Feasibility of Combined Percutaneous Transluminal Angioplasty and Minimally Invasive Direct Coronary Artery Bypass in Patients With Multivessel Coronary Artery Disease

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 2.79Ϯ1.05 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. (Circulation. 1998;98;1048-1050.)

Complete Versus Incomplete Revascularization With Coronary Artery Bypass Graft or Percutaneous Intervention in Stable Coronary Artery Disease

“…At least in small early-experience studies with short-term follow-up, hybrid revascularization appears feasible and safe. [41][42][43] However, an increased need for early antiplatelet therapy with the risk for bleeding complications and repeat revascularization, driven by IR and in-stent restenosis, may reduce the overall benefit. 8,44 In addition, Lichtenberg et al 45 showed that multivessel disease was an independent risk factor for adverse outcome in patients undergoing minimally invasive revascularization of the LAD using the internal thoracic artery (n=149), with, however, acceptable midterm morbidity and mortality.…”

Angioplasty-Bypass Surgery Combination Therapy

“…A recent report of 31 cases treated by combined LITA to LAD and PTCA showed the procedure to be safe and effective at least 7 months postoperatively. 6 In the present case, several conditions existed that were unfavorable to both conventional CABG and coronary stenting. Primary concerns were the patient's advanced age and hemorrahagic colon cancer.…”

Same-Day Combined Percutaneous Coronary Intervention and Coronary Artery Surgery

“…A combination of PCI and CABG to treat multivessel coronary artery disease has been reported previously [8, 9, 11]. The present pilot study sought to assess the safety and feasibility of a same-day implementation of this approach in the treatment of severe two- or three-vessel coronary artery disease.…”

“…Furthermore, the right coronary artery (RCA) is an independent predictor of early saphenous vein aortocoronary bypass occlusion [7]. A ‘hybrid’ procedure combining surgical revascularization of multivessel coronary artery disease with IMA bypass and an additional percutaneous interventional procedure is considered to be an attractive treatment option in some patients [8, 9]. The aim of the present prospective study was to evaluate the feasibility, safety and efficacy of such a hybrid procedure combining initial RCA angioplasty and surgical left coronary artery revascularization using the left and/or right IMA in the following 16 h.…”