Vol. 27 No. 3 (2023)
CORONARY ARTERY DISEASES

Microscope-assisted coronary artery bypass grafting in diffuse coronary artery disease: immediate and mid-term results

pdf (Русский)
  • A.N. Semchenko,
  • A.M. Shevchenko,
  • I.V. Zaicev,
  • A.V. Semchenko,
  • T.B. Vnukova
A.N. Semchenko
Federal Center for Cardiovascular Surgery, Ministry of Health of Russian Federation, Khabarovsk
Bio
A.M. Shevchenko
Federal Center for Cardiovascular Surgery, Ministry of Health of Russian Federation, Khabarovsk
I.V. Zaicev
Federal Center for Cardiovascular Surgery, Ministry of Health of Russian Federation, Khabarovsk
A.V. Semchenko
Federal Center for Cardiovascular Surgery, Ministry of Health of Russian Federation, Khabarovsk
T.B. Vnukova
Federal Center for Cardiovascular Surgery, Ministry of Health of Russian Federation, Khabarovsk
Cumulative curves of the study endpoints before and after propensity score matching
DOI: https://doi.org/10.21688/1681-3472-2023-3-31-43

Published 2023-09-29

Keywords

  • Coronary Artery Bypass,
  • Coronary Artery Disease,
  • Microsurgery,
  • Plaque, Atherosclerotic,
  • Retrospective Studies

How to Cite

Semchenko, A., Shevchenko, A., Zaicev, I., Semchenko, A., & Vnukova, T. (2023). Microscope-assisted coronary artery bypass grafting in diffuse coronary artery disease: immediate and mid-term results. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 27(3), 31–43. https://doi.org/10.21688/1681-3472-2023-3-31-43

Copyright (c) 2023 Semchenko A.N., Shevchenko A.M., Zaicev I.V., Semchenko A.V., Vnukova T.B.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Background: In recent years, a typical candidate for coronary artery bypass grafting (CABG) has become a patient with complex, multivessel coronary artery disease (CAD), often with an unsatisfactory and small distal bed. The prevalence of diffuse CAD is 4.2%-46.0%, and the CABG refusal rate due to this disease accounts for 1.3%-15.0%. Diffuse CAD is an independent predictor of mortality and poor prognosis after CABG. Due to a lack of uniform criteria for diffuse CAD and randomized trials, there is no preferred surgical treatment option for such patients.
Objective: To evaluate immediate and mid-term results of microscope-assisted CABG in patients with ischemic heart disease and diffuse CAD.
Methods: We calculated a diffuseness score and determined whether the criterion of diffuse lesion by SYNTAX score was met. For our retrospective study we selected 187 ischemic heart disease patients with 3-vessel CAD who underwent microscope-assisted CABG. A coronary lesion with a diffuseness score of >18 was considered diffuse if the SYNTAX score criterion was met for each of the main coronary arteries. The patients were divided into 2 groups: group 1 for patients with diffuse CAD (n = 60) and group 2 for patients with CAD that did not meet the criterion to be considered diffused (n = 127). The propensity score matching was used to reduce differences between the groups. The primary end point was death from any cause; the secondary end points were adverse cardiovascular events (death from cardiac causes, myocardial infarction, repeated revascularization, acute cerebrovascular accident) and angina.
Results: No significant differences in the frequency of in-hospital specific and nonspecific complications were found. The frequency of achieved complete revascularization was comparable between the groups. There were no significant differences in the long-term survival, adverse cardiovascular events, and freedom from angina during the median follow-up of 39 months (min 1 month; max 60 months). The univariate analysis after the propensity score matching showed that diffuse CAD was not a significant predictor of death from any cause [hazard ratio (HR), 1.141; 95% CI, 0.348-3.742; P = .83], adverse cardiovascular events [HR, 0.940; 95% CI, 0.425-2.078; P = .88], and angina [HR, 0.817; 95% CI, 0.394-1.696; P = .59]. The multivariate analysis revealed no significant association between diffuse CAD and death from any cause both before [HR, 1.382; 95% CI, 0.396-4.815; P = .61] and after propensity score matching [HR, 2.079; 95% CI, 0.158-27.422; P = .58]. We found that within 60 months after CABG, the risk of death from any cause was increased: by patient’s age [HR, 1.166; 95% CI, 1.043-1.303; P = .007], male sex [HR, 5.583; 95% CI, 1.062-29.344; P = .042], and diabetes mellitus [HR, 3.673; 95% CI, 1.143-11.805; P = .029] before the propensity score matching and by patient’s age [HR, 2.055; 95% CI, 1.028-4.104; P = .041] and cardiopulmonary bypass time [HR, 1.190; 95% CI, 1.014-1.397; P = .033] after the propensity score matching.
Conclusion: Microscope-assisted CABG in patients with diffuse CAD can achieve satisfactory immediate and mid-term results. We found no association between diffuse CAD and the risk of adverse events.

Received 30 January 2023. Revised 29 June 2023. Accepted 5 July 2023.

Funding: The study did not have sponsorship.

Conflict of interest: The authors declare no conflict of interest.

Contribution of the authors
Conception and study design: A.N. Semchenko
Data collection and analysis: A.M. Shevchenko, I.V. Zaicev, A.V. Semchenko, T.B. Vnukova
Statistical analysis: A.N. Semchenko
Drafting the article: A.N. Semchenko, I.V. Zaicev
Critical revision of the article: A.M. Shevchenko, A.V. Semchenko, T.B. Vnukova
Final approval of the version to be published: A.N. Semchenko, A.M. Shevchenko, I.V. Zaicev, A.V. Semchenko, T.B. Vnukova

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