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International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Coronary Artery Bypass Or Percutaneous Intervention For Chronic Left Anterior Descending Artery Occlusion?
Dmitrii Zhiltsov
Specialized Clinical Cardiac Surgery Hospital of academic B.A. Korolev, Nizhny Novgorod, Russian Federation

Objective: The final target is to discover benefits of both revascularization methods, including economical parameters, and choose the most preferable way in similar clinical cases. Background: We have analyzed the studies about revascularization methods for chronic total occlusion (CTO) of left anterior descending coronary artery (LAD) which included percutaneous coronary intervention (PCI) and minimally invasive direct coronary artery bypass (MIDCAB) together in one study or separately in a few studies over the last 10 years period. The results of the research have demonstrated ambivalent data and we haven’t found any study which compares PCI with MIDCAB in a surgical treatment of LAD CTO, just only for LAD stenosis. Methods: From January 2018 to December 2019 were operated 134 patients with LAD CTO. 48 of them underwent MIDCAB: 36 (75%) males and 12 (25%) females; aged 58.7 ±8.7; 7 (14,6%) with previous diabetes; 10 (20,8%) with previous PCI of LAD with drug-eluting stent. In the PCI group there were 86 patients: 52 (60,5%) males and 34 (39,5%) females; aged 64.8 ±8.3; 23 (26,7%) with previous diabetes. Results: Hospital mortality was 0 (0%) in MIDCAB unlike 1 (1,2%) in PCI. Myocardial infarction was 0 (0%) in both the groups. In MIDCAB the number of conversions to on-pump and sternotomy was 0 (0%), there were 6 (12,5%) pleuritis with pleural puncture and 3 patients (6,2%) with long wound-aches. The hospitalization period was 10.7±2.9 days for MIDCAB and 9.9 ±3.9 days for PCI. In the PCI group 2.0 ±1.0 drug-eluting stents were used. In-hospital costs were higher for PCI 3809€ unlike 3258€ for MIDCAB. Conclusions: Both methods of revascularization for LAD CTO are very good for patients, but each of them has a lot of nuances. MIDCAB is associated with lower incidence of revascularization repeat and in-hospital mortality in the literature data and it costs lower than PCI for LAD CTO. A long-term analysis will demonstrate more objective results about quality of life, survival and freedom from re-intervention. So, our hospital has started randomized prospective clinical research about it.


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