ABSTRACT
OBJECTIVE: To evaluate the clinical effectiveness of bilateral internal mammary artery grafting over long-term (15 years) postoperative period. MATERIAL AND METHODS: There were 276 patients divided into two groups: 135 patients (group A) underwent bilateral internal mammary artery grafting and 141 patients (group B) underwent unilateral internal mammary artery grafting together with venous bypass grafts. On-pump surgeries and cardioplegia, parallel CPB and on-pump procedures were performed in equal proportions. Mean age of patients was 57.3±7.6 years. Diabetes mellitus was detected in 21 (15.5%) and 24 (19.1%) patients, respectively (p>0.05). Mean LV ejection fraction was 55.4±9.9%, revascularization index - 3.1±0.8 and 3.0±0.7, respectively. In the 1st group, 43 patients underwent bilateral internal mammary artery grafting alone. Autovenous grafts were additionally used in other 84 patients. RESULTS: Ten-year survival exceeded 90% in both groups. Freedom from adverse cardiac events after 15 years was significantly higher in group A (77.3% vs. 59.3%, p=0.018). In group A, 16 patients died throughout this period due to cancer (50%), myocardial infarction (12.5%), stroke (18.8%) and complications of diabetes mellitus (6.3%). In group B, 22 patients died mainly from cardiac causes (myocardial infarction - 40.9%, cancer - 27.3%). CONCLUSION: Bilateral internal mammary artery grafting has obvious advantages over traditional coronary artery bypass grafting. If we take into account higher proportion of cardiac causes in structure of mortality in group B, we can talk about positive impact of bilateral internal mammary artery grafting not only on the quality of life, but also on life expectancy in long-term postoperative period.
Subject(s)
Mammary Arteries , Postoperative Complications , Humans , Middle Aged , Female , Male , Mammary Arteries/transplantation , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Russia/epidemiology , Aged , Coronary Artery Disease/surgery , Coronary Artery Disease/complications , Internal Mammary-Coronary Artery Anastomosis/methods , Internal Mammary-Coronary Artery Anastomosis/adverse effects , Coronary Artery Bypass/methods , Coronary Artery Bypass/adverse effects , Treatment Outcome , Quality of Life , Long Term Adverse Effects/etiology , Long Term Adverse Effects/diagnosis , Long Term Adverse Effects/epidemiology , Outcome and Process Assessment, Health CareABSTRACT
OBJECTIVE: To evaluate safety of coronary artery bypass surgery using bilateral internal mammary artery and effectiveness of this procedure in long-term postoperative period. MATERIAL AND METHODS: The study involved 129 patients who underwent CABG for the period 2006-2007. There were 2 groups of patients depending on surgical strategy: group 1 (n=61) - double IMA harvesting, group 2 (n=68) - CABG using single IMA. Short-term results were compared using standard statistical methods. Long-term survival was compared using Kaplan-Meyer method. RESULTS: Revascularization index was 3.014±0.76 in the 1st group and 3.1±0.73 in the 2nd group (p>0.05). In-hospital mortality was 0% and 1.47%, respectively (p> 0.05). A 10-year survival was 95.1% and 91.2%, respectively (p>0.05). Freedom from cardiac events (mortality, myocardial infarction, recurrent angina pectoris) was significantly different (95% vs. 81%, p<0.05). CONCLUSION: Significantly lower rate of adverse cardiac events in long-term postoperative period in comparison with conventional CABG clearly demonstrates high quality of life after coronary artery bypass surgery using bilateral internal mammary artery for a long time. Therefore, this procedure is preferred in patients with coronary artery disease.
Subject(s)
Coronary Artery Bypass/methods , Coronary Artery Disease/surgery , Mammary Arteries/transplantation , Follow-Up Studies , Humans , Quality of Life , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To optimize surgical treatment of patients aged over 70 years with coronary artery disease. MATERIAL AND METHODS: There were 398 patients aged over 70 years with coronary artery disease for the period 2006-2017. All patients were divided into 3 groups: group 1 - on-pump coronary artery bypass grafting (CABG) with cardiac arrest; group 2 - on-pump beating heart CABG, group 3 - off-pump CABG. RESULTS: On-pump beating heart CABG in patients over 70 years old is followed by reduced incidence of perioperative complications including acute heart failure, acute respiratory failure, neurological complications, reduced length of ICU- and hospital-stay compared with on-pump CABG and cardiac arrest. However, off-pump CABG is optimal in advanced age patients because this approach reduces duration of surgery, intraoperative blood loss, incidence of acute heart failure, neurological complications and cardiac rhythm disturbances. Postoperative annual and 5-year survival rates were 98.1 and 84.2%, respectively. CONCLUSION: Off-pump CABG is preferable in advanced age patients. Surgical treatment of these patients is characterized by high clinical efficacy in long-term period after surgery.
Subject(s)
Coronary Artery Bypass, Off-Pump , Coronary Artery Disease , Aged , Coronary Artery Bypass , Humans , Postoperative Complications , Retrospective Studies , Treatment Failure , Treatment OutcomeABSTRACT
Academician B.V. Petrovsky had considerable impact on coronary surgery development in our country. Current Russian coronary surgery comparable with world standards is based on scientific and practical initiatives initiated and developed by B.V. Petrovsky and his students.
