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.