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.