101
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Thielmann M, Sharma V, Al-Attar N, Bulluck H, Bisleri G, Bunge J, Czerny M, Ferdinandy P, Frey UH, Heusch G, Holfeld J, Kleinbongard P, Kunst G, Lang I, Lentini S, Madonna R, Meybohm P, Muneretto C, Obadia JF, Perrino C, Prunier F, Sluijter JPG, Van Laake LW, Sousa-Uva M, Hausenloy DJ. ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: Perioperative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery. Eur Heart J 2019; 38:2392-2407. [PMID: 28821170 PMCID: PMC5808635 DOI: 10.1093/eurheartj/ehx383] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Vikram Sharma
- Department of Internal Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.,The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Nawwar Al-Attar
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Agamemnon Street, G81 4DY, Clydebank, UK
| | - Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, 99 University Avenue, Kingston, Ontario K7L 3N6, Canada
| | - Jeroen Bunge
- Department of Intensive Care, Erasmus Medical Center,'s-Gravendijkwal 230, 3015 CE Rotterdam, Holland
| | - Martin Czerny
- Department of Cardiac Surgery, University Heart Center Freiburg-Bad Krozingen, Hugstetterstrasse 55, Freiburg, D-79106, Germany
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Üllői út 26, H - 1085 Budapest, Hungary.,Pharmahungary Group, Szeged, Graphisoft Park, 7 Záhony street, Budapest, H-1031, Hungary
| | - Ulrich H Frey
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Hufelandstr. 55, 45122 Essen, Germany
| | - Johannes Holfeld
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Christoph-Probst-Platz 1, Innrain 52, A-6020 Innsbruck, Austria
| | - Petra Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Hufelandstr. 55, 45122 Essen, Germany
| | - Gudrun Kunst
- Department of Anaesthetics, King's College Hospital and King's College London, Denmark Hill, London, SE5 9RS, UK
| | - Irene Lang
- Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Vienna, Austria
| | - Salvatore Lentini
- Department of Cardiac Surgery, The Salam Center for Cardiac Surgery, Soba Hilla, Khartoum, Sudan, Italy
| | - Rosalinda Madonna
- Center of Aging Sciences and Translational Medicine-CESI-Met and Institute of Cardiology, Department of Neurosciences, Imaging and Clinical Sciences "G. D"'Annunzio University, Via dei Vestini, 66100 Chieti, Italy.,The Center for Cardiovascular Biology and Atherosclerosis Research, Department of Internal Medicine, The University of Texas Medical School at Houston, 6431 Fannin Street, MSB 1.240, Houston, TX 77030, USA
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Claudio Muneretto
- Department of Cardiac Surgery, University of Brescia Medical School. P.le Spedali Civili, 1., Brescia, 25123, Italy
| | - Jean-Francois Obadia
- Department of Cardiothoracic Surgery, Louis Pradel Hospital, 28 Avenue du Doyen Jean Lépine, 69677 Bron Cedex, Lyon, France
| | - Cinzia Perrino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Corso Umberto I 40 - 80138 Naples, Italy
| | - Fabrice Prunier
- Department of Cardiology, Institut MITOVASC, University of Angers, University Hospital of Angers, 2 rue Lakanal, 49045 Angers Cedex 01, Angers, France
| | - Joost P G Sluijter
- Cardiology and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Linda W Van Laake
- Department of Cardiology, Division of Heart and Lungs and Regenerative Medicine Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Miguel Sousa-Uva
- Department of Cardiothoracic Surgery, Hospital da Cruz Vermelha, Lisbon, Portugal
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK.,The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Maple House Suite A 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK.,Cardiovascular and Metabolic Disorder Research Program, Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, 8 College Road, Singapore 169857, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
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102
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Janiec M, Dimberg A, Nazari Shafti TZ, Lagerqvist B, Lindblom RPF. No improvements in long-term outcome after coronary artery bypass grafting with arterial grafts as a second conduit: a Swedish nationwide registry study. Eur J Cardiothorac Surg 2019; 53:448-454. [PMID: 28958083 DOI: 10.1093/ejcts/ezx280] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/13/2017] [Accepted: 07/05/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Coronary artery bypass grafting using saphenous vein grafts (SVGs) in addition to the left internal mammary artery (IMA) graft is vitiated by poor long-term patency of the vein grafts. Hypothetically, the increased use of arterial grafts could confer even better outcomes. Our goal was to evaluate results after coronary artery bypass grafting in Sweden, where arterial grafts were used as a second conduit. METHODS Within the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we identified patients who had coronary artery bypass grafting from 2001 to 2015 using the IMA and the SVG, the radial artery (RA) or the additional IMA [bilateral IMA (BIMA)] as a second conduit. Deaths, postoperative incidence of coronary angiography and need for reintervention were recorded, and multivariable adjusted hazard ratios were calculated for different types of grafts. RESULTS The study population comprised 46 343 cases of IMA + SVG, 1036 cases of IMA + RA and 862 cases of BIMA. The mean follow-up time (SD) was 9.3 (4.2) years for IMA + SVG, 10.7 (4.1) years for IMA + RA grafts and 5.5 (5.0) years for the BIMA graft. The adjusted hazard ratio for death was (95% confidence interval) 1.01 (0.89-1.14) for IMA + RA and 0.87 (0.72-1.06) for BIMA grafts compared with IMA + SVG. The adjusted hazard ratio for the first angiographic examination was (95% confidence interval) 0.96 (0.84-1.10) for IMA + RA and 1.13 (0.95-1.35) for BIMA grafts. The adjusted hazard ratio for the need for reintervention was (95% confidence interval) 0.91 (0.75-1.09) for IMA + RA and 1.26 (1.00-1.58) for BIMA grafts. CONCLUSIONS Patients who had arterial grafts as second conduits did not demonstrate a better outcome in any of the studied end-points. Radial artery grafts seem to be preferable to BIMA grafts as an alternative to an SVG.
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Affiliation(s)
- Mikael Janiec
- Department of Cardiothoracic Surgery and Anaesthesia, Uppsala University Hospital, Uppsala, Sweden.,Section of Thoracic Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Axel Dimberg
- Department of Cardiothoracic Surgery and Anaesthesia, Uppsala University Hospital, Uppsala, Sweden.,Section of Thoracic Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Timo Z Nazari Shafti
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Bo Lagerqvist
- Department of Cardiology and Clinical Physiology, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Rickard P F Lindblom
- Department of Cardiothoracic Surgery and Anaesthesia, Uppsala University Hospital, Uppsala, Sweden.,Section of Thoracic Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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103
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Dreifaldt M, Mannion JD, Geijer H, Lidén M, Bodin L, Souza D. The no-touch saphenous vein is an excellent alternative conduit to the radial artery 8 years after coronary artery bypass grafting: A randomized trial. J Thorac Cardiovasc Surg 2019; 161:624-630. [PMID: 31831193 DOI: 10.1016/j.jtcvs.2019.09.177] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/26/2019] [Accepted: 09/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2004, a prospective randomized trial demonstrated that after 3 years, saphenous veins (SVs) harvested with a no touch (NT) technique had a greater patency than radial grafts for coronary bypass surgery. Here we report the 8-year follow-up data of this trial. METHODS The trial included 108 patients undergoing coronary artery bypass grafting (CABG). Each patient was assigned to receive 1 NT SV and 1 radial artery (RA) graft to either the left or right coronary territory to complement the left internal thoracic artery (LITA). Sequential grafting was common, so overall graft patency as well as the patency of each anastomosis were assessed. RESULTS Angiography was performed in 84 patients (78%) at mean of 97 months postoperatively. Graft patency were high and similar for both NT and RA: 86% for NT versus 79% for RA (P = .22). The patency of coronary anastomoses was significantly higher with the NT SV grafts (91% vs 81%; P = .046). The NT grafts also had excellent patency in coronary arteries with <90% stenosis (93% patency) and in coronary arteries of small diameter (87% patency) or with mild calcification (88% patency). Patency for the LITA was 92%. CONCLUSIONS NT SV grafts have excellent patency similar to that of RA grafts after 8 years. In addition, NT SV grafts can be used in situations that are not ideal for RA grafts.
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Affiliation(s)
- Mats Dreifaldt
- Faculty of Medicine and Health, Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, Örebro University, Örebro, Sweden
| | - John D Mannion
- Department of Surgery, Bayhealth Medical Center, Dover, Del
| | - Håkan Geijer
- Faculty of Medicine and Health, Department of Radiology, Örebro University, Örebro, Sweden
| | - Mats Lidén
- Faculty of Medicine and Health, Department of Radiology, Örebro University, Örebro, Sweden
| | - Lennart Bodin
- Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Domingos Souza
- Faculty of Medicine and Health, Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, Örebro University, Örebro, Sweden.
