Life quality analysis on the application of different methods of surgical myocardial revascularization: prospective randomized trial MICSREVS
1Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus
2Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2018;17(1):68-80.
Objectives. To evaluate the health-related quality of life (HRQOL) of the coronary heart disease patients while applying different methods of surgical myocardial revascularization in the prospective randomized controlled trial «Minimally Invasive Cardiac Surgery Revascularization Strategy» (MICSREVS), which compared the effectiveness of minor invasive cardiac surgery of coronary artery bypass grafting (MICS-CABG) versus off-pump coronary artery bypass grafting (OPCABG) and on-pump coronary artery bypass grafting (ONCABG).
Material and methods. In accordance with its design (http://www.clinicaltrials.gov/show/NCT02047266), the trial was carried out involving 3 parallel groups with 50 persons in each of them. In the main group the MICS-CABG strategy was aimed at the performance of multivessel full arterial revascularization on the beating heart using the aortic no-touch technique via the left minithoracotomy. In the second (OPCABG) and the third (ONCABG) groups of the patients conventional myocardial revascularization was performed via the median sternotomy.
Results. No significant differences between the groups were observed concerning their pain intensity in 1 (46,0±7,7, 43,7±7,3 and 44,0±8,0 scores) and 4 (27,6±7,4, 26,1±6,3 and 25,4±6,8 scores, respectively) days postoperatively as determined by means of visual analog scale (р>0,1). MICS-CABG was associated with much less median time of the return to full physical activity (14 (7; 14), 56 (56; 70) and 56 (56; 84) days, respectively, р˂0,001), more positive postoperative integral parameters of physical component of HRQOL vs. ONCABG (р=0,020), as well as mental component of HRQOL vs. OPCABG (р=0,039) and ONCABG (р=0,044) in two months after the surgical intervention.
Conclusions. Comparable with conventional myocardial revascularization pain intensity at the early postoperative period against the background of continuous regional intercostal analgesia and significantly higher rates of HRQOL in the short term after surgery is observed on MICS-CABG.
Key words: coronary heart disease, minor invasive coronary artery bypass grafting, minimally invasive myocardial revascularization, quality of life, visual analog scale, pain intensity.
1. Jokinen JJ, Hippeläinen MJ, Turpeinen AK, Pitkänen O, Hartikainen JE. Health-related quality of life after coronary artery bypass grafting: a review of randomized controlled trials. J Card Surg. 2010 May;25(3):309-17. doi: http://dx.doi.org/10.1111/j.1540-8191.2010.01017.x
2. Sun JH, Wu XY, Wang WJ, Jin LL. Cognitive dysfunction after off-pump versus on-pump coronary artery bypass surgery: a meta-analysis. J Int Med Res. 2012;40(3):852-8. doi: http://dx.doi.org/10.1177/147323001204000303
3. Cormack F, Shipolini A, Awad WI, Richardson C, McCormack DJ, Colleoni L, et al. A meta-analysis of cognitive outcome following coronary artery bypass graft surgery. Neurosci Biobehav Rev. 2012 Oct;36(9):2118-29. doi: http://dx.doi.org/10.1016/j.neubiorev.2012.06.002
4. Blankenship JC, Marshall JJ, Pinto DS, Lange RA, Bates ER, Holper EM, et al. Effect of percutaneous coronary intervention on quality of life: a consensus statement from the society for cardiovascular angiography and intervention. Catheter Cardiovasc Interv. 2013 Feb;81(2):243-59. doi: http://dx.doi.org/10.1002/ccd.24376
5. Abah U, Dunne M, Cook A, Hoole S, Brayne C, Vale L, Large S. Does quality of life improve in octogenarians following cardiac surgery? A systematic review. BMJ Open. 2015 Apr;5(4):e006904. doi: http://dx.doi.org/10.1136/bmjopen-2014-006904
6. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009 Mar;360(10):961-72. doi: http://dx.doi.org/10.1056/NEJMoa0804626
7. Maznyczka AM, Howard JP, Banning AS, Gershlick AH. A propensity matched comparison of return to work and quality of life after stenting or coronary artery bypass surgery. Open Heart. 2016 Jan;3(1):e000322. doi: http://dx.doi.org/10.1136/openhrt-2015-000322
8. Kulik A. Quality of life after coronary artery bypass graft surgery versus percutaneous coronary intervention: what do the trials tell us? Curr Opin Cardiol. 2017 Nov;32(6):707-714. doi: http://dx.doi.org/10.1097/HCO.0000000000000458
9. Lapierre H, Chan V, Sohmer B, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study. Eur J Cardiothorac Surg. 2011 Oct;40(4):804-10. doi: http://dx.doi.org/10.1016/j.ejcts.2011.01.066
10. McGinn JT Jr, Usman S, Lapierre H, Pothula VR, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting: dual center experience in 450 consecutive patients. Circulation. 2009 Sep;120(11 Suppl):S78-84. doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.108.840041
11. Noyez L, de Jager MJ, Markou AL. Quality of life after cardiac surgery: underresearched research. Interact Cardiovasc Thorac Surg. 2011 Nov;13(5):511-4. doi: http://dx.doi.org/10.1510/icvts.2011.276311
12. Zen'kov AA, Ostrovskiy YuP, Vykhristenko KS, Loyko NG. Comparative analysis of the results of mini-invasive myocardial revascularization, coronary artery bypass grafting on a beating heart and with artificial circulation. Novosti Khirurgii. 2014;22(1):33-43. doi: http://dx.doi.org/10.18484/2305-0047.2014.1.33 (In Russ.)
13. Huskisson EC. Measurement of pain. Lancet. 1974 Nov;2(7889):1127-31.
14. The SF-36 questionnaire (Russian version created and recommended MZIKI) [Elektronnyi resurs]. Rezhim dostupa: www.gepatit.alllipetsk.ru/homeo/oprosnik_sf.doc. Data dostupa: 23.01.2018. (In Russ.)
15. Walther T, Falk V, Metz S, Diegeler A, Battellini R, Autschbach R, et al. Pain and quality of life after minimally invasive versus conventional cardiac surgery. Ann Thorac Surg. 1999 Jun;67(6):1643-7. doi: http://dx.doi.org/10.1016/S0003-4975(99)00284-2
16. Rogers CA, Pike K, Angelini GD, Reeves BC, Glauber M, Ferrarini M, Murphy GJ. An open randomized controlled trial of median sternotomy versus anterolateral left thoracotomy on morbidity and health care resource use in patients having off-pump coronary artery bypass surgery: the Sternotomy Versus Thoracotomy (STET) trial. J Thorac Cardiovasc Surg. 2013 Aug;146(2):306-16.e1-9. doi: http://dx.doi.org/10.1016/j.jtcvs.2012.04.020
17. Nesbitt JJ, Mori G, Mason-Apps C, Asimakopoulos G. Comparison of early and late quality of life between left anterior thoracotomy and median sternotomy off-pump coronary artery bypass surgery. Perfusion. 2017 Jan;32(1):50-56. doi: http://dx.doi.org/10.1177/0267659116657166
Information about authors:
Zenkov A.A. – Candidate of Medical Sciences, head of the cardiovascular department of Vitebsk Regional Clinical Hospital, associate professor of the Chair of Surgery of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University.