mohsin; Garg, Sheena; Santhirakumaran, Gowthanan; Lee, Michelle; Soni, Monika; Khan, Habib

doi:10.21037/acs.2018.06.16

Cited by 21 publications

(18 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Controversy remains regarding the use of PCI for proximal LAD disease with multiple randomized control trials and meta-analyses demonstrating comparable rates of death, myocardial infarction and stroke in comparison to MIDCAB, but with significantly increased rate of repeat revascularization after PCI (1.5% vs 20%, P < 0.001) [ 11 , 12 , 28 ]. A recent meta-analysis pooling 7710 patients demonstrated the superiority of MIDCAB in terms of freedom from repeat intervention and decreased target vessel revascularization when compared to both first and second-generation drug-eluting stents [ 29 ]. However, the majority of studies in this analysis had a limited follow-up of only 1 year, hence the long-term durability of stents remains unproven [ 1 ].…”

Section: Commentmentioning

confidence: 99%

LIMA to LAD grafting returns patient survival to age-matched population: 20-year outcomes of MIDCAB surgery

Manuel

Fong

Betts

et al. 2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

Objectives Previous studies have demonstrated the safety and excellent short-term and mid-term survival after minimally invasive direct coronary artery bypass (MIDCAB) (1, 2). We reviewed the long-term outcomes up to twenty years, including overall survival and freedom from reintervention. Methods Consecutive patients who underwent MIDCAB between February 1997 and August 2020 were identified. Demographic details, operative information and long-term outcomes were obtained. The Australian National Death Index database was accessed to obtain long-term mortality data. Results A total of 271 patients underwent a MIDCAB procedure during the study period. There were no intraoperative deaths and only one 30-day mortality (0.4%). The mean length of follow-up was 9.82 ± 8.08 years. Overall survival at 5, 10, 15 and 20-year survival was 91.9%, 84.7%, 71.3% and 56.5% respectively. Patients with single-vessel disease (LAD only) had significantly better survival compared to patients with multivessel disease (p = 0.0035). During long-term follow-up, there were no patients who required repeat revascularisation of the LAD territory. Sixty-nine patients died with the cause of death in 15 patients (21.7%) being attributable to ischaemic heart disease. An analysis comparing the isolated LAD disease MIDCAB cohort survival with the expected survival among an age/gender/year matched sample of the Australian reference population, using the standardised mortality ratio (SMR), demonstrated that the rate of survival returned to that of the reference population (SMR= 0.94). Conclusions MIDCAB is a safe and effective revascularisation strategy which can be successfully performed in a carefully selected patient population with low morbidity, and excellent long-term results. The survival of MIDCAB patients returns to that of their age/gender/year matched counterparts within the normal population, hence should be offered as an alternative to coronary stenting when counselling patients with ischaemic heart disease.

show abstract

Section: Commentmentioning

confidence: 99%

LIMA to LAD grafting returns patient survival to age-matched population: 20-year outcomes of MIDCAB surgery

Manuel

Fong

Betts

et al. 2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…10 Studies comparing MIDCAB to PCI in single-vessel disease showed a clear benefit in terms of MACCE-free survival due to significantly lower rates of repeated target vessel revascularization. 11 Centers performing MIDCAB on a large-scale report in-hospital mortality rates ranging from 0.8 to 1.9% and a MACCE-free survival rate of 87 to 89.5%. 2,4 However, there is a lack of studies analyzing the outcome of high-risk patients undergoing MIDCAB, particularly, in the presence of MVD.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Direct Coronary Artery Bypass in High-Risk Patients with Multivessel Disease

