EFFECTIVENESS OF THE MINIMALLY INVASIVE MYOCARDIAL REVASCULARIZATION WITH AORTIC NO-TOUCH TECHNIQUE

Objectives. To estimate immediate and long term results of the minimally invasive coronary surgery (MICS) at the multiple lesions of the coronary arteries depending on completeness of the achieved myocardium revascularization for optimization of the surgical treatment of the patients with coronary heart disease (CHD). Materials and methods. From 2011 up to 2013 at the cardiac surgery department of ME “Vitebsk regional clinical hospital” 151 patients with the CHD underwent minimally invasive myocardium revascularization (MIMR) at the multiple lesions of coronary arteries. MIMR strategy was directed to avoid artificial cardiopulmonary bypass with cardioplegia and manipulations on the ascending aorta, usage of the left minithoracotomy access and tendency to perform complete or functionally reasonable arterial myocardium revascularization. 84 patients underwent complete MIMR, 67 patients - functionally reasonable incomplete MIMR. Results. Immediate results of the MIMR were found satisfactory (complete angina retrogression and absence of the major cardiovascular complications) in 99,3% patients and were compared in groups of patients who underwent complete (98,8%) or functionally reasonable (100%) MIMR (р>0,05). Operation time was longer and emergency conversion to the assist extracorporeal circulation (AECC) was more frequent in the complete MIMR group of patients in comparison with functionally reasonable MIMR group (р<0,05). Statistically significant difference in adverse event rate during and after surgery was not found in current groups of patients (р>0,05). There were no major differences in the frequency of the recrudescent angina and major cardiovascular complications (combined adverse patient outcome) between complete and functionally reasonable MIMR groups of patients during long-term follow-up - 2,41% and 5,97% respectively (р>0,05). Conclusion: MICS with aortic no-touch technique can be applied for majority of multivessel CHD patients as a complete, functionally reasonable or hybrid revascularization with or without AECC, saving the effectiveness and clinical effect duration of the coronary procedures.

миниинвазивная реваскуляризация миокарда, функционально адекватная неполная реваскуляризация, композитно-секвенциальное шунтирование, minimally invasive myocardial revascularization, functionally reasonable incomplete revascularization, composite-sequential bypass grafting

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