PURPOSE: Minimally invasive coronary surgery(MICS) for the treatment of isolated left anterior descending artery(LAD) disease with LITA provides incremental benefits especially in terms of fastest recovery, reduced need for blood transfusions and improved aesthetics when compared to conventional CABG. Nevertheless, the potential influence of total occlusion of the LAD on the outcome and patency rate in MICS has not been investigated yet.
METHODS: From 1999 to 2004, MICS was performed in 113 patients: MIDCAB(minimally invasive direct CABG) was used in 42 patients(37.1%) of our series, while a thoracoscopic LITA harvesting along with an EACAB(endoscopic atraumatic CABG) was adopted in 71 patients(62.8%). Fifty-three patients(47%) had totally occluded LAD according to the pre-operative angiography: 16 pts.(38%) in MIDCAB group and 37 pts.(52.1%) in EACAB group. During the early post-operative period(0-3 days), angiography was performed in the first 100 patients of this series; among this group there were 42 pts. with pre-operative evidence of occluded LAD.
RESULTS: Overall grafts patency rate was 96.8%, albeit patients with occluded LAD showed a patency rate of 92.8% versus 100% in patients without occluded LAD (p<0.001). Among patients with occluded LAD, the surgical technique adopted(i.e. MIDCAB or EACAB) did not influence the graft patency (MIDCAB group=13/14 pts., 92.8% versus EACAB group=26/28 pts., 92.8% ; p=NS). No peri-operative myocardial infarctions and deaths were observed. Following angiography, 2 pts.(2/100, 2%) underwent PTCA and 1 pt.(1/100, 1%) underwent surgical revision of the anastomosis .
CONCLUSION: MICS can be safely performed either with a MIDCAB or EACAB approach. Preoperative evidence of totally occluded LAD can affect the early graft patency rate and the need of reinterventions, despite the peri-operative clinical outcome is similar to patients without occluded LAD.
CLINICAL IMPLICATIONS: A long-term follow-up is warranted in order to further investigate the late outcome and graft patency rate in this specific subset of patients.
DISCLOSURE: Tomasz Hrapkowicz, None.