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104
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Tzoumas A, Giannopoulos S, Texakalidis P, Charisis N, Machinis T, Koullias GJ. Synchronous versus Staged Carotid Endarterectomy and Coronary Artery Bypass Graft for Patients with Concomitant Severe Coronary and Carotid Artery Stenosis: A Systematic Review and Meta-analysis. Ann Vasc Surg 2019; 63:427-438.e1. [PMID: 31629126 DOI: 10.1016/j.avsg.2019.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Due to the systemic nature of atherosclerosis, arteries at different sites are commonly simultaneously affected. As a result, severe coronary artery disease (CAD) requiring coronary artery bypass grafting (CABG) frequently coexists with significant carotid stenosis that warrants revascularization. To compare simultaneous carotid endarterectomy (CEA) and CABG versus staged CEA and CABG for patients with concomitant CAD and carotid artery stenosis in terms of perioperative outcomes. METHODS This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A meta-analysis was conducted with the use of a random effects model. The I2 statistic was used to assess for heterogeneity. RESULTS Eleven studies comprising 44,895 patients were included in this meta-analysis (21,710 in the synchronous group and 23,185 patients in the staged group). The synchronous CEA and CABG group had a statistically significant lower risk for myocardial infarction (MI) (odds ratio [OR] 0.15, 95% CI 0.04-0.61, I2 = 0%) and higher risk for stroke (OR 1.51, 95% CI 1.34-1.71, I2 = 0%) and death (OR 1.33, 95% CI 1.01-1.75, I2 = 47.8%). Transient ischemic attacks (TIAs) (OR 1.27, 95% CI 1.00-1.61, I2 = 0.0%), postoperative bleeding (OR 0.82, 95% CI 0.22-3.05, I2 = 0.0%), and pulmonary complications (OR 1.52, 95% CI 0.24-9.60, I2 = 67.5%) were similar between the 2 groups. CONCLUSIONS Patients in the simultaneous CEA and CABG group had a significantly higher risk of 30-day mortality and stroke and lower risk for MI as compared to staged CEA and CABG group. The rates of TIA, postoperative bleeding, and pulmonary complications were similar between the 2 groups. Future randomized trials or prospective cohorts are needed to validate our results.
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Affiliation(s)
- Andreas Tzoumas
- Department of Internal Medicine, Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Pavlos Texakalidis
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA
| | - Nektarios Charisis
- Division of Surgical Oncology, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Theofilos Machinis
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA
| | - George J Koullias
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY
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105
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Nawrocki MJ, Perek B, Sujka-Kordowska P, Konwerska A, Kałużna S, Zawierucha P, Bruska M, Zabel M, Jemielity M, Nowicki M, Kempisty B, Malińska A. Differences in Expression of Genes Involved in Bone Development and Morphogenesis in the Walls of Internal Thoracic Artery and Saphenous Vein Conduits May Provide Markers Useful for Evaluation Graft Patency. Int J Mol Sci 2019; 20:ijms20194890. [PMID: 31581653 PMCID: PMC6801533 DOI: 10.3390/ijms20194890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 01/22/2023] Open
Abstract
Coronary artery bypass grafting (CABG) is one of the most efficient procedures for patients with advanced coronary artery disease. From all the blood vessels with the potential to be used in this procedure, the internal thoracic artery (ITA) and the saphenous vein (SV) are the most commonly applied as aortocoronary conduits. Nevertheless, in order to evaluate the graft patency and efficiency effectively, basic knowledge should be constantly expanding at the molecular level as well, as the understanding of predictive factors is still limited. In this study, we have employed the expressive microarray approach, validated with Real-Time Quantitative Polymerase Chain Reaction (RT-qPCR), to analyze the transcriptome of both venous and arterial grafts. Searching for potential molecular factors, we analyzed differentially expressed gene ontologies involved in bone development and morphogenesis, for the possibility of discovery of new markers for the evaluation of ITA and SV segment quality. Among three ontological groups of interest—“endochondral bone morphogenesis”, “ossification”, and “skeletal system development”—we found six genes common to all of them. BMP6, SHOX2, COL13A1, CSGALNACT1, RUNX2, and STC1 showed differential expression patterns in both analyzed vessels. STC1 and COL13A1 were upregulated in ITA samples, whereas others were upregulated in SV. With regard to the Runx2 protein function in osteogenic phenotype regulation, the RUNX2 gene seems to be of paramount importance in assessing the potential of ITA, SV, and other vessels used in the CABG procedure. Overall, the presented study provided valuable insight into the molecular background of conduit characterization, and thus indicated genes that may be the target of subsequent studies, also at the protein level. Moreover, it has been suggested that RUNX2 may be recognized as a molecular marker of osteogenic changes in human blood vessels.
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Affiliation(s)
- Mariusz J Nawrocki
- Department of Anatomy, Poznan University of Medical Sciences, 60-781 Poznań, Poland.
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Poznań, Poland.
| | - Patrycja Sujka-Kordowska
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznań, Poland.
| | - Aneta Konwerska
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznań, Poland.
| | - Sandra Kałużna
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznań, Poland.
| | - Piotr Zawierucha
- Department of Anatomy, Poznan University of Medical Sciences, 60-781 Poznań, Poland.
| | - Małgorzata Bruska
- Department of Anatomy, Poznan University of Medical Sciences, 60-781 Poznań, Poland.
| | - Maciej Zabel
- Division of Anatomy and Histology, University of Zielona Góra, 65-046 Zielona Góra, Poland.
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-368 Wrocław, Poland.
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Poznań, Poland.
| | - Michał Nowicki
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznań, Poland.
| | - Bartosz Kempisty
- Department of Anatomy, Poznan University of Medical Sciences, 60-781 Poznań, Poland.
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznań, Poland.
- Department of Obstetrics and Gynecology, University Hospital and Masaryk University, 601 77 Brno, Czech Republic.
| | - Agnieszka Malińska
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznań, Poland.
- Division of Anatomy and Histology, University of Zielona Góra, 65-046 Zielona Góra, Poland.
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106
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Samadashvili Z, Sundt TM, Wechsler A, Chikwe J, Adams DH, Smith CR, Jordan D, Girardi L, Lahey SJ, Gold JP, Ashraf MH, Hannan EL. Multiple Versus Single Arterial Coronary Bypass Graft Surgery for Multivessel Disease. J Am Coll Cardiol 2019; 74:1275-1285. [DOI: 10.1016/j.jacc.2019.06.067] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/27/2022]
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107
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Jha AK, Malik V. Diagnosis and Management of Ischemic Mitral Regurgitation: Evidence-Based Clinical Decision Making at the Point of Care. Semin Cardiothorac Vasc Anesth 2019; 23:268-281. [PMID: 29291344 DOI: 10.1177/1089253217745363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Abstract
Anatomical, functional, and pathophysiologic mechanisms of ischemic mitral regurgitation (IMR) are markedly different from the primary mitral regurgitation. The older and ubiquitous cutoff of EROA (effective regurgitant orifice area) and Rvol (regurgitant volume) for IMR has been reinstated in the new guideline after a brief hiatus. There had always been a lack of good-quality evidence for its introduction for guiding IMR severity in the previous guideline, and we still do not have quality evidences that could justify its reintroduction. Unlike primary MR, IMR is usually associated with reduced ejection fraction. Therefore, it appears unrealistic to keep the similar cutoff for primary MR and IMR. The cutoff of severity can be modified according to projected values of Rvol normalized to ejection fraction and EROA normalized to Rvol. In addition, the treatment outcome in these patients is determined by factors (left ventricular dyssynchrony, annular dilatation, tenting area, tenting height, tenting volume, and myocardial viability) other than the simple grading. In this review article, a series of graph have been constructed from the numerical data derived from the literatures on IMR to depict the relationship between EROA, Rvol, left ventricular end diastolic volume, and ejection fraction in order to obtain a reasonable projection formula for EROA and Rvol. Furthermore, a management algorithm has been proposed for patients with IMR undergoing coronary artery bypass grafting based on echocardiographic predictors that influence the postoperative outcome.
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Affiliation(s)
- Ajay Kumar Jha
- 1 Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vishwas Malik
- 2 All India Institute of Medical Sciences, New Delhi, India
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108
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Aty W, Lo E, Xuan W, Dignan RJ, French B, Verchin R. Predictors of acute kidney insufficiency post isolated coronary artery bypass grafting surgery. THE CARDIOTHORACIC SURGEON 2019. [DOI: 10.1186/s43057-019-0005-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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109
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Multiarterial coronary artery bypass grafting: is the radial artery fulfilling the unkept promise of the right internal thoracic artery? Curr Opin Cardiol 2019; 34:628-636. [PMID: 31389824 DOI: 10.1097/hco.0000000000000670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW The debate on the second best conduit for CABG is still intense. In this review, we discuss the role of the radial artery and the right internal thoracic artery (RITA) compared with saphenous vein grafts (SVG). RECENT FINDINGS The recent RADIAL STUDY has been the first evidence based on randomized trials of a clinical benefit using a second arterial graft in CABG.On the other hand, the definitive 10-year results of the ART trial failed to show a clinical advantage associated with the use of bilateral internal thoracic artery (BITA). A thorough and contextualized analysis of this and other studies, however, may offer a different perspective. SUMMARY Arterial conduits in CABG have shown better patency rates than SVG. Whether this leads to better clinical outcomes is still debated. In this setting, the radial artery and the RITA seem to offer a similar advantage, although with different indications and contraindications.
