Myocardial perfusion imaging evidence of functionally complete revascularization by minimally invasive direct coronary artery bypass in 2-vessel coronary artery disease

Abstract

Whether patency of a second diseased vessel still impacts myocardial perfusion when complete revascularization of the left anterior descending coronary artery (LAD) territory has been achieved is currently undetermined. In patients with 2-vessel coronary artery disease and complex LAD lesions, we evaluated the impact of single LAD or integrated revascularization on single photon emission computed tomography-assessed reversible myocardial ischemia. Thirty-five candidates for revascularization with double-vessel disease including the LAD and a preoperative stress single photon emission computed tomography study were studied. Revascularization was performed by minimally invasive direct coronary artery bypass (MIDCAB) alone (n = 15) or by an integrated procedure with second-vessel angioplasty, either soon after surgery (n = 13) or at 2 months (n = 7), according to the extent of reversible perfusion defects in the second vessel territory. At 1 year, the total ischemic area decreased from 9.3 +/- 5.1 to 0.8 +/- 1.5 in MIDCAB-only patients and from 8.2 +/- 4.9 to 1.6 +/- 2.9 in the integrated group (P = .87 for treatment and P < .001 for time). The ischemic area in the second vessel territory similarly decreased in both groups (P = .81 for treatment and P < .001 for time). In 2-vessel coronary artery disease involving the LAD, MIDCAB alone achieves, in a substantial proportion of patients, functionally complete revascularization even in the nonrevascularized second vessel territory.