КОРОНАРНОЕ ШУНТИРОВАНИЕ НА РАБОТАЮЩЕМ СЕРДЦЕ БЕЗ МАНИПУЛЯЦИЙ НА ВОСХОДЯЩЕМ ОТДЕЛЕ АОРТЫ С ИСПОЛЬЗОВАНИЕМ НЕСКЕЛЕТИРОВАННОЙ БОЛЬШОЙ ПОДКОЖНОЙ ВЕНЫ У ПАЦИЕНТОВ С МНОГОСОСУДИСТЫМ АТЕРОСКЛЕРОТИЧЕСКИМ ПОРАЖЕНИЕМ КОРОНАРНЫХ АРТЕРИЙ

Abstract

Objective. To compare early postoperative hospital and one-year outcomes of coronary artery bypass grafting on a "working heart" (OPCABG) and coronary bypass grafting without manipulation of the ascending aorta (anCABG) in patients with multivessel atherosclerotic coronary artery disease. Methods. The object of the prospective, single-center, randomized study was 80 patients with multivessel atherosclerotic coronary artery lesions who underwent myocardial revascularization at Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology in 2018-2020. One group consisted of the patients (38 people) who underwent anCABG using composite grafts and great saphenous vein harvested "with surrounding tissue". The second group (42 patients) consisted of the patients who underwent OPCABG. Results. Two observation groups did not differ significantly according to the main initial variables. The severity of coronary lesions according to SYNTAX Score was 25.1±6.15 in the anCABG group and 24.3±7.47 in the OPCABG group (p>0.05). All patients underwent complete myocardial revascularization. The number of distal anastomoses was 2.66±0.68 in the anCABG group and 2.36±0.48 in the OPCABG group (p>0.05). There was no in-hospital mortality in either group. Perioperative myocardial infarction occurred in two patients in the OPCABG group and one patient in the anCABG group. One patient in the OPCABG group had an atherothrombotic stroke and another patient developed a transient ischemic attack. Time of stay both in the intensive care unit after the operation and in the cardiac surgery inpatient department was significantly longer in the OPCABG group (p<0.05). Conclusion. The anCABG method showed advantages in comparison with OPCABG at the early postoperative inpatient stage in patients with multivessel atherosclerotic lesions of the coronary arteries. It was expressed in lower frequency of neurological complications and perioperative myocardial infarction and statistically shorter time of stay in intensive care unit and cardiac surgical inpatient department (p<0.05). In the long-term period there was lower incidence of venous graft dysfunction in the anCABG group using large saphenous vein harvested "with surrounding tissue", it being expressed in the reduced frequency of major adverse cardiovascular events.