Hospital And 1-year Results Of Randomised Trial Micsrevs - Minimally Invasive Cardiac Surgery Revascularization Strategy
Aliaksandr Ziankou1, Aliaksandr Zhyhalkovich2, Mikalaj Laiko1, Kyril Vykhrystsenka1, Vjacheslau Chuyashou1, Yuri Ostrovsky2.
1Vitebsk State Medical University, regional clinical hospital, Vitebsk, Belarus, 2Republic Research-Practical Center ‘‘Cardiology", Minsk, Belarus.
OBJECTIVE: We evaluated hospital and 1-year results of the prospective randomised controlled trial (RCT) MICSREVS, which compared the effectiveness of multivessel small thoracotomy coronary artery bypass grafting (MVST-CABG) versus off-pump (OPCABG) and on-pump coronary artery bypass grafting (ONCABG).
METHODS: The RCT MICSREVS was started in January 2014 (http://www.clinicaltrials.gov/show/NCT02047266). In accordance with the trial design, 150 patients were included, divided into 3 groups of 50 people. In group I, the MVST-CABG strategy was directed to perform multivessel arterial revascularization via a left minithoracotomy on the beating heart, using the aortic no-touch technique. In control groups II (OPCABG) and III (ONCABG), conventional surgery was performed via median sternotomy. Randomization was carried out by the blind method (‘envelopes’). Primary outcome measures were accepted death from any cause and major adverse cardiac and cerebrovascular events (MACCE). During the hospitalization period, as well as 12 and 36 months following primary myocardial revascularization, were planned as the control points.
RESULTS: MVST-CABG was associated with less perioperative blood loss, lower number of blood transfusions, shorter hospital length of stay and time to return to full physical activity, greater improvement in 30 days physical health component of quality of life, compared with other groups; less postoperative ventilation time, compared with ONCAB group. The MVST-CABG patients demonstrated an associative trend toward shorter intensive care unit stay, less new onset atrial fibrillation versus ONCABG patients, and fewer deep wound infections versus OPCABG patients. The mean follow-up duration constituted 21.6±8.3 months. 139 (92.7%) patients passed the 1-year control point at this moment. During the 1-year follow-up one patient died of cardiovascular cause in the ONCABG group, and one patient received coronary angioplasty in the MVST-CABG group. Cumulative midterm survival and freedom from MACCE did not differ signiﬁcantly between the treatment groups.
CONCLUSIONS: The full arterial aortic no-touch MVST-CABG demonstrated good results at in-hospital point of RCT MICSREVS and can be applied to most patients with multivessel coronary heart disease saving the effectiveness during midterm follow up.
|Characteristic||MICS-CABG (n=50)||OPCABG (n=50)||ONCABG (n=50)||MVST-CABG vs OPCABG||MVST-CABG vs ONCABG|
|No. distal anastomoses, mean±SD||2.7±0.5||2.9±0.6||3.1±0.6||0.070||<0.001|
|Intraoperative blood loss (ml)||250 (200; 300)||475 (350; 587.5)||400 (300; 500)||<0.001||<0.001|
|First twenty-four hours postoperative blood loss (ml)||450 (252.5; 587.5)||575 (450; 800)||500 (400; 800)||0.003||0.007|
|Transfusion of blood and/or derivatives, n (%)||9 (18.0)||20 (40.0)||33 (66.0)||0.015||<0.001|
|Deep wound infection, n (%)||-||3 (6.0)||-||0.079||-|
|Death, n (%)||-||-||1 (2.0)||-||0.315|
|Postoperative length of stay (surgical department) (d)||6.5 (5.0; 8.5)||8.5 (8.0; 10.0)||8.5 (8.0; 10.5)||0.003||0.008|
|Median time to return to full physical activity (d)||14 (7; 21)||56 (42; 77)||56 (44; 79)||<0.001||<0.001|
|Physical health component SF-36 Health Status Survey quality of life||50.9 (45,3; 52,8)||47.3 (44.9; 50.2)||48.3 (45.4; 50.5)||0.026||0.079|
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