MINIMALLY INVASIVE CORONARY-ARTERY BYPASS-GRAFTING DECREASES HOSPITALSTAY AND COST

Objective The authors performed a retrospective cost analysis for pati ents undergoing revascularization of their left anterior descending (L AD) coronary artery either by standard coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), or min imally invasive coronary artery bypass grafting (MICABG). Summary Back ground Data Minimally invasive CABG has become a safe and effective al ternative treatment for single-vessel coronary artery disease. However , the acceptance of this procedure as a routine alternative for the tr eatment of coronary artery disease will depend on both long-term graft patency rates as well as a competitive market cost. Methods The autho rs conducted a retrospective analysis of three patient groups undergoi ng LAD coronary revascularization from January 1995 to July 1996. Ten patients were selected randomly from this period after PTCA of an LAD lesion with or without stenting. Nine patients underwent standard CABG on cardiopulmonary bypass with a left internal mammary artery. Nine p atients received MICABG via a limited left anterior thoracotomy and le ft internal mammary artery to LAD grafting without the use of cardiopu lmonary bypass. Results Percutaneous transluminal coronary angioplasty (n = IO) was unsuccessful in two patients. One patient in the MICABG group (n = 9) was converted successfully to conventional CABG because of an intramyocardial LAD and dilated left ventricle. There was no ope rative morbidity or mortality in any group. Average length of stay pos tprocedure was decreased significantly for both the MICABG and PTCA gr oups when compared with that of conventional CABG (n = 9) (2.7 + 0.26, p = 0.009, and 2.6 + 0.54, p = 0.006, vs. 4.8 + 0.46, respectively). Total hospital costs for the MICABG and PTCA groups were significantly less when compared with those of standard CABG ($10,129 + 1104, p = 0 .0028, and $9113 + 3,039, p = 0.0001, vs. $17,816 + 1 043, respectivel y). There were no statistically significant differences between the MI CABG and PTCA groups. Conclusions The final role of minimally invasive CABG is unclear. This procedure is clearly cost effective when compar ed with that of PTCA and conventional CABG. The long-term patency rate s for MICABG, will determine its overall efficacy.