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110
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Tam DY, Bakaeen F, Feldman DN, Kolh P, Lanza GA, Ruel M, Piccolo R, Fremes SE, Gaudino M. Modality Selection for the Revascularization of Left Main Disease. Can J Cardiol 2019; 35:983-992. [DOI: 10.1016/j.cjca.2018.12.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 01/30/2023] Open
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111
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Hui DS, Lee R. Treatment of postoperative atrial fibrillation: The long road ahead. J Thorac Cardiovasc Surg 2019; 159:1840-1843. [PMID: 31358335 DOI: 10.1016/j.jtcvs.2019.05.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Richard Lee
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Ga.
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112
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Gaudino M, Angiolillo DJ, Di Franco A, Capodanno D, Bakaeen F, Farkouh ME, Fremes SE, Holmes D, Girardi LN, Nakamura S, Head SJ, Park S, Mack M, Serruys PW, Ruel M, Stone GW, Tam DY, Vallely M, Taggart DP. Stroke After Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention: Incidence, Pathogenesis, and Outcomes. J Am Heart Assoc 2019; 8:e013032. [PMID: 31242821 PMCID: PMC6662343 DOI: 10.1161/jaha.119.013032] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew YorkNY
| | | | | | - Davide Capodanno
- Division of CardiologyC.A.S.T., P.O. “Rodolico”Azienda Ospedaliero‐Universitaria “Policlinico‐Vittorio Emanuele”University of CataniaItaly
| | | | - Michael E. Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar CentreUniversity of TorontoOntarioCanada
| | - Stephen E. Fremes
- Schulich Heart CentreSunnybrook Health ScienceUniversity of TorontoCanada
| | | | | | | | - Stuart J. Head
- Department of Cardiothoracic SurgeryErasmus University Medical CentreRotterdamThe Netherlands
| | - Seung‐Jung Park
- Department of CardiologyHeart InstituteUniversity of Ulsan College of MedicineAsian Medical CenterSeoulKorea
| | | | | | - Marc Ruel
- Division of Cardiac SurgeryUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | | | - Derrick Y. Tam
- Schulich Heart CentreSunnybrook Health ScienceUniversity of TorontoCanada
| | - Michael Vallely
- Sydney Medical SchoolThe University of SydneyNew South WalesAustralia
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113
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Shahian DM. Commentary: Driving improvement. J Thorac Cardiovasc Surg 2019; 159:1794-1795. [PMID: 31255341 DOI: 10.1016/j.jtcvs.2019.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Affiliation(s)
- David M Shahian
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
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114
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Shahian DM. Professional Society Leadership in Health Care Quality: The Society of Thoracic Surgeons Experience. Jt Comm J Qual Patient Saf 2019; 45:466-479. [DOI: 10.1016/j.jcjq.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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115
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Fortier JH, Ferrari G, Glineur D, Gaudino M, Shaw RE, Ruel M, Grau JB. Implications of coronary artery bypass grafting and percutaneous coronary intervention on disease progression and the resulting changes to the physiology and pathology of the native coronary arteries. Eur J Cardiothorac Surg 2019; 54:809-816. [PMID: 29688287 DOI: 10.1093/ejcts/ezy171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/26/2018] [Indexed: 11/13/2022] Open
Abstract
Myocardial revascularization can be achieved through 2 different methods: coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Clinical trials comparing PCI and CABG generally use the composite end points of death, stroke, myocardial infarction and target vessel revascularization to determine superiority. Other effects of these interventions, including the preservation of normal coronary physiology, the response of the coronary tree to stressors and the response of the vessel wall to the revascularization intervention, are not routinely considered, but these may have significant implications for patients in the medium and long term. For PCI, relatively small differences in clinical outcomes have been reported between bare metal and drug-eluting stents, and the latter seems to have inconsistent and somewhat unpredictable effects on the vascular biology of the coronary arteries. In coronary bypass, the use of arterial conduits is associated with superior clinical outcomes, better long-term patency and the preservation of essentially normal coronary function after intervention. This review assembles the clinical, physiological, angiographic and pathological literature currently available and attempts to provide a more complete picture of the effects of CABG and PCI on coronary arteries.
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Affiliation(s)
- Jacqueline H Fortier
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | | | - David Glineur
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, USA
| | - Richard E Shaw
- The Valley Columbia Heart Center, Ridgewood, New Jersey, USA
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - Juan B Grau
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
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116
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Pu A, Ding L, Shin J, Price J, Skarsgard P, Wong DR, Bozinovski J, Fradet G, Abel JG. Long-term Outcomes of Multiple Arterial Coronary Artery Bypass Grafting: A Population-Based Study of Patients in British Columbia, Canada. JAMA Cardiol 2019; 2:1187-1196. [PMID: 29049458 DOI: 10.1001/jamacardio.2017.3705] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Although the long-term survival advantage of multiple arterial grafting (MAG) vs the standard use of left internal thoracic artery (LITA) supplemented by saphenous vein grafts (LITA+SVG) has been demonstrated in several observational studies, to our knowledge its safety and other long-term clinical benefits in a large, population-based cohort are unknown. Objective To compare the safety and long-term outcomes of MAG vs LITA+SVG among overall and selected subgroups of patients. Design, Setting, and Participants In this population-based observational study, we included 20 076 adult patients with triple-vessel or left-main disease who underwent primary isolated coronary artery bypass grafting (MAG, n = 5580; LITA+SVG, n = 14 496) in the province of British Columbia, Canada, from January 2000 to December 2014, with follow-up to December 2015. We performed propensity-score analyses by weighting and matching and multivariable Cox regression to minimize treatment selection bias. Exposures Multiple arterial grafting or LITA+SVG. Main Outcomes and Measures Mortality, repeated revascularization, myocardial infarction, heart failure, and stroke. Results Of 5580 participants who underwent MAG, 586 (11%) were women and the mean (SD) age was 60 (8.7) years. Of 14 496 participants who underwent LITA+SVG, 2803 (19%) were women and the mean (SD) age was 68 (8.9) years. The median (interquartile range) follow-up time was 9.1 (5.1-12.6) years and 8.1 (4.5-11.7) years for the groups receiving MAG and LITA+SVG, respectively. Compared with LITA+SVG, MAG was associated with reduced mortality rates (hazard ratio [HR], 0.79; 95% CI, 0.72-0.87) and repeated revascularization rates (HR, 0.74; 95% CI, 0.66-0.84) in 15-year follow-up and reduced incidences of myocardial infarction (HR, 0.63; 95% CI, 0.47-0.85) and heart failure (HR, 0.79; 95% CI, 0.64-0.98) in 7-year follow-up. The long-term benefits were coherent by all 3 statistical methods and persisted among patient subgroups with diabetes, obesity, moderately impaired ejection fraction, chronic obstructive pulmonary disease, peripheral vascular disease, or renal disease. Multiple arterial grafting was not associated with increased morbidity or mortality rates at 30 days overall or within patient subgroups. Conclusions and Relevance Compared with LITA+SVG, MAG is associated with reduced mortality, repeated revascularization, myocardial infarction, and heart failure among patients with multivessel disease who are undergoing coronary artery bypass grafting without increased mortality or other adverse events at 30 days. The long-term benefits consistently observed across multiple outcomes and subgroups support the consideration of MAG for a broader spectrum of patients who are undergoing coronary artery bypass grafting in routine practice.
