Outcomes Of Bilateral Internal Thoracic Arteries In Minimally Invasive Cabg With Analogy To The Syntax Trial
PRADEEP NAMBIAR1, Sanjay Kumar2.
1National Heart Institute, New Delhi, India, 2Benares Hindu University, Varanasi, India.
Background Minimally invasive CABG is making positive strides in the evolution of Coronary artery bypass surgery. . We carried out a retrospective study of the efficacy and outcomes of the usage of bilateral internal thoracic arteries in MICS CABG patients over a 6 year period using primary (MACCE) and secondary outcome measures and also carried out a subgroup analysis in patients with diabetes, methodology of revascularization and with analogy to the syntax trial of the relative risk. Materials & Methods 940 patients underwent multivessel MICS -CABG via a left minithoracotomy from Aug 2011 to Sept 2017 and complete revascularization was done using the left internal thoracic artery - right internal thoracic artery Y (LITA-RITA Y) composite conduit. Efficacy and outcomes were evaluated by Primary (MACCE), and Secondary outcome measures including total length of stay, return to full physical activity and quality of life. Propensity score matched analyses were carried out in diabetics, methodology of revascularization (MICS- OPCABG vs MICS- ONCABG) and with comparison to the syntax trial of the relative risk. Mean follow-up was 2.9 years (Maximum was 5.6 yrs.) Results Out of the 940 patients, 839(89.3 %) were diabetic and complete revascularization was achieved in 920 patients (97.9%). Average grafts were 3.2. ICU stay and mortality were higher in the diabetic population and in patients of MICS -ONCABG 39+/- 8 hrs. vs 34+/- 5.5 hrs. &< 0.0001, Mortality 2 (2.29%) vs 1 (1.14% )&> 0.05 ;( MICS OPCABG VS MICS ONCABG); ICU stay 34+/- 8 hrs. vs 52+/- 5.5 hrs. <0.0001, Mortality 1 (1.16%) vs 2 (3.3 %)& >0.05. Comparison to the syntax trial showed a reduction in all cause risk . Stroke 2(0.2%) vs 33 (3.7%) vs 21 (2.4%) RR 0.06, 95% CI (0.01-0.24) 0.09(0.22-0.39), Mortality 9(0.9%) vs 102(11.4%) vs 125 (13.9%) 0.05 ( 0.02- 0.12) 0.03 ( 0.01-0.05); Reintervention 10 (1.0 6%) vs122(13.7%) vs 233( 25.9%) 0.07(0.04-0.14) 0.04(0.02-0.07); Post op MI 3(0.31 %) vs 34 (3.8 %) vs 87 (9.7%) 0.08(0.03-0.27) 0.03(0.01-0.10); Length of stay 3.1+/- 1.2 vs 9.5+/-8.0 vs 3.4+/-4.5 9.1+/-0.5 % .. Conclusions The safety, efficacy, and outcomes of minimally invasive CABG evaluated by primary (MACCE), secondary outcomes and quality of life measures have been good in this study especially in diabetics and have shown results better than conventional CABG. The learning curve can be safely negotiated by using peripheral cardiopulmonary bypass assistance and comparison with the syntax trial has shown a relative reduction in all cause risk.
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