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Kundu A, Yadava OP, Taggart D. Off-pump versus on-pump coronary artery bypass grafting-a surreal controversy? Indian J Thorac Cardiovasc Surg 2018; 34:266-271. [PMID: 33060948 DOI: 10.1007/s12055-018-0668-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 02/28/2018] [Accepted: 03/06/2018] [Indexed: 11/26/2022] Open
Abstract
As per the findings of the SYNTAX Trial, it has been established that coronary artery bypass grafting (CABG) affords the best long-term results in patients with multivessel disease. However, it is still a point of contention whether 'off-pump' CABG (OPCAB) (on cardiopulmonary bypass) is better. Many studies appear to establish the superiority of one or the other. But there is still no well-planned multi-centre randomised controlled trial looking into all aspects of the issue that can, once and for all, put the controversy to rest. But as long as one is able to give the patient a good result, does it really matter whether the procedure is done off or on pump? This article looks at the available evidence with regard to various parameters comparing OPCAB and conventional CABG in an attempt to answer the question, if at all, it is a question!
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Affiliation(s)
- Anirban Kundu
- National Heart Institute, 49 Community Centre, New Delhi, Delhi 110065 India
| | - Om Prakash Yadava
- National Heart Institute, 49 Community Centre, New Delhi, Delhi 110065 India
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102
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Off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg 2018; 155:1545-1553.e7. [DOI: 10.1016/j.jtcvs.2017.10.135] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 09/07/2017] [Accepted: 10/16/2017] [Indexed: 11/20/2022]
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103
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Smart NA, Dieberg G, King N. Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. J Am Coll Cardiol 2018; 71:983-991. [DOI: 10.1016/j.jacc.2017.12.049] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022]
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104
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Balkhy HH, Nisivaco S, Kitahara H, McCrorey M, Patel B. Robotic Beating Heart Totally Endoscopic Coronary Artery Bypass in Higher-Risk Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Husam H. Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL USA
| | - Sarah Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL USA
| | - Hiroto Kitahara
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL USA
| | - Mackenzie McCrorey
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL USA
| | - Brooke Patel
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL USA
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105
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Benedetto U, Lau C, Caputo M, Kim L, Feldman DN, Ohmes LB, Di Franco A, Soletti G, Angelini GD, Girardi LN, Gaudino M. Comparison of Outcomes for Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Low-Volume and High-Volume Centers and by Low-Volume and High-Volume Surgeons. Am J Cardiol 2018; 121:552-557. [PMID: 29291888 DOI: 10.1016/j.amjcard.2017.11.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/25/2022]
Abstract
In terms of in-hospital outcomes, controversy still remains whether off-pump coronary artery bypass grafting is superior to on-pump coronary artery bypass surgery. We investigated whether the volume of off-pump coronary artery bypass procedures by hospital and individual surgeon influences patient outcomes when compared with on-pump coronary artery bypass surgery. Discharge records from the Nationwide Inpatient Sample were retrospectively reviewed for in-hospital admissions from 2003 to 2011, including 999 hospitals in 44 states. A total of 2,094,094 patients undergoing on- and off-pump coronary artery bypass surgery were included. In patients requiring 2 or more grafts, off-pump coronary artery bypass compared with on-pump coronary artery bypass was associated with increased risk-adjusted mortality when performed in low-volume centers (<29 cases per year) (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.06 to 1.57) or by low-volume surgeons (<19 cases per year) (OR 1.26, 95% CI 1.02 to 1.56). In high-volume off-pump coronary artery bypass centers (≥164 cases per year) and surgeons (≥48 cases per year), off-pump coronary artery bypass reduced mortality compared with on-pump coronary artery bypass in cases requiring a single graft (OR 0.66, 95% CI 0.49 to 0.89 and OR 0.33, 95% CI 0.22 to 0.47, respectively) or 2 or more grafts (OR 0.82, 95% CI 0.66 to 0.99 and OR 0.63, 95% CI 0.49 to 0.81, respectively). In conclusion, the outcome of off-pump coronary artery bypass grafting procedures is dependent on volume at both the institution and the individual surgeon level. Off-pump coronary artery bypass should not be performed at low-volume centers and by low-volume surgeons.
