1 . 2018

Early and late results of no-touch aorta multivessel minimally invasive coronary artery bypass grafting: a propensity score-matched study

Aliaksandr А. Ziankou

Abstract

The invasiveness of coronary artery bypass grafting remains considerable and has not decreased over 40–50 years. The development of new minimally invasive methods in coronary surgery builds on the aspiration to optimise the results of surgical treatment of patients with coronary heart disease, especially those with an increased risk of complications associated with extracorporeal circulation, sternotomy and aortic manipulations.

Aim – to carry out the comparative analysis of early and midterm results of no-touch aorta multivessel minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG), conventional off-pump (OPCABG) and on-pump CABG (ONCABG).

Material and methods. From 2008 to 2016, 657 consecutive patients underwent CABG. Propensity score computer matching was performed and a total of 552 patients were successfully matched in 3 groups of 184 patients in each.

Results. MICS CABG was associated with less intraoperative blood loss: 200.0 (150.0; 250.0) ml in MICS CABG versus 400.0 (300.0; 500.0) ml in OPCABG vs 300.0 (237.5; 400.0) ml in ONCABG group; first 24-hour postopera- tive blood loss: 350.0 (250.0; 500.0), 500.0 (365.0; 650.0) and 500 (400; 870) ml, respectively; transfusion of blood and derivatives: 29 (15.8%), 83 (45.1) and 104 (56.5) patients, respectively; rate of deep wound infection: 0 (0.0%), 5 (2.7%) and 7 (3.8%) patients, respectively; intensive care unit stay: 18.0 (16.0; 20.1), 38.8 (17.5; 66.0) and 42.0 (19.0; 68.25) hours, and postoperative duration of hospital stay: 12.0 (9.0; 15.0), 15.0 (13.0; 17.0) and 14.0 (13.0; 20.0) days, respectively (p<0.05); postoperative ventilation time: 4.0 (2.5; 6.0), 5.0 (3.0; 7.0) and 5.0 (3.0; 7.0) hours, respectively (p<0.1); increasing of operation time: 335.8±83.8, 302.0±64.1 and 309.9±72.6 min, respectively (p<0,05). No significant differences were observed in rates of severe in-hospital events, cumulative midterm survival, and freedom from major adverse cardiac and cerebrovascular events (p>0.05).

Conclusion. Based on the propensity score matched retrospective trial with the II evidentiary level, developed strategy of the minimally invasive myocardial revascularization potentially can be safely applied to every patient with coronary heart disease who need multivessel CABG in a planned manner, saving the effectiveness during midterm follow-up.

Keywords:coronary heart disease, minimally invasive coronary artery bypass grafting, minimally invasive myocardial revascularization

Clin. Experiment. Surg. Petrovsky J. 2018; 1 (19): 10–20.

DOI: 10.24411/2308-1198-2018-00002

Received: 29.11.2017. Accepted: 25.01.2018.

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