Combination of minimally invasive coronary bypass and percutaneous transluminal coronary angioplasty in the treatment of double-vessel coronary disease: Two-year follow-up of a new hybrid procedure compared with "on-pump" double bypass grafting.
OBJECTIVE
Percutaneous transluminal coronary angioplasty (PTCA) or surgery can be chosen as first-line therapies in multiple-vessel coronary disease. A mammary-to-left anterior descending (LAD) graft is the most important statistical determinant of a favorable outcome after coronary artery bypass grafting (CABG) and can be performed with lower morbidity off pump through a minithoracotomy. PTCA and stenting of the "non-LAD" vessels compete with CABG in terms of patency rates. Our purpose was to compare a combination of minimally invasive direct coronary artery bypass (MIDCAB) and PTCA with double CABG as a treatment for double-vessel coronary artery disease involving the proximal LAD.


METHODS
Two matched groups of 20 patients with double-vessel coronary disease undergoing either sequential MIDCAB and PTCA (group 1) or double CABG on cardiopulmonary bypass (group 2) were compared. Angiographic control, complications, hospital costs, quality of life, and 2-year follow-up of ischemia are reported.


RESULTS
All bypasses were patent at early control. Three adverse events were noted in group 1 and 17 in group 2. The hybrid-procedure group exhibited a shorter intensive care unit stay, fewer blood products transfused, less pain, better early quality of life, faster return to work, and similar cost. Three patients required a second PTCA in group 1, one of which for restenosis. At 2 years all the patients are asymptomatic with no residual ischemia.


CONCLUSIONS
We conclude from this pilot study that the hybrid procedure is feasible and appears to be a safe therapy for double-vessel coronary artery disease and that it appears to generate less perioperative morbidity than classic double CABG does. Therefore we believe that there is room to undertake prospective randomized studies on a larger-scale basis.
de Cannière
D
D
Departments of Cardiac Surgery, Anesthesiology, and Invasive Cardiology, Erasme University Hospital, Brussels, Belgium. ddc@skynet.be
Jansens
J L
JL
Goldschmidt-Clermont
P
P
Barvais
L
L
Decroly
P
P
Stoupel
E
E
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002315:Cardiopulmonary Bypass; D003131:Combined Modality Therapy; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010865:Pilot Projects; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome