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J Thorac Cardiovasc Surg 1997;114:434-439
© 1997 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

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

Received for publication Dec. 18, 1996; revisions requested Jan. 22, 1997; revisions received June 2, 1997; accepted for publication June 2, 1997. Address for reprints: Piet W Boonstra, MD, PhD, Thorax Center, University Hospital Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands.

Abstract

Background: Isolated stenosis of the left anterior descending coronary artery can be treated with medication, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. Recently a new treatment 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-hospital results and 1-year follow-up in 181 consecutive patients with isolated type C stenosis of the left anterior descending coronary artery between January 1995 and July 1996. Of these patients, 71 underwent minimally invasive bypass and 110 angioplasty. Preoperative characteristics were not significantly different between the two groups. Results: In-hospital death, periprocedural myocardial infarction, emergency reoperation by means of conventional coronary bypass grafting, useof an intraaortic balloon pump, and cerebrovascular accidents were not significantly different between the two groups. At 1-year follow-up, survivial was not significantly different in the two groups (minimally invasive 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 of health care resources, is significantly less with minimally invasive bypass than with angioplasty in patients with isolated type C stenosis of the left anterior descending coronary artery.

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