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Adjunctive TMR with CABG.Does TMR as an adjunct to CABG impact on outcomes of operations .
Ilia Berishvili, Leo Bokeria.
Bakoulev Cardiovascular Scientific Center, Moscow, Russian Federation.

OBJECTIVE: TMR as an adjunct to CABG is an effective procedure in patients with advanced CAD. However, the mechanisms that underlie these results remain controversial. The study was undertaken to evaluate perioperative and late efficacy of patients with CABG alone (I group) versus CABG plus TMR (2 group)
METHODS: Between 1999 and 2009 we selected 172 patients for TMR+CABG for evident diffuse lesions of CA in patients with viable myocardium. Group I patients (n=18) underwent CABG alone. Other 154 patients(group 2) underwent TMR plus CABG . Hospital results and late outcomes(mean 62,6 +11,4 months) of the two groups were compared
RESULTS: A strong trend toward reduced operative mortality(22% vs. 4%) was observed after CABG+TMR compared with CABG alone. Significant difference was found between groups in terms of in postoperative variables (MI, low cardiac output and need in postoperative IABP support)(4,5% versus 11,1% and 2,6% versus 16,6%, respectively ).Within the 5-years follow-up overall treatment success, defined as survival rate(94,2% vs. 72,2%) freedom from MI (98,1% vs.85,7%) and recurrent angina(98,7% vs. 75,9%) was significantly better in the 2-nd group. in CABG alone group requirement in nitrates were also higher (2.3 vs. 1.16 and 30.0 vs. 2.15 respectively). On the contrary, LV EF and exercise tolerance were worse in group I (52.6 vs. 57.4; 84.1 vs. 85.6 respectively). We did not notice the improvement of perfusion in group I. Furthermore, the rates of psychoemotional condition were worse in group 1
CONCLUSIONS: This study suggests that TMR performed adjunctively to CABG in patients not amenable to CABG alone has yielded significantly improved outcomes. Considering comparability of demographic and baseline variables and equal evidence of CAD (initially all patients were selected for TMR+CABG), we conclude that TMR allows to improve efficiency of surgery when used as adjunct to CABG in such category of patients. The mechanism for TMR is likely multifactorial with denervation and vasodilatation of CA responsible for the perioperative benefits and angiogenesis with improvement of perfusion for the long-term success


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