STAGED MINIMALLY INVASIVE DIRECT CORONARY-ARTERY BYPASS AND PERCUTANEOUS ANGIOPLASTY FOR MULTIVESSEL CORONARY-ARTERY DISEASE

Objective: Minimally invasive direct coronary artery bypass (MIDCAB) u sing the left internal mammary artery (IMA) to the left anterior desce nding (LAD) coronary artery can be performed with low operative risk. MIDCAB can be combined with percutaneous transluminal coronary angiopl asty (PTCA) to treat patients with multivessel disease. We report here our experience with staged MIDCAB and PTCA in the management of a sel ected group of patients. Methods and results: 11 patients (9 males, me an age 64.6+/-8.7 years) with multivessel coronary artery disease rece ived left IMA grafts to the LAD using the MIDCAB approach. There were no postoperative morbidity or mortality. All patients were extubated w ithin 4 h of leaving the operating room with a mean ITU stay of 12.8 h . All patients but two underwent coronary angioplasty during the same hospital admission, 3.8+/-1.3 days after the MIDCAB procedure. Angiogr aphy confirmed IMA grafts patency in all patients, and complete revasu larisation by PTCA of other coronary arteries was possible in all pati ents but one. Mean hospital stay was 5.9 days, and all patients remain free of angina at a mean follow-up period of 11.4 months. Conclusions : Staged MIDCAB and angioplasty is an experimental approach for the ma nagement of selected patients with multi-vessel coronary artery diseas e. Further experience is needed to clarify patient selection and the l ong-term outcome of this approach. (C) 1997 Elsevier Science Ireland L td.