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106
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King N. Is there a long-term survival benefit with on pump coronary artery bypass grafting? ANNALS OF TRANSLATIONAL MEDICINE 2018; 5:498. [PMID: 29299459 DOI: 10.21037/atm.2017.10.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nicola King
- School of Biomedical and Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
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107
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Incidence of perioperative stroke in clampless aortic anastomosis during off-pump coronary artery bypass grafting. Heart Vessels 2017; 33:595-604. [PMID: 29230573 DOI: 10.1007/s00380-017-1106-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
This study aimed to assess if clampless off-pump coronary artery bypass grafting (OPCAB) decreases the incidence of perioperative stroke (POS) rate and in-hospital mortality. The secondary aim was to evaluate 12-year rates of overall mortality. Between January 2003 to December 2015, data of 645 consecutive patients undergoing isolated CABG were retrospectively collected. 363 underwent aortic no-touch OPCAB (No-touch group) and 282 underwent OPCAB with the Heartstring device (HS group). In-hospital mortality and perioperative stroke rate as primary endpoint, as well as long-term follow-up outcome were analysed. In-hospital mortality was lower into No-touch group compared with HS group but without significant statistical difference (1.7 vs. 3.2%, p = 0.19, respectively); the rate of postoperative stroke was higher in No-touch group compared with HS group, although this difference did not reach statistically significance. Delirium was reported with higher presentation rate in HS group (3.9 vs. 0.8%, p = 0.01). Blood transfusions rate was higher in HS subjects (23.4 vs. 16.1%, p = 0.01). Intubation time, ICU, and hospital length of stay were increased in the HS group (p = 0.008, p = 0.001 and p = 0.003, respectively). Over a 12-year follow-up period, survival probabilities at 1, 5, and 10 years were 93.6 ± 1.3 vs. 93.2 ± 1.5, 80.4 ± 2.6 vs. 80.3 ± 2.2, and 57.9 ± 5 vs. 58.4 ± 3.8% in the No-touch and HS group, respectively (p = 0.97). In this retrospective study, clampless off-pump CABG lowers perioperative stroke rate whose incidence is, however, not inferior compared with No-touch technique, and no statistically significance was detected. Delirium has a higher presentation rate in clampless off-pump CABG.
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108
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Takagi H, Ando T, Mitta S. Meta-Analysis Comparing ≥10-Year Mortality of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting. Am J Cardiol 2017; 120:1933-1938. [PMID: 28942940 DOI: 10.1016/j.amjcard.2017.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/21/2017] [Accepted: 08/08/2017] [Indexed: 01/28/2023]
Abstract
Off-pump coronary artery bypass grafting (CABG) is suggested to be associated with an increase in long-term (≥5-year) all-cause mortality. To determine whether off-pump CABG is associated with an increase in very long-term (≥10-year) all-cause mortality, we performed a meta-analysis of propensity-score matched observational comparative studies of off-pump versus on-pump CABG. MEDLINE and EMBASE were searched through May 2017. A hazard ratio of follow-up (including early) all-cause mortality for off-pump versus on-pump CABG was extracted from each individual study. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic hazard ratios in the random-effects model. Of 164 potentially relevant studies, our search identified 16 propensity-score matched observational comparative studies of off-pump versus on-pump CABG with ≥10-year follow-up enrolling a total of 82,316 patients. A pooled analysis of all the 16 studies demonstrated that off-pump CABG was significantly associated with an increase in all-cause mortality (hazard ratio 1.07, 95% confidence interval 1.03 to 1.12, p for effect = 0.0008; p for heterogeneity = 0.30, I2 = 12%). In a sensitivity analysis, exclusion of any single hazard ratio from the analysis (leave-one-out meta-analysis) did not substantively alter the overall result. There was no evidence of a significant publication bias. In conclusion, off-pump CABG is associated with an increase in very long-term (≥10 years) all-cause mortality compared with on-pump CABG.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
| | - Tomo Ando
- Department of Cardiology, Detroit Medical Center, Detroit, Michigan
| | - Shohei Mitta
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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109
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Nicolini F, Vezzani A, Romano G, Carino D, Ricci M, Chicco MVD, Gherli T. Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly. Int Heart J 2017; 58:647-653. [PMID: 28966319 DOI: 10.1536/ihj.16-468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, the efficacy of this newer technique in the elderly is difficult to prove because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. Moreover, more widespread use of this technique is limited by the concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the decreased blood supply to the sternum and surrounding tissues.The review of the recent literature indicates that the use of bilateral internal thoracic arteries in very elderly patients should not be considered routinely. It seems reasonable to avoid it in octogenarians in the presence of well-known predictors of sternal complications such as diabetes, morbid obesity, and severe chronic lung disease.There is also still controversy about the superiority of the radial artery over the saphenous vein graft as a second or third conduit for surgical myocardial revascularization, although the majority of recent studies seem to support more liberal use of the radial artery as second arterial conduit in the elderly. Although a clinical benefit of arterial graft revascularization cannot be formally excluded for elderly patients, the increased complexity of this technique suggests that careful clinical judgment is necessary to select grafts for individual patients.
