Abstract 12175: Microsurgical Technique in Coronary Surgery Improves Long-term Outcomes
Introduction: The operating microscope is widely used in surgical practice, but there is no common opinion on the benefits of its use in coronary surgery.
Objectives: The aim of this study was to compare the long-term outcomes of coronary artery bypass grafting with microsurgical technique and conventional technique.
Methods: We have studied 270 patients operated on for coronary artery disease by the same surgical team in 2004. We included observations of 3-vessel disease in which at least 1 bypassed vessel was type C according to Coronary Artery Surgery Study protocol or had the diameter at the anastomotic site of less than 1.5 mm. Patients were randomly assigned to 2 groups: microsurgical group (n=128); patients were operated on using a microsurgical technique (8-12х magnification, 8-0 polypropylene sutures with a 3/8, 6.5 mm needle for distal anastomoses) and nonmicrosurgical group (n=142); patients were operated on with a magnifying loupes (3.5х magnification, 8-0 polypropylene sutures with a 3/8, 8.0 mm needle). The mean number of distal anastomoses in microsurgical group was 4.1±0.8 vs 3.9±0.9 (p=ns) in nonmicrosurgical group, the number of anastomoses to arteries of less than 1.5 mm - 254 vs 121 (p=<0.001) and patients with endarterectomies - 3 vs 44 (p=<0.001), respectively. In all cases the left internal thoracic artery was anastomosed to the left anterior descending coronary artery. Follow-up was complete in 95% (258 patients). Survival curves were constructed using the Kaplan-Meier method and compared by the log-rank test.
Results: Ten-year survival rates in groups of patients operated on with and without the use of microsurgical technique were 82.7% vs 72.0% (p=0.03), incidence of non-fatal myocardial infarction - 9.8% vs 16.1% (p=0.14), recurrence of angina - 14.7% vs 22.7% (p=0.11), repeat interventions - 8.1% vs 17.6% (p=0.02), all cardiac events - 34.4% vs 58.8% (p=0.0001), respectively.
Conclusions: The use of the microsurgery compared with the conventional technique yields superior clinical results in coronary surgery during a 10-year follow-up.
Author Disclosures: A. Shiryaev: None. M. Lepilin: None. D. Galyautdinov: None. V. Vasilyev: None. D. Cherkashin: None. R. Akchurin: None.
- © 2016 by American Heart Association, Inc.