Hoffmann

Friedrich

Huenges

et al. 2021

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Background High-risk patients with multivessel disease (MVD) including a complex stenosis of the left anterior descending coronary may not be ideal candidates for guideline compliant therapy by coronary artery bypass grafting (CABG) regarding invasiveness and perioperative complications. However, they may benefit from minimally invasive direct coronary artery bypass (MIDCAB) grafting and hybrid revascularization (HCR). Methods A logistic European system for cardiac operative risk evaluation score (logES) >10% defined high risk. In high-risk patients with MVD undergoing MIDCAB or HCR, the incidence of major adverse cardiac and cerebrovascular events (MACCEs) after 30 days and during midterm follow-up was evaluated. Results Out of 1,250 patients undergoing MIDCAB at our institution between 1998 and 2015, 78 patients (logES: 18.5%; age, 76.7 ± 8.6 years) met the inclusion criteria. During the first 30 days, mortality and rate of MACCE were 9.0%; early mortality was two-fold overestimated by logES. Complete revascularization as scheduled was finally achieved in 64 patients (82.1%). Median follow-up time reached 3.4 (1.2–6.5) years with a median survival time of 4.7 years. Survival after 1, 3, and 5 years was 77, 62, and 48%. Conclusion In high-risk patients with MVD, MIDCAB is associated with acceptable early outcome which is better than predicted by logES. Taking the high-risk profile into consideration, midterm follow-up showed satisfying results, although scheduled HCR was not realized in a relevant proportion. In selected cases of MVD, MIDCAB presents an acceptable alternative for high-risk patients.

show abstract

“…In recent years, there are many studies on CABG and PCI in patients with coronary artery disease, such as SYNTAX trial, 4,5 CARDIA trial, 6 FREEDOM trial, 7 and so forth. However, limited data are available on the study in iLAD patients, only 10 Randomized Controlled trials (RCT) compared CABG versus PCI in PLAD patients, 8,9 including two trials compared CABG versus DES. For biodegradable Stent (BDS) has not been widely used in clinical practice, the drug-eluting stent (DES) implantation is still the best PCI treatment choice.…”

Section: Introductionmentioning

confidence: 99%

Robotically assisted coronary artery bypass graft surgery versus drug‐eluting stents for patients with stable isolated proximal left anterior descending disease

Zhang

Xiao

et al. 2021

J Card Surg

View full text Add to dashboard Cite

Objective To compare the midterm outcomes of patients with isolated left anterior descending disease (iLAD) who underwent robotically assisted coronary artery bypass graft (R‐CABG) and percutaneous coronary intervention (PCI) with drug eluting stents (DES). Method Clinic data was collected in 223 patients who underwent R‐CABG in our hospital between July, 2007 to November, 2014. Cardiology Database System of our hospital was used to identify 4047 patients who underwent PCI with DES for LAD lesion between April, 2011 to November, 2014. Total 496 patients received DES and 108 patients underwent R‐CABG after screening. Patients were propensity matched into 108 R‐CABG and DES pairs according to vital statistic. Mortality, myocardial infarction (MI), stroke, repeat target lesion revascularization (r‐TLR), main adverse cardiac and cerebral events (MACCE), and angina relief were compared across pairs. Result Kaplan–Meier estimates for R‐CABG and DES had no significant difference in mortality (p = 1.00), MI (p = .32), Stroke (p = .80), and MACCE (p = .47), but the rate of r‐TLR (p = .03) were lower in R‐CABG group. Patients who underwent R‐CABG had better angina relief (p = .02), lower rate of arrhythmia (p < .001), and recurrent angina (p = .02) after operation compared patients received DES. Conclusion R‐CABG offers lower r‐TLR rate and better angina relief compared with DES for revascularization in patients with isolated proximal LAD stenosis and there was no difference in mortality, MI, stroke, and MACCE between them.

show abstract

Comparison of minimally invasive direct coronary artery bypass and drug-eluting stents for management of isolated left anterior descending artery disease: a systematic review and meta-analysis of 7,710 patients

Cited by 21 publications

References 16 publications

LIMA to LAD grafting returns patient survival to age-matched population: 20-year outcomes of MIDCAB surgery

LIMA to LAD grafting returns patient survival to age-matched population: 20-year outcomes of MIDCAB surgery

Minimally Invasive Direct Coronary Artery Bypass in High-Risk Patients with Multivessel Disease

Robotically assisted coronary artery bypass graft surgery versus drug‐eluting stents for patients with stable isolated proximal left anterior descending disease

Contact Info

Product

Resources

About