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Affiliation(s)
- Francesco Nicolini
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | | | - Giorgio Romano
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | - Davide Carino
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | - Matteo Ricci
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | | | - Tiziano Gherli
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
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110
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Head SJ, Milojevic M, Taggart DP, Puskas JD. Current Practice of State-of-the-Art Surgical Coronary Revascularization. Circulation 2017; 136:1331-1345. [DOI: 10.1161/circulationaha.116.022572] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Stuart J. Head
- From Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands (S.J.H., M.M.); Department of Cardiovascular Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, UK (D.P.T.); and Department of Cardiovascular Surgery, Mount Sinai Saint Luke’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.)
| | - Milan Milojevic
- From Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands (S.J.H., M.M.); Department of Cardiovascular Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, UK (D.P.T.); and Department of Cardiovascular Surgery, Mount Sinai Saint Luke’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.)
| | - David P. Taggart
- From Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands (S.J.H., M.M.); Department of Cardiovascular Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, UK (D.P.T.); and Department of Cardiovascular Surgery, Mount Sinai Saint Luke’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.)
| | - John D. Puskas
- From Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands (S.J.H., M.M.); Department of Cardiovascular Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, UK (D.P.T.); and Department of Cardiovascular Surgery, Mount Sinai Saint Luke’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.)
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111
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Can we settle the on-pump or off-pump debate with more than a million patients? J Thorac Cardiovasc Surg 2017; 155:180-181. [PMID: 28942980 DOI: 10.1016/j.jtcvs.2017.08.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 08/30/2017] [Indexed: 12/13/2022]
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112
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Comparison of Outcome of Coronary Artery Bypass Grafting Versus Drug-Eluting Stent Implantation for Non-ST-Elevation Acute Coronary Syndrome. Am J Cardiol 2017; 120:380-386. [PMID: 28595861 DOI: 10.1016/j.amjcard.2017.04.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 11/23/2022]
Abstract
There is limited data comparing effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). We compared the long-term outcomes of the 2 revascularization strategies in 1,246 patients presented with NSTE-ACS for left main or multivessel coronary artery disease. Data were pooled from the Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease (BEST) trial, the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease (PRECOMBAT) trial, and the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial. The primary outcome was a composite of death from any causes, myocardial infarction, or stroke. The baseline characteristics were similar between the 2 study groups. During the median follow-up of 60 months, the rate of the primary outcome was significantly lower with CABG than with PCI (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.56 to 0.98; p = 0.036). This difference was mainly attributed to a significant reduction in the rate of myocardial infarction (HR 0.50; 95% CI 0.31 to 0.82, p = 0.006). The superiority of CABG over PCI was consistent across the major subgroups. The individual risks of death from any causes or stroke were not different between the 2 groups. In contrast, the rate of repeat revascularization was significantly lower in the CABG group than in the PCI group (HR 0.56; 95% CI 0.41 to 0.75, p <0.001). In this study, among patients with NSTE-ACS for left main or multivessel coronary artery disease, CABG significantly reduces the risk of death from any causes, myocardial infarction, or stroke compared with PCI with drug-eluting stents.
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113
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Szwed K, Pawliszak W, Serafin Z, Kowalewski M, Tomczyk R, Perlinski D, Szwed M, Tomaszewska M, Anisimowicz L, Borkowska A. CArbon dioxide surgical field flooding and aortic NO-touch off-pump coronary artery bypass grafting to reduce Neurological injuries after surgical coronary revascularisation (CANON): protocol for a randomised, controlled, investigator and patient blinded single-centre superiority trial with three parallel arms. BMJ Open 2017; 7:e016785. [PMID: 28698347 PMCID: PMC5642650 DOI: 10.1136/bmjopen-2017-016785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Neurological injuries remain a major concern following coronary artery bypass grafting (CABG) that offsets survival benefit of CABG over percutaneous coronary interventions. Among numerous efforts to combat this issue is the development of off-pump CABG (OPCABG) that obviates the need for extracorporeal circulation and is associated with improved neurological outcomes. The objective of this study is to examine whether the neuroprotective effect of OPCABG can be further pronounced by the use of two state-of-the-art operating techniques. METHODS AND ANALYSIS In this randomised, controlled, investigator and patient blinded single-centre superiority trial with three parallel arms, a total of 360 patients will be recruited. They will be allocated in a 1:1:1 ratio to two treatment arms and one control arm. Treatment arms undergoing either aortic no-touch OPCABG or OPCABG with partial clamp applying carbon dioxide surgical field flooding will be compared against control arm undergoing OPCABG with partial clamp. The primary endpoint will be the appearance of new lesions on control brain MRI 3 days after surgery. Secondary endpoints will include the prevalence of new focal neurological deficits in the first 7 days after surgery, the occurrence of postoperative cognitive dysfunction at either 1 week or 3 months after surgery and the incidence of delirium in the first 7 days after surgery. Data will be analysed on intention-to-treat principles and a per protocol basis. ETHICS AND DISSEMINATION Ethical approval has been granted for this study. Results will be disseminated through peer-reviewed media. TRIAL REGISTRATION NUMBER NCT03074604; Pre-results. DATE AND VERSION IDENTIFIER 10-Mar-2017 Original.
