title: 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.
  
  
  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.
authors.affiliation: From the Divisions of Cardiology and Cardiovascular Surgery, The University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA 15213, USA. cohenha@msx.upmc.edu
authors.forename: H A
authors.initials: HA
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Zenati
authors.forename: A J
authors.initials: AJ
authors.lastname: Smith
authors.forename: J S
authors.initials: JS
authors.lastname: Lee
authors.forename: S
authors.initials: S
authors.lastname: Chough
authors.forename: Z
authors.initials: Z
authors.lastname: Jafar
authors.forename: P
authors.initials: P
authors.lastname: Counihan
authors.forename: M
authors.initials: M
authors.lastname: Izzo
authors.forename: J E
authors.initials: JE
authors.lastname: Burchenal
authors.forename: A M
authors.initials: AM
authors.lastname: Feldman
authors.forename: B
authors.initials: B
authors.lastname: Griffith
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery* / Q000628:therapy*; D003331:Coronary Vessels; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome