Early and Mid-term Results of No-touch Aorta Multi-Vessel Small Thoracotomy CABG versus Conventional Off-pump and On-pump CABG: A Propensity Score Matched Study
Aliaksandr Ziankou1, Urij Ostrovskij2.
1Vitebsk State Medical University, Vitebsk, Belarus, 2Republic Research-Practical Center "Cardiology", Minsk, Belarus.
OBJECTIVE: We carried out the comparative analysis of early and mid-term results of no-touch aorta multi-vessel small thoracotomy (MVST-CABG), conventional off pump (OPCABG) and on pump coronary artery bypass grafting (ONCABG) in propensity score matched groups of patients.
METHODS: From 2007 to 2014, 537 consecutive patients underwent CABG by the same surgeon: MVST-CABG - 212, OPCABG - 174 and ONCABG - 151 patients. Patients in the MVST-CABG group had lower body mass index, greater left ventricular ejection fraction, smaller average number of diseased coronary territories and less complexity of coronary disease (SYNTAX Score). Propensity score computer matching was performed to correct for and minimize selection bias. A total of 453 patients were successfully matched in three groups of 151 patients without differences in preoperative baseline characteristics.
RESULTS: Significant differences between MVST-CABG and conventional CABG groups were found in the operation time, intraoperative and first 24-hours postoperative blood loss, median time to return to full physical activity (р<0.05); deep wound infections rate and postoperative length of stay (surgical department), (р<0.1). No significant differences were observed in rates of severe in-hospital events, including death, stroke and myocardial infarction (р˃0.05).
At the 5-year postoperative period cumulative survival was 94.6%, 94.0% and 95.7% in the treatment groups. (MVST-CABG vs. OPCABG, log-rank test, p=0.634; HR: 1.46, 95% CI: 0.43-5.02, p=0.55; MVST-CABG vs. ONCABG, log-rank test, p=0.844; HR: 1.12, 95% CI: 0.31-4.03, p=0.857). Freedom from major adverse cardiac and cerebrovascular events rates were 85.0%, 86.0% and 90.6% (MVST-CABG vs. OPCABG, log-rank test, р=0.838; HR: 1.16, 95% CI: 0.50-2.71, p=0.724; MVST-CABG vs. ONCABG, log-rank test, р=0.953; HR: 1.09, 95% CI: 0.42-2.32, p=0.986).
CONCLUSIONS: The MVST-CABG appears as safe as OPCABG and ONCABG and is associated with less wound infections, perioperative blood loss, shorter hospital length of stay and time to return to full physical activity. MVST-CABG can be applied to the majority of multi-vessel patients saving the effectiveness during mid-term follow up. The MVST-CABG can be introduced avoiding a prolonged learning curve.
|Characteristic||MVST CABG (n=151)||OPCABG (n=151)||ONCABG (n=151)||p-value, MVST CABG vs. OPCABG||p-value, MVST CABG vs. OPCABG|
|Average number of distal anastomoses||2.9 ± 0.5||3.0 ± 0.6||3.1 ± 0.6||0.662||0.148|
|Operation time, min||352.4 ± 74.4||289.3 ± 55.0||280.4 ± 56.4||˂0.001||˂0.001|
|Intraoperative blood loss, ml||220 (180; 300)||400 (300; 550)||350 (250; 435)||0.039||0.048|
|First twenty-four hours postoperative blood loss, ml||170 (100; 280)||320 (200; 470)||380 (200; 500)||0.034||0.028|
|Transfusion of blood and/or derivatives||18 (11.9)||31 (20.5)||29 (19.2)||0.043||0.081|
|Deep wound infection||-||3 (2.0)||3 (2.0)||0.082||0.082|
|Death||1 (0.7)||1 (0.7)||2 (1.3)||1.000||0.562|
|Postoperative length of hospital stay (surgical department), days||4.5 (4.0; 9.0)||7.0 (5.0; 14)||7.5 (5.5; 16)||0.076||0.039|
|Median time to return to full physical activity, days||14 (7; 21)||56 (42; 77)||56 (42; 77)||˂0.001||˂0.001|
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