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 sta tistical determinant of a favorable outcome after coronary artery bypass gr afting (CABG) and can be performed with lower morbidity off pump through a minithoracotomy. PTCA and stenting of the "non-LAD" vessels compete with CA BG in terms of patency rates. Our purpose was to compare a combination of m inimally invasive direct coronary artery bypass (MIDCAB) and PTCA with doub le 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 disea se undergoing either sequential MIDCAB and PTCA (group 1) or double CABG on cardiopulmonary bypass (group 2) were compared. Angiographic control, comp lications, hospital costs, quality of life, and 2-year follow-up of ischemi a are reported. Results All bypasses were patent at early control. Three adverse events wer e 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 p ain, 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 resteno sis. 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 undert ake prospective randomized studies on a larger-scale basis.