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OBJECTIVE: To analyze the results of LAD bypass in patients with isolated lesion who have undergone MIDCAB procedure and in patients with multivessel disease using the hybrid approach.
METHODS: 85 patients were enrolled in the study: 52 of them (LAD lesion only) underwent MIDCAB LAD, and 33 patients (with multivessel disease) - hybrid revascularization (MIDCAB LAD with PCI of other coronary lesions).
Indications for surgery were hemodynamically significant stenosis or LAD occlusion, high risk of PCI or a failed prior PCI attempt, contraindications to perform sternotomy (anatomical criteria). High-grade angina, a positive stress test in asymptomatic patients. Indications for the hybrid method were the availability to perform PCI of other affected arteries and the ones mentioned above.
The average age of patients was 55,26 ± 8,5 years. Male patients (90.5%) prevailed. 55% of patients demonstrated angina FC II, 25% - FC III, 9.5% - CVA , 4.7% - diabetes. The average left ventricular ejection fraction was 48,6 ± 9,7%.
Two-vessel CAD was found in 21 patients, three-vessel CAD - in 11 patients. One patient was presented with the lesion of the left main coronary artery with three-vessel CAD.
RESULTS: All patients underwent off-pump LIMA-LAD grafting via minithoracotomy in the fifth intercostal space. There were no intraoperative complications. Blood loss was 270 ± 160 ml, postop ventilation time was 5 ± 2 hrs, ICU length of stay was 16 ± 3.9 hrs.
Good patency of the grafts were confirmed with flowmetry at the OR and then at the cath-lab (Fitz-Gibbon A). On day 1-3 PCI as a second stage of the hybrid method was performed with the further confirmation of CA patency (no complications, TIMI 3 grade flow). Average number of stents per patient was 1.36.
There were no deaths, MACCE, repeated revascularization in the in-hospital period. There were no cases of incomplete myocardial revascularization, technical difficulties and others complications in our study. The average in-hospital stay was 9 ± 1,9 days.
CONCLUSIONS: MIDCAB in isolated LAD stenosis as well as MIDCAB + PCI in multivessel disease patients have demonstrated high efficacy and safety.