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Affiliation(s)
- Krzysztof Szwed
- Department of Clinical Neuropsychology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Wojciech Pawliszak
- Department of Cardiac Surgery, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Zbigniew Serafin
- Department of Radiology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Remigiusz Tomczyk
- Department of Cardiac Surgery, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Damian Perlinski
- Department of Cardiac Surgery, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Magdalena Szwed
- Department of Clinical Neuropsychology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Marta Tomaszewska
- Department of Clinical Neuropsychology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Lech Anisimowicz
- Department of Cardiac Surgery, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Alina Borkowska
- Department of Clinical Neuropsychology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
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114
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Hori D, Yamaguchi A, Adachi H. Coronary Artery Bypass Surgery in End-Stage Renal Disease Patients. Ann Vasc Dis 2017; 10:79-87. [PMID: 29034031 PMCID: PMC5579782 DOI: 10.3400/avd.ra.17-00024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 12/21/2022] Open
Abstract
The number of patients requiring hemodialysis is continuously increasing around the world. Hemodialysis affects patient quality of life and it is also associated with a higher risk for cardiovascular events. In addition to traditional risk factors for cardiovascular events such as hypertension, hyperlipidemia, and diabetes, hemodialysis is associated with hyperphosphatemia, chronic inflammation, vascular calcification, and anemia which accelerate atherosclerosis, vascular stiffness, and cardiac ischemia. Treatment strategy for coronary revascularization in this progressive disease remains controversial. However, a systematic treatment including medical therapy and complete revascularization through a less invasive strategy should be considered in addressing this problem. This review discusses the epidemiology, vascular pathology and current treatment options in patients with end-stage renal disease requiring coronary revascularization.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
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115
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Wang Y, Zhu S, Gao P, Zhou J, Zhang Q. Off-pump versus on-pump coronary surgery in patients with chronic kidney disease: a meta-analysis. Clin Exp Nephrol 2017. [DOI: 10.1007/s10157-017-1432-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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116
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Suwalski G, Emery R, Mróz J, Kaczejko K, Gryszko L, Cwetsch A, Skrobowski A. Right atrium positioning for exposure of right pulmonary veins during off-pump atrial fibrillation ablation. Interact Cardiovasc Thorac Surg 2017; 24:823-827. [PMID: 28329210 DOI: 10.1093/icvts/ivx026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/10/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Concomitant surgical ablation of atrial fibrillation (AF) is recommended for patients undergoing off-pump coronary revascularization in the presence of this arrhythmia. Achievement of optimal visualization of pulmonary veins while maintaining stable haemodynamic conditions is crucial for proper completion of the ablation procedure. This study evaluates the safety and feasibility of right atrial positioning using a suction-based cardiac positioner as opposed to compressive manoeuvres for exposure during off-pump surgical ablation for AF. METHODS Thirty-four consecutive patients underwent pulmonary vein isolation, ganglionated plexi ablation and left atrial appendage occlusion during off-pump coronary artery bypass grafting. Right atrial suction positioning was used to visualize right pulmonary veins. Safety and feasibility end points were analysed intraoperatively and in the early postoperative course. RESULTS In all patients, right atrial positioning created optimal conditions to complete transverse and oblique sinus blunt dissection, correct placement of a bipolar ablation probe, detection and ablation of ganglionated plexi and conduction block assessment. In all patients, this entire right-sided ablation procedure was completed with a single exposure manoeuvre. Feasibility end points were achieved in all study patients. CONCLUSIONS This report documents the safety and feasibility of right atrial exposure using a suction-based cardiac positioner to complete ablation for AF concomitant with off-pump coronary revascularization. This technique may be widely adopted to create stable haemodynamic conditions and optimal visualization of the right pulmonary veins.