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Affiliation(s)
- Aihua Pu
- Cardiac Services BC, Vancouver, British Columbia, Canada
| | - Lillian Ding
- Cardiac Services BC, Vancouver, British Columbia, Canada
| | - Jungwon Shin
- Cardiac Services BC, Vancouver, British Columbia, Canada
| | - Joel Price
- Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Skarsgard
- Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel R Wong
- University of British Columbia, Vancouver, British Columbia, Canada.,Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - John Bozinovski
- University of British Columbia, Vancouver, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Guy Fradet
- University of British Columbia, Vancouver, British Columbia, Canada.,Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - James G Abel
- University of British Columbia, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
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Barbarash OL, Zhidkova II, Shibanova IA, Ivanov SV, Sumin AN, Samorodskaya IV, Barbarash LS. The impact of comorbidities and age on the nosocomial outcomes of patients undergoing coronary artery bypass grafting. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-2-58-64] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - I. I. Zhidkova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - I. A. Shibanova
- L.S. Barbarash Kemerovo Regional Clinical Cardiology Dispensary
| | - S. V. Ivanov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - A. N. Sumin
- Research Institute for Complex Issues of Cardiovascular Diseases
| | | | - L. S. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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118
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Shahian DM, Fernandez FG, Badhwar V. The Society of Thoracic Surgeons National Database at 30: Honoring Our Heritage, Celebrating the Present, Evolving for the Future. Ann Thorac Surg 2019; 107:1259-1266. [DOI: 10.1016/j.athoracsur.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 12/01/2022]
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119
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Bagheri H, Ebrahimi H, Abbasi A, Atashsokhan G, Salmani Z, Zamani M. Effect of Preoperative Visitation by Operating Room Staff on Preoperative Anxiety in Patients Receiving Elective Hernia Surgery. J Perianesth Nurs 2019; 34:272-280. [DOI: 10.1016/j.jopan.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/07/2018] [Accepted: 04/14/2018] [Indexed: 10/28/2022]
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Brieger DB, Ng ACC, Chow V, D'Souza M, Hyun K, Bannon PG, Kritharides L. Falling hospital and postdischarge mortality following CABG in New South Wales from 2000 to 2013. Open Heart 2019; 6:e000959. [PMID: 31168375 PMCID: PMC6519410 DOI: 10.1136/openhrt-2018-000959] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/24/2019] [Accepted: 02/10/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives To describe changes in mortality among patients undergoing coronary artery bypass grafting (CABG) in New South Wales (NSW) Australia from 2000 to 2013. Methods Patients undergoing CABG were identified from the NSW Admission Patient Data Collection (APDC) registry, linked to the NSW state-wide death registry database. Changes in all-cause mortality over time were observed following stratification of the study cohort into two year groups. Results We identified 54 767 patients undergoing CABG during the study period. The risk profile of patients increased over time with significant increases in age, comorbidities and concomitant valve surgery (all p < 0.0001). During a median follow-up period of 6 years, a total 12 161 (22.2%) of patients had died. Survival curves and adjusted analyses showed a steady fall in mortality rate: those operated on during 2012–2013 had 40 % lower mortality than those operated on during 2000–2001 (HR 0.61; 95% CI 0.53 to 0.69). This was contributed to both by a fall in mortality both in hospital (HR 0.48, 95% CI 0.37 to 0.62) and postdischarge (HR 0.73; 95% CI 0.61 to 0.86). Conclusions We report a consistent reduction in medium-term mortality among a large unselected cohort of NSW patients undergoing CABG between 2000 and 2013. This fall is attributable both to an improvement in outcomes in hospital and in the postdischarge period.
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Affiliation(s)
- David B Brieger
- Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
| | - Austin C C Ng
- Department of Cardiology, Concord Hospital and The University of Sydney, Concord, New South Wales, Australia
| | - Vincent Chow
- Department of Cardiology, Concord Hospital, The University of Sydney and ANZAC Medical Research Institute, Sydney, New South Wales, Australia
| | - Mario D'Souza
- Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
| | - Karice Hyun
- Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
| | - Paul G Bannon
- Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
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121
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Virk HUH, Lakhter V, Ahmed M, O' Murchu B, Chatterjee S. Radial Artery Versus Saphenous Vein Grafts in Coronary Artery Bypass Surgery: a Literature Review. Curr Cardiol Rep 2019; 21:36. [PMID: 30903300 DOI: 10.1007/s11886-019-1112-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Coronary artery bypass grafting is a preferred strategy for complete coronary revascularization in patients who have multi-vessel coronary artery disease, left ventricular dysfunction, and/or diabetes. Both arterial (internal thoracic artery/radial artery) and venous grafts are utilized to bypass the obstruction in native vessels. Despite having radial arterial grafts as a preferred second conduit for bypass, venous grafts are more commonly used. RECENT FINDINGS We review the existing literature and report the preferred conduit based on a recently published meta-analysis of 6 randomized controlled trials. The analysis concluded that radial artery grafts are associated with fewer adverse cardiac events and better graft patency at 5 years of follow-up. Although saphenous vein grafting is the most commonly used conduit in addition to ITA, current data suggests that total arterial bypass (using RA conduit in addition to ITA) may be the better strategy. Both the US and European consensus guidelines advocate for the use of arterial over SV grafting for most patients.
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Affiliation(s)
- Hafeez Ul Hassan Virk
- Department of Cardiovascular Diseases, Einstein healthcare Network, Philadelphia, PA, USA
| | - Vladimir Lakhter
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Muhammad Ahmed
- Department of Cardiology, Ochsner Health system, New Orleans, LA, USA
| | | | - Saurav Chatterjee
- Division of Cardiology, Hoffman Heart Institute, St Francis Hospital, Hartford, CT, USA.
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122
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Rodríguez-Cubillo B, Carnero-Alcázar M, Cobiella-Carnicer J, Rodríguez-Moreno A, Alswies A, Velo-Plaza M, Pérez-Camargo D, Sánchez Fructuoso A, Maroto-Castellanos L. Impact of postoperative acute kidney failure in long-term survival after heart valve surgery. Interact Cardiovasc Thorac Surg 2019; 29:35-42. [DOI: 10.1093/icvts/ivz035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/26/2019] [Accepted: 01/29/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Manuel Carnero-Alcázar
- Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Cobiella-Carnicer
- Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ali Alswies
- Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Daniel Pérez-Camargo
- Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Luis Maroto-Castellanos
- Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
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123
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Gaudino MFL, Spadaccio C, Taggart DP. State-of-the-Art Coronary Artery Bypass Grafting: Patient Selection, Graft Selection, and Optimizing Outcomes. Interv Cardiol Clin 2019; 8:173-198. [PMID: 30832941 DOI: 10.1016/j.iccl.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite the progressive expansion of clinical indications for percutaneous coronary intervention and the increasingly high risk profile of referred patients, coronary artery bypass grafting (CABG) remains the mainstay in multivessel disease, providing good long-term outcomes with low complication rates. Multiple arterial grafting, especially if associated with anaortic techniques, might provide the best longer-term outcomes. A surgical approach individualized to the patients' clinical and anatomic characteristics, and surgeon and team experience, are key to excellent outcomes. Current evidence regarding patient selection, indications, graft selection, and potential strategies to optimize outcomes in patients treated with CABG is summarized.
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Affiliation(s)
- Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10021, USA.
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow G81 4DY, UK; University of Glasgow, Institute of Cardiovascular and Medical Sciences, 126 University Place, Glasgow G128TA, UK
| | - David P Taggart
- Department of Cardiovascular Surgery, University of Oxford, Headley Way, Oxford, Oxforshire OX39DU, UK; Department Cardiac Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, Oxfordshire OX3 9DU, UK
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124
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Wallgren S, Nielsen S, Pan E, Pivodic A, Hansson EC, Malm CJ, Jeppsson A, Wallinder A. A single sequential snake saphenous vein graft versus separate left and right vein grafts in coronary artery bypass surgery: a population-based cohort study from the SWEDEHEART registry†. Eur J Cardiothorac Surg 2019; 56:518-525. [DOI: 10.1093/ejcts/ezz057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/20/2018] [Accepted: 02/19/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
OBJECTIVES
Our goal was to compare short- and midterm outcomes after coronary artery bypass grafting (CABG) using 2 different revascularization strategies.
METHODS
A total of 6895 patients were included who had CABG in Sweden from 2009 to 2015 using the left internal mammary artery to the left anterior descending artery and either a single sequential saphenous vein graft connecting the left and right coronary territories to the aorta (snake graft, n = 2122) or separate vein grafts to both territories (n = 4773). Data were obtained from the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) and the Swedish Patient Registry. The groups were compared using adjusted logistic regression for short-term (30-day) and Cox regression and flexible parametric survival models for midterm outcomes. Primary outcome was a composite of all-cause mortality, myocardial infarction (MI), reangiography and new revascularization. The median follow-up time was 35 months.
RESULTS
At 30 days, the incidences of the composite end point [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.03–1.68; P = 0.03] and reangiography (OR 1.51, 95% CI 1.07–2.14; P = 0.02) were higher in the snake group. There was also a trend towards higher mortality (OR 1.47, 95% CI 0.97–2.22; P = 0.07). The event rates during the complete follow-up period were 6.5 (5.9–7.2) and 5.7 (5.3–6.1) per 100 person-years for the snake group and the separate vein group, respectively. At the midterm follow-up, no significant difference between the groups could be shown for the composite end point [hazard ratio (HR) 1.08, 95% CI 0.95–1.22; P = 0.24], mortality (HR 0.95, 95% CI 0.79–1.14; P = 0.56), MI (HR 1.11, 95% CI 0.88–1.41; P = 0.39) or new revascularization (HR 1.19, 95% CI 0.94–1.50; P = 0.15), whereas reangiography remained more common in the snake group (HR 1.25, 95% CI 1.05–1.48; P = 0.01).
