Discussion
Coronary artery bypass grafting (CABG), mainly utilizing multi-arterial
conduits, is the best therapeutic strategy for patients with diabetes
and multivessel CAD. The use of LIMA as a graft to the LAD has been
shown to have excellent long-term results in terms of patency,
event-free survival, and relief of angina in patients undergoing
coronary revascularization. On the other hand, the disadvantages of CABG
are epitomized by the invasiveness of the sternotomy, the use of
cardiopulmonary bypass, and other frequent complications (bleeding,
atrial fibrillation, and stroke) that results in prolonged
hospitalization4,5.
As a result, the search towards more minimally invasive CABG techniques
has known a long history. Total endoscopic approach with
robotically-assisted harvesting of the internal mammary artery and
anastomosing to the LAD on beating heart through a mini-thoracotomy is a
well-known approach in expert centers. The main benefits of RE-MIDCAB
are related to the reduction of typical complications of surgery while
increasing patient satisfaction paired with excellent long-term graft
patency6. If the advantages of using multi-arterial
conduits are well known, the use of saphenous vein grafts (SVGs) has
shown a high incidence of failure compared to ischemia-driven
multivessel PCI. PCI is less invasive and offers a reduced risk of
immediate complications coupled with a lessening of the length of
stay7.
In the field of interventional cardiology, R-PCI is a novel and emerging
approach. The interventional cardiologist can perform PCI using controls
for rotational and longitudinal movements of the coronary guidewire,
guide catheter, and for advancement and retraction of balloons and
stents (Video4) . Several studies have corroborated the safety
and efficacy of R-PCI for the treatment of simple and complex lesions
(CORA-PCI study)8.