Minimal invasive direct coronary artery bypass grafting via partial inferior sternotomy
Today, treatment of single vessel coronary artery disease is primarily the realm of catheter intervention. A number of current studies compared revascularization of the left anterior descending (LAD) coronary artery by percutaneous transluminal coronary angioplasty (PTCA, with or without stent placement) with coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). The PTCA groups showed higher reintervention rates and in some studies an increased incidence of postinterventional myocardial infarctions [8-10]. Despite these observations and although the long-term results of ITA grafts are excellent [13, 14], most patients will favor the less invasive approach when given the choice between PTCA and CABG. Yet surgical revascularization of the LAD with an ITA graft can also be accomplished via a minimal invasive approach without extracorporeal circulation (ECC), using a technique called minimal invasive direct coronary artery bypass grafting (MIDCAB). This technique could fill a gap in the treatment options and may at the same time allow surgical myocardial revascularization in high-risk patients. Initial data of a current randomized study show that on 6-month follow-up, revascularization by MIDCAB compares favorably with catheter interventional stent implantation when freedom of angina pectoris (79 vs. 62%) and reintervention rates (8 vs. 29%) are used as endpoints .
KeywordsCoronary Artery Bypass Grafting Left Anterior Descend Right Coronary Artery Internal Mammary Artery Internal Thoracic Artery
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