Endoscopically-assisted Coronary Bypass Grafting in Left Anterior Descending Revascularization
Vadim Popov, Egor Malyshenko, Maxim Novikov, Giorgiy Edzhibiya, Georgiy Plotnikov, Amiran Revishvili
A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation
BACKGROUND: Minimally invasive coronary surgery is one of the most important strategies for left anterior descending (LAD) revascularization. Endoscopically-assisted coronary artery bypass grafting (EndoACAB) without cardiopulmonary bypass is preferable option for that in our hospital. Here is an analysis of this technique’s efficacy and safety.
METHODS: 2 groups of patients were studied. 1st group - EndoACAB, included 55 patients, 2nd group is minimally invasive direct coronary artery bypass (MIDCAB) included 52 patients. Baseline characteristics did not statistically differ in both groups. Inclusion criterion was isolated LAD lesion, suitable for both EndoACAB and MIDCAB. Primary end-points (major adverse cardiovascular and cerebrovascular events (MACCE)) and secondary end-points (operation time, conversion rate, bleeding in perioperative period, pain, quality of life, ICU-stay, ventilation time) have been assessed 24 and 48 weeks after procedures.
RESULTS: Perioperative mortality was 0 in both groups. MI incidence (EndoACAB 0 % vs MIDCAB: 0.3%; р=0,1) and stroke rate (EndoACAB 0 % vs MIDCAB: 0%, р=0,1) significantly did not differ. Operation time was higher in EndoACAB group [292 (250-345) min in EndoACAB group vs 201 (173-289) min in MIDCAB group (P < 0,001)]. ICU-stay had no statistical difference. Length-of-stay was lower in EndoACAB group 4(3-5) days vs 8(7-9) days in MIDCAB group. Significant difference was achieved in postoperative pain - EndoACAB 2 (1-3) points vs MIDCAB 7 (6-8) points according to visual analogue scale). Postoperative pleural effusion occurred in 2% cases in EndoACAB groups vs 25% in MIDCAB group.
CONCLUSIONS: Efficacy of EndoACAB is comparable to MIDCAB, however it was less traumatic according to visual analogue score.