Isolated Occlusion of Proximal LAD: a Stent or BH TECAB?
Vidadi Efendiev, MD, Sergey Alsov, MD, Alexey Arkhipov, MD, Vitaliy Baystrukov, MD, Nikita Kravchenko, MD, Alexander Chernyavskiy*, MD, Alexander Karaskov*, MD.
Academician E.N.Meshalkin State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
OBJECTIVE: In case of isolated left anterior descending artery (LAD) occlusion it is important to minimize the possible risks and perform efficient myocardial revascularization. It is still not clear which method is preferential: percutaneous coronary intervention (PCI) with stenting or totally endoscopic coronary artery bypass on beating heart (BH TECAB). The goal of this study was to compare the outcome of patients with isolated occlusion of LAD after PCI with stenting or BH TECAB using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California).
METHODS: Patients with isolated occlusion of proximal segment of LAD were randomized for PCI with stenting (n=40) and BH TECAB (n=40). They were followed-up during one to two years (average, 17 months). The first end point was the freedom from major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiac death, myocardial infarction, stroke and redo CABG or PCI of LAD. The second end points were angina class and need in antianginal medications during the follow-up period.
RESULTS: 12,5% of patients after PCI with stenting had MACCEs versus 2,5% of patients after surgical revascularization (р=0,02). Freedom from angina in case of PCI was 77,5% and 95% after BH TECAB (p=0,022). The need in antianginal therapy was significantly lower after surgery in comparison with PCI (p=0,002).
CONCLUSIONS: Beating heart TECAB showed significantly better results in outcome of patients with isolated occlusion of proximal segment of LAD during follow-up period comparing with PCI.
* shared last authorship
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