CONCLUSIONS
Snake grafts were associated with a higher rate of early postoperative complications, possibly reflecting a more demanding surgical technique, whereas midterm outcomes were comparable. Based on these data, one strategy cannot be recommended over the other.
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Affiliation(s)
- Sara Wallgren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne Nielsen
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emily Pan
- Department of Cardiothoracic surgery, Turku University Hospital, Turku, Finland
| | | | - Emma C Hansson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Johan Malm
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Wallinder
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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125
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Zhu P, Chen A, Wang Z, Ye X, Zhou M, Liu J, Zhao Q. Long-term outcomes of multiple and single arterial off-pump coronary artery bypass grafting. J Thorac Dis 2019; 11:909-919. [PMID: 31019780 PMCID: PMC6462725 DOI: 10.21037/jtd.2019.01.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/17/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND To compare the clinical outcomes between multiple arterial (MA) and single arterial (SA) off-pump coronary artery bypass grafting (OPCAB) when applied to left main coronary disease or three-vessel disease. METHODS A total of 537 patients with left main coronary disease or three-vessel disease underwent MA OPCAB (n=114) or SA OPCAB (n=423) in our center from January 2006 to December 2008. The propensity score matching (PSM) was used to obtain the risk-adjusted outcome. Both the perioperative and long-term results were analyzed. RESULTS The median follow-up time was 117 months (interquartile range, 110 to 128 months). There was no statistical difference in postoperative mortality and the volume of drainage. The intensive care unit (ICU) length of stay (LOS) of the MA group was shorter than that of the SA group {1 [1-2] vs. 2 [1-3], P=0.001). In the long term, the mortality (5.7% vs. 17.5%, P=0.006), cardiac mortality (1.0% vs. 8.8%, P=0.008), fatal myocardial infarction (MI) rate (0.0% vs. 6.1%, P=0.015) and incidence of readmission for heart failure (19.8% vs. 37.7%, P=0.003) were lower in the MA group than in the SA group. The distributions of NYHA class (P<0.001) and CCS class (P<0.001) were better in the MA group than in the SA group. There was no significant difference in other outcomes. These results were consistent with the K-M curves of freedom from the adverse events. CONCLUSIONS MA OPCAB was as safe as SA OPCAB, providing better perioperative recovery and better long-term clinical outcomes in the treatment of left main coronary disease or three-vessel disease.
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Affiliation(s)
- Pengxiong Zhu
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Anqing Chen
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhe Wang
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiaofeng Ye
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Mi Zhou
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jun Liu
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qiang Zhao
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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126
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Paez RP, Hossne Junior NA, Santo JADE, Berwanger O, Santos RHN, Kalil RAK, Jatene FB, Cavalcanti AB, Zilli AC, Bettiati Jr LC, Figueira FAMDS, D'Azevedo SSP, Soares MJF, Fernandes MP, Ardito RV, Bogdan RAB, Campagnucci VP, Nakasako D, Rodrigues CG, Rodrigues Junior AB, Cascudo MM, Atik FA, Lima EB, Nina VJDS, Heluy RA, Azeredo LG, Henrique Junior OS, de Mendonça JT, Silva KKDOG, Pandolfo M, de Lima Júnior JD, Faria RM, dos Santos JG, Coelho GHB, Pereira SN, Senger R, Buffolo E, Caputi GM, de Oliveira JAB, Gomes WJ. Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry. Braz J Cardiovasc Surg 2019; 34:142-148. [PMID: 30916123 PMCID: PMC6436784 DOI: 10.21470/1678-9741-2018-0313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/27/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. OBJECTIVE To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. METHODS A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. RESULTS Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. CONCLUSION CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.
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Affiliation(s)
- Rodrigo Pereira Paez
- Hospital São Paulo, Escola Paulista de Medicina da
Universidade Federal de São Paulo, (EPM - UNIFESP), São Paulo, SP,
Brazil
| | - Nelson Américo Hossne Junior
- Hospital São Paulo, Escola Paulista de Medicina da
Universidade Federal de São Paulo, (EPM - UNIFESP), São Paulo, SP,
Brazil
| | | | - Otavio Berwanger
- Instituto de Pesquisa do Hospital do Coração (IP -
HCor), São Paulo, SP, Brazil
| | | | - Renato Abdala Karam Kalil
- Instituto de Cardiologia do Rio Grande do Sul -
Fundação Universitária de Cardiologia, Porto Alegre, RS,
Brazil
| | - Fabio B. Jatene
- Cardiovascular Surgery Division, Instituto do Coração
do Hospital das Clínicas da Faculdade de Medicina da Universidade de
São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | - Roberto Vito Ardito
- Instituto de Moléstias Cardiovasculares (IMC), São
José do Rio Preto, SP, Brazil
| | | | - Valquíria Pelisser Campagnucci
- Irmandade da Santa Casa de São Paulo (INCT-HPV/Faculdade de
Ciências Médicas da Santa Casa de São Paulo), São Paulo,
SP, Brazil
| | - Diana Nakasako
- Irmandade da Santa Casa de São Paulo (INCT-HPV/Faculdade de
Ciências Médicas da Santa Casa de São Paulo), São Paulo,
SP, Brazil
| | - Clarissa Garcia Rodrigues
- Instituto de Cardiologia do Rio Grande do Sul -
Fundação Universitária de Cardiologia, Porto Alegre, RS,
Brazil
| | | | | | | | | | | | | | | | | | | | | | - Marcelo Pandolfo
- Instituto de Cirurgia Cardiovascular (ICCV)/Hospital Nossa Senhora
da Salete, Cascavel, PR, Brazil
| | | | | | | | | | | | - Roberta Senger
- Hospital Universitário de Santa Maria, Santa Maria, RS,
Brazil
| | - Enio Buffolo
- Hospital do Coração (HCor), São Paulo, SP,
Brazil
| | | | | | - Walter J. Gomes
- Hospital São Paulo, Escola Paulista de Medicina da
Universidade Federal de São Paulo, (EPM - UNIFESP), São Paulo, SP,
Brazil
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127
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Dadkhah-Tirani H, Hasandokht T, Agostoni P, Salari A, Shad B, Soltanipour S. Comparison of cardiovascular risk factors among coronary artery bypass graft patients in 2010 and 2016: A single-center study in Guilan province, Iran. ARYA ATHEROSCLEROSIS 2019; 14:205-211. [PMID: 30783410 PMCID: PMC6368195 DOI: 10.22122/arya.v14i5.1740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There has been a change in the risk factor profile of patients with coronary artery disease (CAD) in the western world. We sought to compare the risk factor profile of patients undergoing coronary artery bypass graft (CABG) surgery in northern part of Iran in 2010 and 2016. METHODS In a cross-sectional study, medical records of 296 CABG patients in 2010 and 500 patients in 2016 were collected from a referral university hospital in Guilan province, Iran. We compared the risk factor profile using chi-square test or independent t-test as needed in the two time points, 2010 and 2016. RESULTS The age of CABG patients significantly decreased from 62.49 ± 8.05 to 58.09 ± 9.20 over time. The frequency of hypertension (HTN) (66.2% vs. 59.1%, P = 0.045), diabetes mellitus (DM) (51.8% vs. 43.6%, P = 0.025), smoking (35.6% vs. 28.0%, P = 0.028), and patients with multimorbidity (31.8% vs. 26.7%, P = 0.001) increased in the second period compared to the first period of study. Whereas, the prevalence of hypercholesterolemia and positive family history of coronary heart disease (CHD) remained stable over time (49.6% vs. 49.0%, P = 0.870; 10.5% vs. 11.1%, P = 0.810, respectively). CONCLUSION We observed a dramatic increase in DM, HTN, and cigarette smoking as well as the multimorbidity prevalence in 2016 compared to 2010. Even with considering all study limitations, primary and secondary prevention program to decrease cardiovascular disease is required.
