Invited commentary

Abstract

Di Giammarco and colleagues [1Di Giammarco G. Pano M. Giancane M. Di Francesco A. Di Mauro M. Off-pump revascularization of chronically occluded left anterior descending artery through left anterior small thoracotomy: early and late angiographic and clinical follow-up.Ann Thorac Surg. 2006; 82: 1446-1451Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar] evaluate the safety and efficacy of off-pump left internal mammary artery to an occluded left anterior descending artery through a left anterior small thoracotomy. Overall survival, freedom from cardiac death, reintervention, and major adverse cardiac event are notably good at follow-up.Although this surgical strategy has been described before, the authors address a topic that is still of immense importance in the era in which patients desire treatment by less invasive procedures. If a patient is asked what kind of procedure he prefers for his single vessel disease, he will favor catheter intervention. Re-stenoses after drug eluting stents is less compared with balloon angioplasty and bare metal stents. However, the mortality rate has not been improved and patients with chronically occluded coronary arteries represent a challenging patient population for angioplasty. In addition, published results so far do not reach the success rates of clinical outcomes after coronary artery bypass grafting. Alternative strategies featuring minimally invasive surgical access for revascularization, such as the one described here, may convince patients to choose the procedure with the best long-term results.Although there are parts in the article worthy of discussion, the article is an important contribution to the discussion of therapeutic options available to patients with occluded single vessel disease in experienced centers. Di Giammarco and colleagues [1Di Giammarco G. Pano M. Giancane M. Di Francesco A. Di Mauro M. Off-pump revascularization of chronically occluded left anterior descending artery through left anterior small thoracotomy: early and late angiographic and clinical follow-up.Ann Thorac Surg. 2006; 82: 1446-1451Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar] evaluate the safety and efficacy of off-pump left internal mammary artery to an occluded left anterior descending artery through a left anterior small thoracotomy. Overall survival, freedom from cardiac death, reintervention, and major adverse cardiac event are notably good at follow-up. Although this surgical strategy has been described before, the authors address a topic that is still of immense importance in the era in which patients desire treatment by less invasive procedures. If a patient is asked what kind of procedure he prefers for his single vessel disease, he will favor catheter intervention. Re-stenoses after drug eluting stents is less compared with balloon angioplasty and bare metal stents. However, the mortality rate has not been improved and patients with chronically occluded coronary arteries represent a challenging patient population for angioplasty. In addition, published results so far do not reach the success rates of clinical outcomes after coronary artery bypass grafting. Alternative strategies featuring minimally invasive surgical access for revascularization, such as the one described here, may convince patients to choose the procedure with the best long-term results. Although there are parts in the article worthy of discussion, the article is an important contribution to the discussion of therapeutic options available to patients with occluded single vessel disease in experienced centers. Off-Pump Revascularization of Chronically Occluded Left Anterior Descending Artery Through Left Anterior Small Thoracotomy: Early and Late Angiographic and Clinical Follow-UpThe Annals of Thoracic SurgeryVol. 82Issue 4PreviewThe aim of this retrospective study was to evaluate the safety and efficacy of left anterior small thoracotomy for treatment of isolated chronic total occlusion of the left anterior descending artery. Full-Text PDF