This journal is
indexed in Scopus
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.
- Head SJ, Davierwala PM, Serruys PW, Redwood SR, Colombo A, Mack MJ5, Morice MC, Holmes DR Jr, Feldman TE, Stahle E, Underwood P, Dawkins KD, Kappetein AP, Mohr FW. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart J. 2014 Oct 21;35(40):2821-30. doi: 10.1093/eurheartj/ehu213.
- Lapierre H, Chan V, Sohmer B, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study. Eur J Cardiothorac Surg. 2011 Oct;40(4):804-10. doi: 10.1016/j.ejcts.2011.01.066.
- Ruel M, Une D, Bonatti J, McGinn JT. Minimally invasive coronary artery bypass grafting: is it time for the robot? Curr Opin Cardiol. 2013 Nov;28(6):639-45. doi: 10.1097/HCO.0b013e3283653fd1.
- Poston RS, Tran R, Collins M, Reynolds M, Connerney I, Reicher B, Zimrin D, Griffith BP, Bartlett ST. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg. 2008 Oct;248(4):638-46. doi: 10.1097/SLA.0b013e31818a15b5.
- Puskas JD, Williams WH, Mahoney EM, Huber PR, Block PC, Duke PG, Staples JR, Glas KE, Marshall JJ, Leimbach ME, McCall SA, Petersen RJ, Bailey DE, Weintraub WS, Guyton RA. Off-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA. 2004 Apr 21;291(15):1841-49. doi: 10.1001/jama.291.15.1841.
- Shennib H. Evolving strategies in minimally invasive coronary artery surgery. Int J Cardiol. 1997 Dec 1;62 Suppl 1:S81-88.
- Calafiore AM, Giammarco GD, Teodori G, Bosco G, D’Annunzio E, Barsotti A, Maddestra N, Paloscia L, Vitolla G, Sciarra A, Fino C, Contini M. Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass. Ann Thorac Surg. 1996 Jun;61(6):1658-63; discussion 1664-65. doi: 10.1016/0003-4975(96)00187-7.
- McGinn JT Jr, Usman S, Lapierre H, Pothula VR, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients. Circulation. 2009 Sep 15;120(11 Suppl):S78-84. doi: 10.1161/CIRCULATIONAHA.108.840041.
- Bonaros N, Schachner T, Lehr E, Kofler M, Wiedemann D, Hong P, Wehman B, Zimrin D, Vesely MK, Friedrich G, Bonatti J. Five hundred cases of robotic totally endoscopic coronary artery bypass grafting: predictors of success and safety. Ann Thorac Surg. 2013 Mar;95(3):803-12. doi: 10.1016/j.athoracsur.2012.09.071.
- Halkos ME, Walker PF, Vassiliades TA, Douglas JS, Devireddy C, Guyton RA, Finn AV, Rab ST, Puskas JD, Liberman HA. Clinical and angiographic results after hybrid coronary revascularization. Ann Thorac Surg. 2014 Feb;97(2):484-90. doi: 10.1016/j.athoracsur.2013.08.041.
- Ziankou AA, Laiko MG. Comparative Effectiveness of the Minimally Invasive Coronary Artery Bypass Grafting [Electronic resourse]. Clinicaltrials.gov. Available from: http://clinicaltrials.gov/show/NCT02047266
- Barsoum EA, Azab B, Shah N, Patel N, Shariff MA, Lafferty J, Nabagiez JP, McGinn JT Jr. Long-term mortality in minimally invasive compared with sternotomy coronary artery bypass surgery in the geriatric population (75 years and older patients). Eur J Cardiothorac Surg. 2015 May;47(5):862-67. doi: 10.1093/ejcts/ezu267.
- Ruel M, Shariff MA, Lapierre H, Goyal N, Dennie C, Sadel SM, Sohmer B, McGinn JT Jr. Results of the Minimally Invasive Coronary Artery Bypass Grafting Angiographic Patency Study. J Thorac Cardiovasc Surg. 2014 Jan;147(1):203-8. doi: 10.1016/j.jtcvs.2013.09.016.
- Shen L, Hu S, Wang H, Xiong H, Zheng Z, Li L, Xu B, Yan H, Gao R. One-stop hybrid coronary revascularization versus coronary artery bypass grafting and percutaneous coronary intervention for the treatment of multivessel coronary artery disease: 3-year follow-up results from a single institution. J Am Coll Cardiol. 2013 Jun 25;61(25):2525-33. doi: 10.1016/j.jacc.2013.04.007.
210037, The Republic of Belarus,
Vitebsk, W.-internationalists Str., 37,
Vitebsk Regional Clinical Hospital,
Cardiac Surgery Unit,
Tel. office: +375 212 61-63-15,
Ziankou Aliaksandr A.
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.
Vykhrystsenka Kiryl S., PhD, Assistant of the Hospital Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Lojko Nikolaj G., Cardiac Surgeon of the Cardiac Surgery Unit, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
Chueshow Wjacheslaw A., Angiosurgeon of the Cardiac Surgery Unit, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
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.