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J Thorac Cardiovasc Surg 2006;131:956-962
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Integrated coronary revascularization with drug-eluting stents: Immediate and seven-month outcome

Thomas A. Vassiliades, Jr, MD a , * , John S. Douglas, MD b , Douglas C. Morris, MD b , Peter C. Block, MD b , Ziyad Ghazzal, MD b , S. Tanveer Rab, MD b , Christopher U. Cates, MD b

a Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
b Division of Cardiology, Emory University School of Medicine, Atlanta, Ga.

Presented at the 31st annual meeting of the Western Thoracic Surgical Association, Victoria, British Columbia, June 22-25, 2005.

Received for publication June 28, 2005; accepted for publication October 4, 2005.

* Address for reprints: Thomas A. Vassiliades Jr, MD, The Emory Clinic Bld A, 1365A Clifton Road, NE, Suite 2100, Atlanta, GA 30322. (Email: thomas.vassiliades{at}emoryhealthcare.org).

OBJECTIVE: We sought to demonstrate the safety and feasibility of an integrated coronary revascularization strategy that combines minimally invasive left internal thoracic artery to left anterior descending coronary artery anastomosis with drug-eluting stent implantation to non-left anterior descending coronary artery lesions.

METHODS: Over 18 months, 47 consecutive patients with multivessel coronary artery disease underwent thoracoscopic harvesting of the left internal thoracic artery to graft the left anterior descending coronary artery. Anastomoses were constructed by hand, off-pump, and under direct vision through a 4-cm non–rib-spreading, muscle-sparing chest incision. Non-left anterior descending coronary artery lesions were then treated percutaneously using sirolimus- or paclitaxel-eluting stents. Angiographic follow-up was performed in all patients.

RESULTS: Within the first 90 days of hospitalizations, there were no deaths, myocardial infarctions, neurologic events, or wound complications. Forty patients underwent left internal thoracic artery to left anterior descending coronary artery grafting, and 7 patients underwent left internal thoracic artery to left anterior descending coronary artery/diagonal sequential grafting for a total of 54 anastomoses. Angiographic patency scores were FitzGibbon A 96.2% (52/54) and FitzGibbon A + B 100% (54/54). A total of 65 drug-eluting stents were implanted in 61 non-left anterior descending coronary artery coronary lesions of which 49.1% (30/61) were type B2 or C lesions, including 5 left main lesions. Diabetes was present in 53.2% of patients (25/47). At a mean follow-up time of 7.0 ± 4.8 months, the target lesion or vessel repeat revascularization rate was 6.6% (4/61) for drug-eluting stents and 1.9% (1/54) for left internal thoracic artery to left anterior descending coronary artery grafting. One anastomosis required balloon dilation, but no patients have required repeat coronary artery bypass grafting.

CONCLUSIONS: Integrated coronary revascularization using drug-eluting stents is feasible and safe. There are sufficient data to justify a randomized comparison of integrated coronary revascularization with standard coronary artery bypass grafting.

Abbreviations and Acronyms DES = drug-eluting stent; EF = ejection fraction; endoACAB = endoscopic atraumatic coronary artery bypass; ICR = integrated coronary revascularization; LAD = left anterior descending coronary artery; LITA = left internal thoracic artery; LV = left ventricular; PCI = percutaneous coronary intervention; TLVR = target lesion repeat revascularization




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