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Affiliation(s)
- Grzegorz Suwalski
- Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Robert Emery
- Department of Cardiac Surgery, St Joseph's Hospital, St. Paul, MN, USA
| | - Jakub Mróz
- Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Kamil Kaczejko
- Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Leszek Gryszko
- Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Andrzej Cwetsch
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Andrzej Skrobowski
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
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117
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King N. On vs. off pump coronary artery bypass grafting: the next chapter. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:116. [PMID: 28361081 DOI: 10.21037/atm.2017.01.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nicola King
- School of Biomedical and Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
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118
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Calafiore AM, Prapas S, Osman A, Di Mauro M. Coronary artery bypass grafting off-pump or on-pump: another brick in the wall. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:168. [PMID: 28480204 DOI: 10.21037/atm.2017.03.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Sotirios Prapas
- Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece
| | - Ahmed Osman
- Department of Critical Care, Cairo University, Giza, Egypt
| | - Michele Di Mauro
- Department of Cardiac Surgery, University G. D'Annunzio, Chieti, Italy
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119
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Raja SG, Benedetto U, Taggart DP. Off-pump coronary artery bypass grafting: where are we now? J Thorac Dis 2016; 8:S756-S757. [PMID: 27942393 DOI: 10.21037/jtd.2016.10.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, UK.
| | | | - David P Taggart
- Department of Cardiovascular Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
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On-pump versus off-pump: It's all about the grafts! J Thorac Cardiovasc Surg 2016; 153:298-299. [PMID: 27814903 DOI: 10.1016/j.jtcvs.2016.10.006] [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: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 11/21/2022]
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121
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Davierwala PM. Current outcomes of off-pump coronary artery bypass grafting: evidence from real world practice. J Thorac Dis 2016; 8:S772-S786. [PMID: 27942395 DOI: 10.21037/jtd.2016.10.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery bypass grafting (CABG) can be performed conventionally using cardiopulmonary bypass (CPB) and aortic clamping or on a beating heart (BH) without the use of CPB, the so-called off-pump CABG. Some surgeons, who are proponents of off-pump CABG, preferentially use this technique for the majority of operations, whereas others use it only in certain situations which warrant avoidance of CPB. Ever since the conception of off-pump CABG, the never-ending debate about which technique of CABG is safe and efficacious continues to date. Several randomized controlled trials (RCTs) have been conducted that have either favored on-pump CABG or have failed to show a significant difference in outcomes between the two techniques. However, these RCTs have been fraught with claims that they do not represent the majority of patients undergoing CABG in real world practice. Therefore, assessment of the benefits and drawbacks of each technique through observational and registry studies would be more representative of patients encountered in daily practice. The present review examines various retrospective studies and meta-analyses of observational studies that compare the early and long-term outcomes of off- and on-pump CABG, which assesses their safety and efficacy. Additionally, their outcomes in older patients, females, and those with diabetes mellitus, renal dysfunction, presence of ascending aortic disease, and/or acute coronary syndrome (ACS) have also been discussed separately. The general consensus is that early results of off-pump CABG are comparable to or in some cases better than on-pump CABG. However, on-pump CABG provides a survival benefit in the long term according to a majority of publications in literature.
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Affiliation(s)
- Piroze M Davierwala
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
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122
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Guida GA, Chivasso P, Fudulu D, Rapetto F, Sedmakov C, Marsico R, Zakkar M, Bryan AJ, Angelini GD. Off-pump coronary artery bypass grafting in high-risk patients: a review. J Thorac Dis 2016; 8:S795-S798. [PMID: 27942397 DOI: 10.21037/jtd.2016.10.107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The role of off-pump coronary artery bypass (OPCAB) grafting in high risk patients remains controversial. While there have been studies showing the potential benefits of it, there is still a lot to be learned from the application of this technique in this sub-group of patients. The results of the different trials and papers that we reviewed seem to indicate a benefit in the OPCAB group. Despite of the fact that trials were significantly different in methodology, especially when choosing the risk score stratification tool or the cut-off to define high risk the literature seems to suggest a benefit from the use of OPCAB surgery. Here, we present a review which focussed on early and late outcome in high risk patients undergoing on- and off-pump coronary revascularization.
