Authors
Zhbanov I.V., Kiladze I.Z., Uryuzhnikov V.V., Martirosyan A.K., Shabalkin B.V.
B.V. Petrovsky Russian Research Center of Surgery, Moscow
Abstract
Rationale: CABG is the gold standard of treatment for coronary artery disease. Surgery as a whole is based on the desire to optimize its results, which can be achieved by minimizing the traumatism of this operation. And in particular, the use of new minimally invasive methods is preferable with an increased risk of complications associated with artificial blood circulation, sternotomy and manipulation on the aorta.
Objective: to compare the immediate results of patients operated according to the classical method through median sternotomy and patients operated through left-sided mini-thoracotomy, and to identify the advantages of one method over the other.
Methods: The study group consisted of 90 patients who underwent CABG via left-sided mini-thoracotomy (group A). Control group B included 104 patients after isolated CABG via median sternotomy. The average age of patients was 63,8±7,2 years in group A and 59,9±8,1 years in group B. The body mass index in group A was 28,2±4,3 kg/m2 and in group B 31,2±4 kg/m2. All patients were diagnosed with multivessel CA lesion. The average left ventricular ejection fraction (LV EF) was 58,2±9,9% in group A and 55,7±9,1% in group B. In group A 27,8% patients and 39,4% in group B had previously performed coronary angioplasty.
Results: The difference in the average duration of minimally invasive (251±88 min) and traditional (243±62,2 min) CABG was unreliable. The majority of patients in both groups operated without CPB — 92,5% in group A and 89,4% in group B. The revascularization index in the study groups was 2,6±0,9 and 3,1±0,85. The complex and longer harvesting of two IMA through a mini-step at the stage of mastering MICS CABG technology explains the less frequently performed BIMA CABG in group A (41,3%) compared to group B (71,1%, p<0,05). Both intraoperative (283±92 ml vs. 527±172,2 ml) and postoperative drainage blood loss (205±50 vs. 350±46 ml) was significantly less in group A. Patients after minimally invasive CABG were more quickly transferred to independent breathing (mean ventilator time 123±38,1 min vs. 274,4±62,8 min after traditional CABG, p<0,05). In the absence of significant differences in the duration of stay in cardiac intensive care, patients returned home faster after minimally invasive CABG (7,1±2,1 days after surgery versus 8,5±2,2 days in group B, p<0,05).
Conclusion: The results obtained show that multiple CABG via left mini-thoracotomy is not accompanied by an increase in the frequency of perioperative complications and an increase in hospital mortality. Already at the stage of mastering such operations, it becomes obvious that MICS CABG technology in most patients does not limit the required volume of surgery, and as experience accumulates, it allows using two IMA to achieve autoarterial myocardial revascularization. Lesion LCA, a disabled myocardium with a moderate decrease in LV contractility do not exclude the possibility of performing CABG through a mini-thoracotomy. In such cases, there is always a risk of developing acute myocardial ischemia and severe hemodynamic disorders with dislocation of the heart can be eliminated through the use of peripheral CPB.
Keywords: CABG, left-sided mini-thoracotomy, BIMA CABG.
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