What is the optimal revascularization technique for isolated disease of the left anterior descending artery: minimally invasive direct coronary artery bypass or percutaneous coronary intervention?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, ‘What is the optimal revascularization technique for isolated disease of the left anterior descending artery (LAD) in terms of patient survival, morbidity such as myocardial infarction (MI) and need for repeat target vessel revascularization: minimally invasive direct coronary artery bypass graft (MIDCAB) or percutaneous coronary intervention (PCI)?’ Altogether 504 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. Outcome parameters that were used in the assessment include the incidence of major adverse cardiovascular or cerebral events (MACCEs), mortality and the rate of repeat target vessel revascularization. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. One meta-analysis showed no significant difference in terms of individual incidences of MI, stroke or mortality, but when considered as a composite MACCE outcome, this was found to be significantly lower in the MIDCAB group. Moreover, further meta-analytical data have revealed a 5-fold increase in the need for repeat revascularization with PCI, with some centres reporting rates of up to 34%. However, retrospective data have shown that average length of hospital stay was longer in the MIDCAB group (7.4 ±...
Source: Interactive CardioVascular and Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Adult Cardiac Source Type: research