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Affiliation(s)
- Heidar Dadkhah-Tirani
- Assistant Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Tolou Hasandokht
- Assistant Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Piergiuseppe Agostoni
- Professor, Centro Cardiologico Monzino IRCCS AND Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Arsalan Salari
- Associate Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Bijan Shad
- Associate Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Soltanipour
- Associate Professor, Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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128
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Pretreatment with glucose-insulin-potassium improves ventricular performances after coronary artery bypass surgery: a randomized controlled trial. J Clin Monit Comput 2019; 34:29-40. [PMID: 30788810 PMCID: PMC7223403 DOI: 10.1007/s10877-019-00280-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/12/2019] [Indexed: 12/19/2022]
Abstract
Heart failure is the main cause of poor outcome following open heart surgery and experimental studies have demonstrated that glucose–insulin–potassium (GIK) infusion exerts cardioprotective effects by reducing myocardial ischemia–reperfusion injuries. This randomized controlled trial was designed to assess the effects of GIK on left ventricular function in moderate-to-high risk patients undergoing on-pump isolated coronary artery bypass surgery (CABGS), or combined with aortic valve replacement. The primary outcomes were the effects of GIK on two- and three-dimensional left ventricular ejection fraction (2D and 3D-LVEF), and on transmitral flow propagation velocity (Vp), that occurred between the pre- and post-CPB periods. GIK administration was associated with favorable interaction effects (p < 0.001) on 2D-LVEF, 3D-LVEF and Vp changes over the study periods. In GIK pretreated patients (N = 54), 2-D and 3D-LVEF and Vp increased slightly during surgery (mean difference [MD] + 3.5%, 95% confidence interval [95% CI] − 0.2 to 7.1%, MD + 4.0%, 95% CI 0.6–7.4%, and MD + 22.2%, 95% CI 16.0–28.4%, respectively). In contrast, in the Placebo group (N = 46), 2D-and 3D-LVEF, as well as Vp all decreased after CPB (MD − 7.5% [− 11.6 to − 3.4%], MD − 12.0% [− 15.2 to − 8.8%] and MD − 21.3% [− 25.7 to − 16.9%], respectively). In conclusion, the administration of GIK resulted in better preservation of systolic and diastolic ventricular function in the early period following weaning from CPB.
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129
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Schulman-Marcus J, Peterson K, Banerjee R, Samy S, Yager N. Coronary Revascularization in High-Risk Stable Patients With Significant Comorbidities: Challenges in Decision-Making. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:5. [PMID: 30739215 DOI: 10.1007/s11936-019-0706-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW There is a growing cohort of complex high-risk patients with stable ischemic heart disease (SIHD) who present for coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). These patients are older, have complex coronary disease, and a substantial comorbidity burden including frailty. The procedural risks and outcomes of CABG and PCI in these patients are more difficult to assess based on the available literature, which has generally studied a younger population with a lower comorbidity burden. RECENT FINDINGS There have been initiatives to recalibrate and expand risk models derived from procedural registries to inform the care of complex higher-risk patients, including patients "turned down" for CABG. There is greater recognition of the need for improved assessment of risk, quality, and benefits of coronary revascularization in higher-risk SIHD patients with a substantial comorbidity burden. Clinicians and patients should be aware that there are significant evidence gaps regarding revascularization in complex high-risk patients. The limitations of procedural-derived risk scores should be understood when presenting treatment options. Future randomized controlled trials and expanded registries are greatly desired and should be achievable. Meanwhile, a multidisciplinary heart team approach should be employed for proper decision-making.
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Affiliation(s)
- Joshua Schulman-Marcus
- Division of Cardiology, Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA.
| | | | - Riju Banerjee
- Division of Cardiology, Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Sanjay Samy
- Division of Cardiothoracic Surgery, Albany Medical Center, Albany, USA
| | - Neil Yager
- Division of Cardiology, Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA
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130
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Walters D, Patel M, Penny W. Saphenous Vein Graft Aneurysm: A Case-Based Review of Percutaneous Management. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1190-1195. [PMID: 30850317 DOI: 10.1016/j.carrev.2019.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 11/25/2022]
Abstract
SVG aneurysms are relatively rare clinical entities most often encountered discovered as an incidental finding in patients with prior CABG surgery. There is a substantial risk of complications including rupture and death, thus surgical or percutaneous management may be considered in particular in symptomatic patients. Here, three cases are presented highlighting various percutaneous management options and considerations, including covered stent placement, coil occlusion, and a combined approach with the use of a peripheral covered stent. Intervention within this patient population lacks large population long-term outcomes and as such should be performed carefully by experienced operators, often the guidance of a Heart Team based approach.
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Affiliation(s)
- Daniel Walters
- University of California, San Diego, United States of America.
| | - Mitul Patel
- University of California, San Diego, United States of America.
| | - William Penny
- University of California, San Diego, United States of America.
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131
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Tai YH, Wu HL, Su FW, Chang KY, Huang CH, Tsou MY, Lu CC. The effect of high-dose nitroglycerin on the cerebral saturation and renal function in cardiac surgery: A propensity score analysis. J Chin Med Assoc 2019; 82:120-125. [PMID: 30839502 DOI: 10.1097/jcma.0000000000000013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the effects of high-dose nitroglycerine administered during cardiopulmonary bypass on the intraoperative cerebral saturation and postoperative serum creatinine concentration in cardiac surgery. METHODS In a retrospective cohort study, a total of 239 patients undergoing cardiac surgery with cardiopulmonary bypass at a tertiary medical center were included. General anesthesia consisted of volatile anesthetic and either intravenous loading of high-dose nitroglycerin (infusion rate 10 to 20 mg·h with a total dose of ≥0.5 mg·kg) starting from rewarming of cardiopulmonary bypass throughout the end of the surgery (NTG group; N = 96) or without high-dose nitroglycerin (control group; N = 143). Data for intraoperative cerebral saturation and serum creatinine concentrations before and after cardiac surgery were collected. Propensity score method was used to adjust for potential confounders. RESULTS Patients receiving high-dose nitroglycerin had significantly lower mean arterial pressure and hematocrit levels during and after cardiopulmonary bypass. The risk of intraoperative cerebral desaturation was left-sided 23.9% versus 38.5% (p = 0.023), right-sided 28.1% versus 35.7% in the NTG and control groups, respectively. The risk of new-onset stroke and postoperative dialysis was 2.1% versus 6.3% and 1.0% versus 3.5% in the NTG and control groups, respectively. CONCLUSION An infusion of high-dose nitroglycerin initiating at rewarming of cardiopulmonary bypass and throughout the postbypass interval may induce hypotension and hemodilution in cardiac surgical patients. Cerebral saturation and renal function were well maintained without increasing the risk of stroke and renal replacement therapy after cardiac surgery with cardiopulmonary bypass.
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Affiliation(s)
- Ying-Hsuan Tai
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Surgery, Taipei Veterans General Hospital, Yuli Branch, Hualien, Taiwan, ROC
| | - Fu-Wei Su
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuang-Yi Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Cheng-Hsiung Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Mei-Yung Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chih-Cherng Lu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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132
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Clopidogrel versus Ticagrelor for Secondary Prevention after Coronary Artery Bypass Grafting. J Clin Med 2019; 8:jcm8010104. [PMID: 30658402 PMCID: PMC6352018 DOI: 10.3390/jcm8010104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/02/2019] [Accepted: 01/14/2019] [Indexed: 12/02/2022] Open
Abstract
We sought to evaluate the outcomes of postoperative three-month dual antiplatelet therapy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) following off-pump coronary artery bypass grafting (OPCAB) with exclusively arterial grafts. Between 2013–2016, dual antiplatelet therapy (DAPT) with either aspirin + clopidogrel (ASA + CPD group, n = 100) or aspirin + ticagrelor (ASA + TCG group, n = 169) was prescribed postoperatively in 269 NSTE-ACS patients after total arterial OPCAB. Patients with indications for other oral anticoagulants were excluded from the study. Three-month DAPT was completed in 259 patients (96%); ASA + CPD group (n = 94) vs. ASA + TCG group (n = 165). A one-to-one propensity score matching was performed. Unadjusted comparison between the groups showed no significant difference in overall survival (P = 0.253) and composite outcome of major adverse cerebrovascular and cardiovascular event (MACCE) and major bleeding (P = 0.276). The rate of freedom from composite outcome at one year in the ASA + CPD and ASA + TCG groups was 91 ± 3% and 93 ± 2%, respectively. In multivariable analysis, being in the ASA + TCG group did not increase the risk of the composite outcome of MACCE and major bleeding (P = 0.972, hazard ratio: 1.0, 95% confidence interval: 0.4–2.3). Propensity score-matched comparison (76 pairs) showed no significant difference in the overall survival (P = 0.423) and composite outcome between the groups (P = 0.442). In the setting of exclusive arterial grafting, post-OPCAB three-month DAPT showed acceptable outcomes in patients with NSTE-ACS. There was no significant difference in overall survival or composite outcome of MACCE and major bleeding between the ASA + CPD and ASA + TCG groups.
