MINIMALLY INVASIVE CORONARY-ARTERY BYPASS-GRAFTING VERSUS CORONARY ANGIOPLASTY FOR ISOLATED TYPE-C STENOSIS OF THE LEFT ANTERIOR DESCENDINGARTERY

Background: Isolated stenosis of the left anterior descending coronary artery can be treated with medication, percutaneous transluminal coro nary angioplasty, or coronary artery bypass grafting. Recently a new t reatment has been developed, which is called minimally invasive direct coronary artery bypass grafting. This new treatment is a modification of the conventional bypass operation and is performed through a small anterolateral thoracotomy without cardiopulmonary bypass. Methods: To compare minimally invasive bypass with angioplasty, we evaluated in-h ospital results and 1-year follow-up in 181 consecutive patients with isolated type C stenosis of the left anterior descending coronary arte ry between January 1995 and July 1996. Of these patients, 71 underwent minimally invasive bypass and 110 angioplasty. Preoperative character istics were not significantly different between the two groups. Result s: In-hospital death, periprocedural myocardial infarction, emergency reoperation by means of conventional myocardial infarction, emergency reoperation by means of conventional coronary bypass grafting, use of an intraaortic balloon pump, and cerebrovascular accidents were not si gnificantly different between the two groups. At 1-year follow-up, sur vival was not significantly different in the two groups (minimally inv asive bypass 95.7% +/- 0.2% vs angioplasty 95.3% +/- 0.2%; p = 0.89), whereas freedom from repeated revascularization was significantly more common in the group undergoing minimally invasive bypass (bypass 96.9 % +/- 0.2% vs angioplasty 67.6% +/- 0.5%; p < 0.001). This study shows that the need for repeated revascularization, and therefore the use o f health care resources, is significantly less with minimally invasive bypass than with angioplasty in patients with isolated type C stenosi s of the left anterior descending coronary artery.