Long-term results of coronary bypass grafting supplemented with surgical stimulation of extracardiac myocardial vascularization in patients with diffuse coronary artery disease

Abstract

Highlights. In recent decades, the number of patients with diffuse, multivessel coronary artery disease has increased due to widespread use of endovascular methods of treatment, long-term conservative management of patients, and the expansion of indications for surgical revascularization. In order to improve the results of treatment, in 2007 academician Yu. L. Shevchenko developed and began using the method of stimulation of extracardiac angiogenesis – «YurLeon». The present article demonstrates the long-term results of supplementing coronary bypass surgery with this method in patients with diffuse coronary artery disease.Aim. To evaluate long-term results of coronary bypass surgery supplemented by extracardiac myocardial revascularization.Methods. The prospective, randomized study included 205 patients with diffuse, multivessel coronary artery disease who were treated at the St. George Thoracic and Cardiovascular Surgery Clinic, National Medical and Surgical Center named after N.I. Pirogov. The majority of patients were men – 75% (n = 153), whereas women accounted for 25% (n = 52), all patients were 60 to 78 years old (67.3±5.74 years). The group I consisted of patients with coronary bypass surgery supplemented with the «YurLeon» technique, the group II consisted of patients with coronary bypass grafting only. All patients provided consent to participate in the study. The clinical condition of patients, echocardiography, myocardial scintigraphy and coronary angiography data, quality of life indicators (the 36-Item Short Form Health Survey) were assessed.Results. In the long-term postoperative period (36 months), the group I, compared with the group II, presented with a statistically significant decrease in the functional class of angina pectoris (1[1–2] vs. 2[1–2], p = 0.02); fewer adverse events: myocardial infarction (4.5% vs. 11.6%, p = 0.011), recurrent angina pectoris (10% vs. 17.9%, p = 0.038); an increase in the left ventricular ejection fraction (59.0±5.15% vs. 53.2±6.13%, p = 0.001); a decrease in the Summed Rest Score (SRS) (4.5±3.5 vs. 8.4±5.7, p = 0.012) according to myocardial scintigraphy with technetril; a decrease in the Summed Thickening Score (STS) (6.1±3.3 vs. 10.7±2.9, p = 0.012); a decrease in the hibernating myocardium (3.5±2.2% vs. 7.4±5.1%, p = 0.03); additional extracardiac sources were found in the group I according to coronary graft angiography, there were no statistically significant differences between the groups by occluded autogenous venous bypass grafts (in the group I – 23 out of 46 venous conduits (49%), in the group II – 30 out of 49 venous conduits (51%), p = 0.089); The groups differed in terms of quality of life (the 36-Item Short Form Health Survey): physical functioning (87.3±10.32 vs. 75.3±14.15 points, p = 0.001); role-based functioning due to physical condition (90.1±10.50 vs. 79.7±7.01 points, p = 0.012); pain (93.10±6.37 vs. 80.5±5.21 points, p = 0.03); the total physical component of health (57.9±5.4 vs. 45.8±6.1 points, p = 0.012).Conclusion. We have accumulated 15 years of experience in conducting complex myocardial revascularization in patients with coronary artery disease and diffuse coronary atherosclerosis, which allowed us to prove the effectiveness and safety of the YurLeon technique.