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133
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Chatterjee S. Commentary: Enhanced recovery after cardiac surgery: A game changer, passing fad, or somewhere in between? J Thorac Cardiovasc Surg 2019; 157:1889-1890. [PMID: 30635180 DOI: 10.1016/j.jtcvs.2018.11.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Subhasis Chatterjee
- Divisions of General and Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Division of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
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134
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Daligadu J, Pollock CL, Carlaw K, Chin M, Haynes A, Thevaraajah Kopal T, Tahsinul A, Walters K, Colella TJF. Validation of the Fitbit Flex in an Acute Post-Cardiac Surgery Patient Population. Physiother Can 2018; 70:314-320. [PMID: 30745716 DOI: 10.3138/ptc.2017-34] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This study examined the validity of the Fitbit Flex activity monitor for step count and distance walked among post-cardiac surgery patients. Method: Participants (n=20) from a major urban cardiac surgery centre were recruited 1-2 days before hospital discharge. The Fitbit Flex step count and distance walked outputs and video recording of each participant performing the 6-minute walk test were collected. Fitbit Flex output was compared with criterion measures of manual step count obtained from the video recording and manual measurement of distance walked. Statistical analysis compared the output and criterion measures using paired sample t-tests, Pearson correlation coefficients, Lin's concordance correlations, and Bland-Altman plots. Sub-analysis compared slower walking (<0.8 m/s; n=11) and faster walking (≥0.8 m/s; n=8) group speeds (1 participant was excluded from analysis). Results: Steps counted and distance walked were significantly different between the Fitbit Flex outputs and criterion measures (p<0.05). The Fitbit Flex steps counted and distance walked showed moderate association with manual measure steps counted (r=0.67) and distance walked (r=0.45). Lin's concordance coefficients revealed a lack of agreement between the Fitbit Flex and the criterion measurement of both steps counted (concordance correlation coefficient [CCC]=0.43) and distance walked (CCC=0.36). The percentage of relative error was -18.6 (SD 22.7) for steps counted and 25.4 (SD 45.8) for distance walked. Conclusions: The Fitbit Flex activity monitor was not a valid measure of step count and distance walked in this sample of post-cardiac surgery patients. The lack of agreement between outputs and criterion measures suggests the Fitbit Flex alone would not be an acceptable clinical outcome measure for monitoring walking progression in the early postoperative period.
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Affiliation(s)
| | - Courtney L Pollock
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver
| | | | | | | | | | - Anam Tahsinul
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver
| | - Kaili Walters
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto
| | - Tracey J F Colella
- Rehabilitation Sciences Institute.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto.,Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute
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135
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Angiographic appearance of patent saphenous vein grafts more than 25 years after coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2018; 68:177-180. [PMID: 30471049 DOI: 10.1007/s11748-018-1041-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
Abstract
Nine patients with ten angiographical patent saphenous vein grafts (SVG) more than 25 years after coronary artery bypass grafting (CABG) at Kawasaki Medical School Hospital between 1976 and 1992 were reviewed. Patent SVG disease was assessed using the FitzGibbon classification, and clinical characteristics which might affect the longevity of SVG were retrospectively evaluated. The mean duration between surgery and current coronary angiography was approximately 30 years (25-35 years). There were two perfectly patent SVGs (FitzGibbon AI, 35 and 32 years after surgery), both of which were bypass grafts to the left anterior descending arteries (LAD). The other eight grafts exhibited some vein graft disease (BII:3, BIII:5). The sequential anastomosis was performed for 5 SVGs. The SVGs bypassed to the good run-off LAD, sequential bypass, strict medical management including cessation of smoking and body weight control may contribute to the slow progression of vein graft disease after CABG.
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136
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Gaudino M, Taggart DP. Fifty years after Favaloro, coronary artery bypass surgery is still an ART. Cardiovasc Res 2018; 114:e99-e101. [PMID: 30351375 DOI: 10.1093/cvr/cvy236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mario Gaudino
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY, USA
| | - David P Taggart
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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137
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Salerno TA, Ferreira A. Deciding the fate of radial arteries: Will surgeons take matters in their own hands? J Thorac Cardiovasc Surg 2018; 157:576-577. [PMID: 30098804 DOI: 10.1016/j.jtcvs.2018.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Tomas A Salerno
- Division of Cardiothoracic Surgery, Jackson Memorial Hospital and the University of Miami Miller School of Medicine, Miami, Fla; Dewitt-Daughtry Department of Surgery, Jackson Memorial Hospital and the University of Miami Miller School of Medicine, Miami, Fla.
| | - Alexandre Ferreira
- Division of Cardiology, Jackson Memorial Hospital and the University of Miami Miller School of Medicine, Miami, Fla
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138
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Smith CR. Radial artery advocacy. J Thorac Cardiovasc Surg 2018; 157:578-579. [PMID: 30100493 DOI: 10.1016/j.jtcvs.2018.06.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Craig R Smith
- Department of Surgery, Vagelos College of Physicians & Surgeons of Columbia University, and Columbia University Irving Medical Center of New York Presbyterian Hospital, New York, NY.
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139
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Pettersen Ø, Wiseth R, Hegbom K, Nordhaug DO. Pedicled Vein Grafts in Coronary Surgery Exhibit Reduced Intimal Hyperplasia at 6 Months. J Am Coll Cardiol 2018; 68:427-9. [PMID: 27443441 DOI: 10.1016/j.jacc.2016.04.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/18/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
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140
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Squiers JJ, Mack MJ. Coronary artery bypass grafting-fifty years of quality initiatives since Favaloro. Ann Cardiothorac Surg 2018; 7:516-520. [PMID: 30094216 DOI: 10.21037/acs.2018.05.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery bypass grafting (CABG) remains one of the most commonly performed major surgical procedures worldwide and the most common procedure performed by cardiac surgeons. Rene Favaloro is widely credited with recognizing the true potential of CABG and subsequently popularizing the technique in a broad manner. Since the era of Favaloro in the late 1960s, the evolution of CABG can be understood through a series of quality initiatives that have defined which patients can benefit from the procedure and via which technique(s) they will derive the greatest benefit. Herein, we will review some of the key developments in CABG over the last 50 years with a focus on ongoing quality initiatives that will continue to refine the optimal applications and outcomes of CABG for the next 50 years.
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Affiliation(s)
- John J Squiers
- Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor Scott & White Health, TX, USA
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141
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Krishnaswamy A, Kapadia SR. Minimizing Stroke and Mortality Risks in Coronary Revascularization. J Am Coll Cardiol 2018; 72:399-401. [DOI: 10.1016/j.jacc.2018.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 05/13/2018] [Indexed: 10/28/2022]
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142
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Ahmadi A, Stanger D, Puskas J, Taggart D, Chandrashekhar Y, Narula J. Is there a role for fractional flow reserve in coronary artery bypass graft (CABG) planning? Ann Cardiothorac Surg 2018; 7:546-551. [PMID: 30094220 PMCID: PMC6082788 DOI: 10.21037/acs.2018.07.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 12/21/2022]
Abstract
The concept of significant lesions has substantially evolved over the last decade. With growing evidence for use of fractional flow reserve (FFR) as a determinant of lesion-specific ischemia and its superiority to angiography-guided revascularization and medical therapy, the field of percutaneous revascularization has shifted to rely exclusively on FFR instead of luminal stenosis alone in guiding revascularization. This transition to physiological assessment has not yet made it to the realm of surgical revascularization. FFR-guided therapy has been shown to be superior to angiography-guided therapy mainly by safe deferral of about 1/3rd of lesions, leading to less periprocedural events and better outcomes. Is it possible that utilization of FFR-guided CABG would lead to less complicated procedures, shorter operating times, more frequent off pump CABG procedures and more hybrid procedures? Can FFR-guided CABG improve the cardiovascular outcomes as compared to current standard of practice? In the following paragraphs we review the concept of FFR, the evidence behind FFR-guided therapy, the emerging data regarding use FFR-guided CABG and discuss where the revascularization field is headed.
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Affiliation(s)
- Amir Ahmadi
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dylan Stanger
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Puskas
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - David Taggart
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Y. Chandrashekhar
- Department of Cardiology, Veterans Administration Hospital and University of Minnesota School of Medicine, Minneapolis, USA
| | - Jagat Narula
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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143
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Percutaneous coronary intervention versus coronary artery bypass grafting: where are we after NOBLE and EXCEL? Curr Opin Cardiol 2018; 32:699-706. [PMID: 28786862 DOI: 10.1097/hco.0000000000000450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The publication of the NOBLE and EXCEL trials, with seemingly conflicting results, brought into question whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is better for low-risk patients with left main coronary artery stenosis (LMCAS). This review appraises the methods and results of NOBLE and EXCEL, contextualizes them within the literature, and determines how they may affect clinical practice. RECENT FINDINGS We appraised the trials and describe differences in methodology and results. NOBLE recruited primarily isolated LMCAS, and found that CABG was superior to PCI. EXCEL's population included patients LMCAS in the context of multivessel CAD, and found PCI and CABG were comparable. Both trials enrolled young patients with few comorbidities, and there was more protocol-mandated consistency in the procedural techniques and medical therapy of patients receiving PCI. SUMMARY The generalizability of these trials is limited by the use of young, healthy patients at highly skilled centres that rarely reflect typical clinical practice. If these studies are to maintain relevance, trialists must address the lack of protocolization of surgical interventions and inconsistent medical therapies. Unfortunately, the limitations of NOBLE and EXCEL mean that we are no closer to answering the question of what is the optimal treatment for patients with LMCAS.
