Intermediate Results Of The Research For Percutaneous And Surgical Treatment For Left Anterior Descending Artery Chronic Total Occlusion.
Dmitrii Zhiltsov, Anton Maximov, Michail Riazanov, Victor Vaykin, Katsubo Elisaveta.
Specialized Clinical Cardiac Surgery hospital of academic B.A. Korolev, Nizhny Novgorod, Russian Federation.
Objective: Is to find out which revascularization methods have less of risk factors and complications after the surgery and long-term period. Methods: From January 2018 to December 2019 were operated 134 patients with LAD CTO. 48 of them underwent MIDCAB: 36 (75%) males and 12 (25%) females; aged 58.7 ±8.7; 7 (14,6%) with previous diabetes; 10 (20,8%) with previous PCI of LAD with drug-eluting stent. In the PCI group there were 86 patients: 52 (60,5%) males and 34 (39,5%) females; aged 64.8 ±8.3; 23 (26,7%) with previous diabetes. Results: Hospital mortality was 0 (0%) in MIDCAB unlike 1 (1,2%) in PCI. Myocardial infarction was 0 (0%) in both the groups. In MIDCAB the number of conversions to on-pump and sternotomy was 0 (0%), there were 6 (12,5%) pleuritis with pleural puncture and 3 (6,2%) with long wound-aches. The hospitalization period was 10.7±2.9 days for MIDCAB and 9.9 ±3.9 days for PCI. In the PCI group 2.0 ±1.0 drug-eluting stents were used. In-hospital costs were higher for PCI 3809€ unlike 3258€ for MIDCAB. After one year in MIDCAB group died 2 (4,2%) patients, from noncardiac causes. In PCI group died 3 (3,5%) patients, all from cardiac causes. Because of pandemic COVID-19 were checked only 48 patients by angiography and general clinical examination: 25 after MIDCAB and 23 after PCI. 5 patients have a graft failure, caused by surgical mistakes. 4 patients have stents restenosis and 1 has LAD’s reoсclusion. Conclusions: Both methods of revascularization for LAD CTO are demonstrated similar results. EuroSCORE II (p-value 0,008) and glomerular filtrating rate (p-value 0,004) are significant potential risk factors for mortality in both groups, age is potential risk factor for graft failure (p-value 0,05). Dyslipidemia is significant risk factor for LAD restenosis in PCI group (p-value 0,02). MIDCAB is associated with lower incidence of revascularization repeat and in-hospital mortality in the literature data and it costs lower than PCI for LAD CTO as our study has shown.
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