Minimally invasive multivessel coronary artery bypass grafting safe and efficient: the experience of the first 500 cases
Abstract
The invasiveness
of coronary artery bypass grafting remains considerable and has not decreased
in over several decades. The development of new minimally invasive technologies
in coronary surgery is based on the intention to optimise the results of surgical
treatment of patients with coronary heart disease (CAD), especially those
with increased risk of complications associated with extracorporeal circulation
(ECC), sternotomy and aortic manipulations.
Aim - to carry out the analysis of immediate and mid-term results of
multivessel minimally invasive coronary artery bypass grafting (MICS CABG) in a
cohort of the first five hundred patients.
Material and methods. From 2011 to 2021, 500 CAD patients with CAD at
multivessel lesions of the coronary arteries underwent MICS CABG. Operation
strategy was directed to perform full myocardial revascularization via left
mini-thoracotomy on the beating heart. The age of the patients was 58.5±7.9 years,
there were 70 (14.0%) women in the group. Diabetes mellitus was detected in 105
(21.0%) patients, obesity - in 187 (37.4%), generalized atherosclerosis - in
121 (24.2%) patients. The risk for EuroScore was 1.2±0.7, the degree of
coronary bed damage according to the SyntaxScore was 26.4±8.8.
Results. The average operation time was 254.5±84.7 minutes, the
number of distal anastomoses was 2.5±0.7. In 189 (37.8%) patients,
mammaro-coronary artery bypass grafting was performed, coronary bypass
surgery without manipulation on the aorta was performed in 311 (62.2%)
patients, including complete arterial myocardial revascularization - 276
(55.2%) patients, hybrid myocardial revascularization - 29 (5.8%) patients. ECC
was used in 24 (4.8%) patients, of which emergency conversion
was performed in 13 (2.6%) patients. The median intraoperative blood loss
was 250 (200; 300) ml, blood loss for the 1st day after
the intervention - 270 (150; 350) ml. Transfusion of blood and its components
was performed in 47 (9.4%) patients. The postoperative ventilation time
was 5.0 (3.0; 8.0) hours, ICU-stay -19.5 (17.0; 24.0) hours. There were no
cases of deep wound infection. Perioperative stroke was recorded in 2
(0.4%) patients, myocardial infarction - in 7 (1.4%), the 30-day mortality was
0.6% (3 patients). The postoperative hospital stay was 7 (7; 10) days,
median time to return to full physical activity - 14 (9; 24) days. With a
follow-up duration of 4.8 (1.4; 7.3) years, the cumulative survival rate
was 93.4%, the absence of major adverse cardiac and cerebrovascular events
was 90.7%.
Conclusion. MICS CABG is a safe operation, associated with a low
incidence of perioperative complications, conversions to ECC and sternotomy,
short hospital stay, and return time to full physical activity. MICS CABG can
be applied to multi-vessel coronary heart disease patients saving the
effectiveness during mid-term follow-up, comparable to traditional CABG.
Keywords:coronary heart disease, minimally invasive coronary artery bypass grafting, minimally invasive myocardial revascularization
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Ziankou A.A., Isaev M.N., Kondratyev D.A., Chernov
I.I., Tarasov D.G. Minimally invasive multivessel coronary artery bypass
grafting safe and efficient: the experience of the first 500 cases. Clinical
and Experimental Surgery. Petrovsky Journal. 2021; 9 (4): 20-8. DOI: https://doi.org/10.33029/2308-1198-2021-9-4-20-28 (in Russian)
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