Preferable Strategies Of LAD Revascularization:early Results Of Randomized Trial
Vadim Popov, Egor Malyshenko, Maxim Novikov, Giorgiy Edzhibiya, Amiran Revishvili.
A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation.
BACKGROUND: To evaluate in-hospital results of prospective RCT ENPILA(EndoACAB vs PCI for LAD Revascularization)METHODS: Our prospective RCT is maintained in A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russia. Trial includes 100 patients. Inclusion criterion is isolated critical LAD lesions, suitable for either EndoACAB, or PCI revascularization. EndoACAB (Endoscopic-Assisted Coronary Artery Bypass) consists of harvesting IMA with endoscopic techniques and LAD direct vision anastomosis formation through the anterolateral minithoracotomy 3-4 cm with myocardium stabilizer. Patients divided into 2 groups, 50 patients each. 1st group includes patients, who underwent LAD EndoACAB. 2nd group includes patients, who underwent PCI to LAD. Check points of postoperative examination in both groups evaluated in 24 and 48 weeks. As an evaluation of myocardial revascularization primal endpoints were analyzed, including major adverse cardiovascular events (MACE), such as death, non-lethal MI, recurrent revascularization; and secondary endpoints: conversion, bleeding in perioperative period, pain, quality of life. To date, this trial includes 52 patients, 25 patients in 1st group and 27 patients in 2nd.RESULTS: In 1st group EndoACAB procedure was successfully performed in all cases (100%). In 2nd group all PCIs are performed without any omplications. During in-hospital period in both groups there were no significant difference in primary and secondary endpoints. All patients in early in-hospital period underwent coronaroangiography and shuntography. Incomplete myocardial revascularization, technical difficulties and other complications did not occur.CONCLUSION: Minimally invasive endoscopic-assisted myocardial revascularization showed good results, comparable with the PCI results during in-hospital period.
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