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Khirurgii

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Year 2018 Vol. 26 No 2

GENERAL & SPECIAL SURGERY

A. A. ZIANKOU 1, 2, K.S. VYKHRYSTSENKA 2, N.G. LOJKO1, W.A. CHUESHOW 1, YU.P. OSTROVSKY 3, 4

MIDTERM DISTANT RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL MICSREVS

Vitebsk Regional Clinical Hospital 1,
Vitebsk State Medical University 2, Vitebsk,
Republic Scientific and Practical Center «Cardiology» 3,
Belarusian Medical Academy of Postgraduate Education 4, Minsk,
The Republic of Belarus

Objective. To evaluate midterm distant results of the prospective randomized controlled trial “Minimally Invasive Cardiac Surgery Revascularization Strategy”, aimed to compare the effectiveness of minimally invasive cardiac surgery coronary artery bypass grafting versus off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting.
Methods. The randomized controlled trial was started in January 2014 (http://www.clinicaltrials.gov/show/NCT02047266). In accordance with the trial plan, 150 patients were included, divided into 3 groups, 50 subjects in each. In the first (main) group, the minimally invasive bypass strategy was directed to perform multivessel full arterial revascularisation on the beating heart without manipulations on the ascending aorta through the left-sided minothoracotomy. Conventional myocardial revascularization was performed on the beating heart (2 group) or with cardio-pulmonary bypass (3 group) via the median sternotomy. Inclusion criteria were multivessel coronary artery disease; II-IV functional class of angina pectoris and terms longer than 1 month after acute myocardial infarction. Exclusion criteria were previous coronary artery bypass grafting, single-vessel disease and need for emergency revascularization. The main endpoints of the study were the main adverse cardiac and brain events, as well as death from the cardiovascular cause and from any cause.
Results. The follow-up period in the groups constituted 975.5 (691.8; 1151.0) days, 792.5 (638.3; 936.3) days and 691.0 (506.0; 803.0) days, respectively. Cumulative survival (taking into account all causes of deaths and cardiovascular death) and freedom from major adverse cardiac and cerebral-vascular events did not differ significantly within the specified terms between the treatment groups of patients (p>0.05).
Conclusions. Minimally invasive myocardial revascularization can be successfully applied potentially in every patient with coronary heart disease who needs the multivessel coronary artery bypass grafting in the scheduled manner, saving the coronary interventions effectiveness during the midterm distant follow-up.

Keywords: arterial myocardial revascularization, off-pump surgery, coronary heart disease, minimally invasive coronary artery bypass grafting, minimally invasive myocardial revascularization, left minithoracotomy
p. 146-154 of the original issue
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Address for correspondence:
210037, The Republic of Belarus,
Vitebsk, W.-internationalists Str., 37,
Vitebsk Regional Clinical Hospital,
Cardiac Surgery Unit,
Tel. office: +375 212 61-63-15,
e-mail: Zenkov_Al@rambler.ru,
Ziankou Aliaksandr A.
Information about the authors:
Ziankou Aliaksandr A., PhD, Head of the Cardiac Surgery Unit, Vitebsk Regional Clinical Hospital, Associate Professor of the Surgery Department of the Faculty of Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-7119-2340
Vykhrystsenka Kiryl S., PhD, Assistant of the Hospital Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-0407-9265
Lojko Nikolaj G., Cardiac Surgeon of the Cardiac Surgery Unit, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-1630-946Õ
Chueshow Wjacheslaw A., Angiosurgeon of the Cardiac Surgery Unit, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-8603-9448
Ostrovsky Youry P., MD, Professor, Academician of NAS of Belarus, Head of the Heart Surgery Laboratory of the Republic Scientific and Practical Center «Cardiology», Head of the Department of Cardiac Surgery with the Course of Transplantology, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-0683-0147
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