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Abstract
PURPOSE OF REVIEW To provide a broad overview of the current state of knowledge of coronary artery bypass grafting with bilateral internal thoracic artery (BITA). RECENT FINDINGS There exists a large body of literature from mostly observational studies supporting the use of BITA in patients undergoing coronary artery bypass grafting but selection bias is a major issue with nonrandomized data. The precise method of BITA use does not appear to impact graft patency nor clinical outcomes - in other words, BITA in any configuration appears to be protective. The major downside is the increased risk of sternal complications, which can be mitigated with sternal-sparring adjuncts. The 5-year interim results of the landmark Arterial Revascularization Trial comparing BITA versus single internal thoracic artery did not show a clinical benefit for BITA but the end-of-trial results are pending. Despite wide guideline support for BITA use, uptake in the surgical community remains low and this is likely because of technical and institutional barriers. SUMMARY The published literature thus far supports surgical revascularization with BITA and we eagerly await the 10-year Arterial Revascularization Trial results. The general consensus is that a greater proportion of surgical revascularization should be performed using BITA.
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Hsu H, Kawai AT, Wang R, Jentzsch MS, Rhee C, Horan K, Jin R, Goldmann D, Lee GM. The Impact of the Medicaid Healthcare-Associated Condition Program on Mediastinitis Following Coronary Artery Bypass Graft. Infect Control Hosp Epidemiol 2018; 39:694-700. [PMID: 29669607 PMCID: PMC5957779 DOI: 10.1017/ice.2018.69] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVEIn 2012, the Centers for Medicare and Medicaid Services expanded a 2008 program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid. We aimed to evaluate the impact of this Medicaid program on mediastinitis rates reported by the National Healthcare Safety Network (NHSN) compared with the rates of a condition not targeted by the program, deep-space surgical site infection (SSI) after knee replacement.DESIGNInterrupted time series with comparison group.METHODSWe included surveillance data from nonfederal acute-care hospitals participating in the NHSN and reporting CABG or knee replacement outcomes from January 2009 through June 2017. We examined the Medicaid program's impact on NHSN-reported infection rates, adjusting for secular trends. The data analysis used generalized estimating equations with robust sandwich variance estimators.RESULTSDuring the study period, 196 study hospitals reported 273,984 CABGs to the NHSN, resulting in 970 mediastinitis cases (0.35%), and 294 hospitals reported 555,395 knee replacements, with 1,751 resultant deep-space SSIs (0.32%). There was no significant change in incidence of either condition during the study. Mediastinitis models showed no effect of the 2012 Medicaid program on either secular trend during the postprogram versus preprogram periods (P=.70) or an immediate program effect (P=.83). Results were similar in sensitivity analyses when adjusting for hospital characteristics, restricting to hospitals with consistent NHSN reporting or incorporating a program implementation roll-in period. Knee replacement models also showed no program effect.CONCLUSIONSThe 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates.Infect Control Hosp Epidemiol 2018;39:694-700.
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Affiliation(s)
- Heather Hsu
- Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, United States
| | - Alison Tse Kawai
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, United States
| | - Rui Wang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Maximilian S. Jentzsch
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Chanu Rhee
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Kelly Horan
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, United States
| | - Robert Jin
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, United States
| | - Donald Goldmann
- Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States
- Institute for Healthcare Improvement, Cambridge, Massachusetts, United States
| | - Grace M. Lee
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, United States
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
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Saran N, Locker C, Said SM, Daly RC, Maltais S, Stulak JM, Greason KL, Pochettino A, Schaff HV, Dearani JA, Joyce LD, Lahr BD, Joyce DL. Current trends in bilateral internal thoracic artery use for coronary revascularization: Extending benefit to high-risk patients. J Thorac Cardiovasc Surg 2018; 155:2331-2343. [DOI: 10.1016/j.jtcvs.2018.01.094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/19/2017] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
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Gaudino M, Benedetto U, Fremes S, Biondi-Zoccai G, Sedrakyan A, Puskas JD, Angelini GD, Buxton B, Frati G, Hare DL, Hayward P, Nasso G, Moat N, Peric M, Yoo KJ, Speziale G, Girardi LN, Taggart DP. Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. N Engl J Med 2018; 378:2069-2077. [PMID: 29708851 DOI: 10.1056/nejmoa1716026] [Citation(s) in RCA: 366] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The use of radial-artery grafts for coronary-artery bypass grafting (CABG) may result in better postoperative outcomes than the use of saphenous-vein grafts. However, randomized, controlled trials comparing radial-artery grafts and saphenous-vein grafts have been individually underpowered to detect differences in clinical outcomes. We performed a patient-level combined analysis of randomized, controlled trials to compare radial-artery grafts and saphenous-vein grafts for CABG. METHODS Six trials were identified. The primary outcome was a composite of death, myocardial infarction, or repeat revascularization. The secondary outcome was graft patency on follow-up angiography. Mixed-effects Cox regression models were used to estimate the treatment effect on the outcomes. RESULTS A total of 1036 patients were included in the analysis (534 patients with radial-artery grafts and 502 patients with saphenous-vein grafts). After a mean (±SD) follow-up time of 60±30 months, the incidence of adverse cardiac events was significantly lower in association with radial-artery grafts than with saphenous-vein grafts (hazard ratio, 0.67; 95% confidence interval [CI], 0.49 to 0.90; P=0.01). At follow-up angiography (mean follow-up, 50±30 months), the use of radial-artery grafts was also associated with a significantly lower risk of occlusion (hazard ratio, 0.44; 95% CI, 0.28 to 0.70; P<0.001). As compared with the use of saphenous-vein grafts, the use of radial-artery grafts was associated with a nominally lower incidence of myocardial infarction (hazard ratio, 0.72; 95% CI, 0.53 to 0.99; P=0.04) and a lower incidence of repeat revascularization (hazard ratio, 0.50; 95% CI, 0.40 to 0.63; P<0.001) but not a lower incidence of death from any cause (hazard ratio, 0.90; 95% CI, 0.59 to 1.41; P=0.68). CONCLUSIONS As compared with the use of saphenous-vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up. (Funded by Weill Cornell Medicine and others.).
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Affiliation(s)
- Mario Gaudino
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Umberto Benedetto
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Stephen Fremes
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Giuseppe Biondi-Zoccai
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Art Sedrakyan
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - John D Puskas
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Gianni D Angelini
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Brian Buxton
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Giacomo Frati
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - David L Hare
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Philip Hayward
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Giuseppe Nasso
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Neil Moat
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Miodrag Peric
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Kyung J Yoo
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Giuseppe Speziale
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - Leonard N Girardi
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
| | - David P Taggart
- From the Departments of Cardiothoracic Surgery (M.G., L.N.G.) and Healthcare Policy and Research (A.S.), Weill Cornell Medicine, and the Icahn School of Medicine at Mount Sinai (J.D.P.), New York; Bristol Heart Institute, Bristol (U.B., G.D.A.), Royal Brompton and Harefield Trust, London (N.M.), and the University of Oxford, Oxford (D.P.T.) - all in the United Kingdom; Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto (S.F.); the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome (G.B.-Z., G.F.), the Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (G.B.-Z., G.F.), and Anthea Hospital, Bari (G.N., G.S.) - all in Italy; the University of Melbourne (B.B., D.L.H.), and the Austin Hospital (P.H.), Melbourne, VIC, Australia; Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia (M.P.); and Yonsei University College of Medicine, Seoul, South Korea (K.J.Y.)
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Devgun JK, Gul S, Mohananey D, Jones BM, Hussain MS, Jobanputra Y, Kumar A, Svensson LG, Tuzcu EM, Kapadia SR. Cerebrovascular Events After Cardiovascular Procedures. J Am Coll Cardiol 2018; 71:1910-1920. [DOI: 10.1016/j.jacc.2018.02.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 12/14/2022]
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Shih T, Lee R. Bilateral internal thoracic artery use-Are the results of one center generalizable to others? J Thorac Cardiovasc Surg 2018; 155:2344-2345. [PMID: 29551542 DOI: 10.1016/j.jtcvs.2018.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Terry Shih
- Department of Cardiac Surgery University of Michigan, Ann Arbor, Mich
| | - Richard Lee
- Center for Comprehensive Cardiovascular Care, Saint Louis University, St Louis, Mo.
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Iribarne A, Westbrook BM, Malenka DJ, Schmoker JD, McCullough JN, Leavitt BJ, Weldner PW, DeSimone J, Kramer RS, Quinn RD, Olmstead EM, Klemperer JD, Sardella GL, Ross CS, DiScipio AW. Should Diabetes Be a Contraindication to Bilateral Internal Mammary Artery Grafting? Ann Thorac Surg 2018; 105:709-714. [DOI: 10.1016/j.athoracsur.2017.08.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/01/2017] [Accepted: 08/28/2017] [Indexed: 01/22/2023]
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