The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart. Single-vessel disease of the left anterior descending (LAD) coronary artery may be surgically revascularized by grafting to the left internal mammary artery (LIMA). This is considered the “gold standard” (best survival rate) graft in Coronary Artery Bypass Graft Surgery.
Most surgeons consider using minimally invasive CABG in patients with isolated proximal left anterior descending (LAD) coronary artery disease and occasionally with LAD and proximal right coronary artery disease.
Large observational studies have shown that the use of an internal mammary artery graft to the left anterior descending (LAD) coronary artery improves survival and reduces the incidence of late myocardial infarction (heart attack), recurrent angina (chest pain), and the need for further cardiac interventions.
A minimally invasive approach to this procedure is associated with a lower incidence of postoperative complications (approximately 2 percent), lower reintervention rates (2.9 percent), a reduced risk of stroke, overall better long-term outcomes and lower mortality rates (2 percent) than conventional surgery.
*Based on an observational study of 274 patients
Bilateral Internal Mammary Artery Grafting (BIMA)
Most patients require grafting of the three main native coronary arteries. For the last 15 years, the "standard" operation has
achieved this using a single internal mammary artery and supplemental vein grafts performed with cardiopulmonary bypass. Although this procedure achieves excellent short and medium term outcome, and over 70 percent of patients are alive 12 years after surgery, the long term results are limited by progressive vein graft failure.
A bilateral internal mammary artery (BIMA) graft approach is superior over single internal mammary artery grafting in select
populations. Although more research is necessary, three recent studies suggest BIMA are favorable, and appear to have significant survival advantages in a wide range of aged patients. In a study published in 1999 by the Cleveland clinic group they reported better survival and reintervention–free survival after 10 years when BIMA was used.
- BIMA surgery is considered highly compatible, if not preferred, to be performed in a minimally invasive manner.
- It is particularly beneficial for elderly and diabetic patients and enhances their survival
Hybrid Surgery is a state-of-the-art procedure, combining the use of stents (angioplasty) with minimally invasive robotic surgery (LIMA to LAD MIDCAB)
- Superior outcomes at 18 months follow-up
- Combines the survival benefit of the LIMA to LAD graft and the less invasive nature of percutaneous coronary intervention (PCI)
- The hybrid procedure requires a slightly longer operative time, but results in a shorter intensive care stay and shorter in-hospital stay. There is typically also less chest tube drainage and blood loss. At a follow-up of 18 months, patients who underwent hybrid procedures saw greater freedom from major adverse cardiac or stroke-related events.