Krzysztof Filipiak1, Seweryn Wiechowski2, Jaroslaw Goracy2, Tomasz Hrapkowicz1, Michael O. Zembala, Jr.1, Marian Zembala1.
1Silesian Center For Heart Diseases, Zabrze, Poland, 2Pomeranian Medical University, Dept of Cardiovascular Surgery, Szczecin, Poland.
OBJECTIVE:
Minimally invasive coronary surgery for isolated left anterior descending (LAD) artery disease provides considerable benefits in terms of faster patient recovery, reduced need for blood transfusions and shorter postoperative stay when compared to conventional CABG. However limited access and indirect vision may influence LIMA patency. Therefore a single-center, randomized, prospective clinical study was designed to compare short, mid (12 months) and long term (24 months) results of two surgical techniques (Minimally Invasive Direct Coronary Artery Bypass vs. Endoscopic Atraumatic Coronary Artery Bypass) for treatment of single vessel coronary artery disease.
METHODS:
100 pts with isolated LAD disease were randomly assigned to receive MIDCAB (n=50) or EACAB (n=50). There were no significant differences in clinical characteristics between the groups, including EuroScore. Early and mid-term graft patency was evaluated by coronary angiography, performed on the 3rd postoperative day and 12 months after the procedure. Long term results were obtained using high resolution multi-slice computed tomography 24 months after the operation.
RESULTS:
There were no deaths and no incidences of perioperative myocardial ischemia in either group. Early graft patency rate was 100% in MIDCAB and 98% in EACAB (NS). One patient with occluded LIMA-LAD anastomosis had no clinical symptoms of graft failure. 1 year after the procedure graft patency rate was assessed in all pts who where enrolled into the study, and was 96% and 97,9% in MIDCAB and EACAB groups respectively (NS). Late graft patency rate was evaluated in all pts (n=100) and equaled 96% and 97.9% in MIDCAB and EACAB groups respectively (NS). All patients were on optimal medical therapy including ASA and statins.
CONCLUSIONS:
1. Both methods of minimally invasive surgical treatment of single vessel disease are equally safe and effective and should be put into practice alternatively according to particular indications. 2. MSCT is a valuable, non-invasive and cost effective tool for assessment of graft patency.
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