STRATEGY OF REVASCULARIZATION COMPARED WITH CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH MULTIVESSEL CORONARY DISEASE WITH STABLE CORONARY ARTERY DISEASE, THIRTY RESULTS

The article presents a comparative analysis of two strategies for surgical myocardial revascularization: a hybrid revascularization, including minimally invasive direct LAD revascularization and implantation of drug-eluting stents (DES) of the second generation of the coronary arteries and the traditional coronary bypass surgery at a selected group of patients.

Purpose. Analyze the results of 30-day strategy hybrid revascularization and CABG in patients with stable coronary heart disease and multivessel coronary disease.

Materials and methods. The study included 100 patients (50 patients in each group) with stable coronary artery disease and multivessel coronary artery disease. In the group of hybrid revascularization, the first step is performed MID CAB (minimally invasive direct coronary artery revascularization) in the LAD followed by other PCI with implantation of DES of the second generation Xience. In group CABG performs traditional coronary artery bypass grafting. 30 day assessment undergone such indicators: the success of the procedure, the frequency of MACE (significant adverse cardiovascular events), bleeding, restenosis / thrombosis of bypass or stent.

 Results. In most cases, it was successful revascularization (98 % hybrid revascularization, CABG – 100 %). Five patients (10 %) in the group of hybrid revascularization request a conversion to sternotomy with performance of the standard CABG.

During the observation period of thirty mortality rate was in the group of hybrid revascularization was 2 % (1 patient). In the group of CABG deaths not registered. In 1 patient (2 %) in the group of hybrid revascularization when performing endovascular stage mammary shunt thrombosis identified in connection with which the underwent PCI. Myocardial infarction and stroke are not fixed in any way.

Conclusion. Strategy hybrid revascularization using MID CAB and subsequent PCI with implantation of drug-eluting stents in the second-generation coronary artery is not LAD localization is an effective and safe treatment for patients with multivessel coronary artery disease. 

1. Hueb W., Lopes N., Gersh B. J. et al. Ten-year followup survival of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease. Circulation. 2010; 122 (10): 949–957.

2. Trial of invasive vs. medical therapy in elderly patients with chronic symptomatic coronaryartery disease (TIME): a randomised trial. Lancet. 2001; 358 (9286): 951–957.

3. Chan V., Sellke F. W., Ruel M. Coronary artery bypass grafting. Sabiston and Spencer’s surgery of the chest, Vol. 2. Philadelphia: Elsevier; 2010: 1367–1397.

4. Cameron A., Davis K. B., Green G., Schaff H. V. Coronary Bypass Surgery with Internal-Thoracic-Artery Grafts – Effects on Survival over a 15-Year Period. NEJM. 1996; 334: 216–220.

5. Percutaneous coronary intervention versus coronary artery bypass grafting for severe coronary artery disease. N. Engl. J. Med. 2009; 360: 961–972.

6. Alexander J. H., Hafley G., Harrington R. A. et al. Efficacy and Safety of Edifoligide, an E2F Transcription Factor Decoy, for Prevention of Vein Graft Failure Following Coronary Artery Bypass Graft Surgery: PREVENT IV: A Randomized Controlled Trial. JAMA. 2005; 294: 2446–2454.

7. Head S. J., Davierwala P. M., Serruys P. W. et al. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year followup of the SYNTAX trial. Eur. Heart. J. 2014. DOI: 10.1093/eurheartj/ehu213.

8. Hlatky M. A., Boothroyd D. B., Bravata D. M. et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet. 2009. 373: 1190–1197.

9. Gilard M., Bezon E., Cornily J. C. et al. Same-day combined percutaneous coronary intervention and coronary artery surgery. Cardiology. 2007; 108: 363–367.

10. Byrne J. G., Leacche M., Vaughan D. E., Zhao D. X. Hybrid cardiovascular procedures. J. Am. Coll. Cardiol. Intv. 2008; 459–468.

11. Zhu P., Zhou P., Sun Y. et al. Hybrid coronary revascularization versus coronary artery bypass grafting for multivesselcoronary artery disease: systematic review and metaanalysis. J. Cardiothorac. Surg. 20151; 10 (1): 63.

12. 2014 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2014; 35: 2541–2619.

13. АКШ без ИК: миф, логика и наука [Электронный ресурс]. Челяб. центр хирургии сердца. Челябинск, 2011. Режим доступа: http://cardiosur.ru. (дата обращения: 16.04.2013). AKSh bez IK: mif, logika i nauka [Internet]. Cheljab. centr hirurgii serdca. Cheljabinsk, 2011. Available from: http://cardiosur.ru. [Updated: 16.04.2013].

14. Harskamp R. E., Bagai A., Halkos M. E., Rao S. V., Bachinsky W. B., Patel M. R. et al. Clinical outcomes after hybrid coronary revascularization versus coronary artery bypass surgery: a meta-analysis of 1,190 patients. Am. Heart J. 2014; 167 (4): 585–592. DOI: 10.1016/j.ahj.2014.01.006.