ABSTRACT 25

INTEGRATED REVASCULARIZATION (MIDCAB+PTCA) IN TWO VESSELS CORONARY DISEASE.PRELIMINARY RESULTS OF A MULTICENTRIC STUDY

A.Repossini, O.Parodi, V.Cianci, P.Sganzerla, A.Della Mea and V.Arena
Cardiovascular Department, Cliniche Gavazzeni, Bergamo, Italy

Angioplasty(PTCA) has become an accepted treatment of coronary artery disease and is commonly used in multivessels disease.The major disadvantage of PTCA is restenosis requiring repeat interventions with loss of initial cost savings. Since the left anterior descending artery (LAD) has been more affected by restenosis compared with the right and circumflex coronary arteries and LAST operation (left anterior small thoracotomy for LAD revascularization)proved to be safe and effective, we strongly supported a multicentric study for integrated revascularization.

The purpose of the study is to prospectively evaluate patients with two vessels coronary disease (LAD and RC, LAD and CFX) first treated by MIDCAB on LAD and then with PTCA with stent on the second vessel after evaluation of residual ischemia (effort perfusion scintigraphy).A second group was randomized to double PTCA with same methods. Since June 1999 23 patients were treated : 12 Last + PTCA in the first 48 h, 3 double PTCA ,2 LAST alone, 6 LAST + PTCA after two months.

RESULTS: the left internal mammary artery (LIMA) anastomosis was patent in all cases (100%).PTCA was performed in 12 pts.(52%) within the first 48 h. In two cases (8.6%) after evaluation of residual ischemia PTCA was not performed . All patients are alive without angina at a mean follow-up of 7.4 ± 0.6 months.

CONCLUSIONS : Early results demonstrate that integrated coronary revascularization is safe and effective. Long term results and cost effectiveness evaluation is running.