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BACKGROUND:
We sought to demonstrate the safety and feasibility of treating multi-vessel coronary artery disease (CAD) patients with an integrated coronary revascularization (ICR) strategy that combines minimally-invasive LIMA to LAD bypass grafting with drug-eluting stent (DES) implantation to non-LAD lesions.
METHODS:
Over 14 months, 32 consecutive patients with multi-vessel CAD underwent thoracoscopic harvesting of the left internal mammary artery (LIMA) and grafting of the left anterior descending coronary artery (LAD). Anastomoses were constructed by hand, off-pump, and under direct vision through a 4-cm non-rib spreading, muscle-sparing chest incision. Non-LAD lesions were then treated percutaneously using sirolimus- or paclitaxil-eluting stents. Angiographic and clinical follow-up were complete in all patients.
RESULTS:
There were no 90-day mortality, myocardial infarctions, strokes, or wound complications. Twenty-seven patients underwent a LIMA to LAD bypass and 5 patients LIMA to LAD/diagonal sequential bypass for a total of 37 anastomoses. Angiographic patency scores were FitzGibbon A 94.6% (35/37) and FitzGibbon A + B 100% (37/37). A total of 42 DES (1.3 stents/patient) were implanted in 38 non-LAD coronary lesions of which 39.5% (15/38) were type B2 or C lesions, including three left main lesions. Diabetes was present in 53.1% (17/32) of patients. The target vessel revascularization rate was 9.4% (3/32) for DES implantation and 2.7% (1/32) for LIMA to LAD bypass. No patient required repeat coronary artery bypass grafting (CABG).
CONCLUSIONS:
ICR using DES is feasible and can be performed with low procedural morbidity. Sufficient data exists to support a randomized clinical trial comparing ICR with conventional CABG.