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Affiliation(s)
| | | | - Daniel Fudulu
- Bristol Heart Institute, Bristol University, Bristol, UK
| | | | | | | | - Mustafa Zakkar
- Bristol Heart Institute, Bristol University, Bristol, UK
| | - Alan J Bryan
- Bristol Heart Institute, Bristol University, Bristol, UK
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123
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Chivasso P, Guida GA, Fudulu D, Bruno VD, Marsico R, Sedmakov H, Zakkar M, Rapetto F, Bryan AJ, Angelini GD. Impact of off-pump coronary artery bypass grafting on survival: current best available evidence. J Thorac Dis 2016; 8:S808-S817. [PMID: 27942399 DOI: 10.21037/jtd.2016.10.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The superiority of either off-pump (OPCAB) or on-pump (ONCAB) coronary artery bypass grafting (CABG) remains unclear despite a large body of literature evidence comparing the two approaches. The potential advantages of avoiding cardiopulmonary bypass (CPB), minimizing aortic manipulation and maintaining pulsatile flow may be associated with reduced inflammatory responses and embolic events. Numerous studies compared OPCAB with ONCAB and the cumulative data have been presented in meta-analyses of both randomized and observational studies. Although there is an abundance of data with respect to the operative morbidity and mortality and the short-term outcomes associated with these two strategies, not much is known about how they impact long-term survival and recurrence of myocardial ischaemic events. Recent studies and meta-analyses have focused on long-term survival and major secondary outcomes in OPCAB vs. ONCAB within the general population. Significant limitations in methodology, however, have raised concerns about the strength of several randomized trials with restrictive inclusion criteria that reduced the populations to those at low risk only, thus creating result bias. Here, we present a review of the best available evidence with a focus on long-term outcomes.
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Affiliation(s)
- Pierpaolo Chivasso
- Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Gustavo A Guida
- Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Daniel Fudulu
- Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Vito D Bruno
- Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Roberto Marsico
- Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Hristo Sedmakov
- Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Mustafa Zakkar
- Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Filippo Rapetto
- Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Alan J Bryan
- Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Gianni D Angelini
- Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK
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124
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Fudulu D, Benedetto U, Pecchinenda GG, Chivasso P, Bruno VD, Rapetto F, Bryan A, Angelini GD. Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials. J Thorac Dis 2016; 8:S758-S771. [PMID: 27942394 DOI: 10.21037/jtd.2016.10.80] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Coronary artery bypass grafting remains the standard treatment for patients with extensive coronary artery disease. Coronary surgery without use of cardiopulmonary bypass avoids the deleterious systemic inflammatory effects of the extracorporeal circuit. However there is an ongoing debate surrounding the clinical outcomes after on-pump versus off-pump coronary artery bypass (ONCAB versus OPCAB) surgery. The current review is based on evidence from randomized controlled trials (RCTs) and meta-analyses of randomized studies. It focuses on operative mortality, mid- and long-term survival, graft patency, completeness of revascularisation, neurologic and neurophysiologic outcomes, perioperative complications and outcomes in the high risk groups. Early and late survival rates for both OPCAB and ONCAB grafting are similar. Some studies suggest early poorer vein graft patency with off-pump when compared with on-pump, comparable midterm arterial conduit patency with no difference in long term venous and arterial graft patency. A recent, pooled analysis of randomised trials shows a reduction in stroke rates with use off-pump techniques. Furthermore, OPCAB grafting seems to reduce postoperative renal dysfunction, bleeding, transfusion requirement and respiratory complications while perioperative myocardial infarction rates are similar to ONCAB grafting. The high risk patient groups seem to benefit from off-pump coronary surgery.
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Affiliation(s)
- Daniel Fudulu
- Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| | | | | | | | | | - Filippo Rapetto
- Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| | - Alan Bryan
- Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
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125
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Raja SG. Off-pump coronary artery bypass grafting in octogenarians. J Thorac Dis 2016; 8:S799-S807. [PMID: 27942398 PMCID: PMC5124585 DOI: 10.21037/jtd.2016.10.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/29/2016] [Indexed: 11/06/2022]
Abstract
Enhanced life expectancy has confronted cardiac surgery with a rapidly growing population of octogenarians needing coronary artery bypass grafting (CABG). Octogenarians are deemed a high-risk patient population with increased postoperative morbidity and mortality following conventional CABG using cardiopulmonary bypass (CPB). In such patients reducing the invasiveness of the surgical procedure by avoiding CPB may be tried in an attempt to improve outcomes. The increasing performance of off-pump coronary artery bypass (OPCAB) grafting within certain centers reflects surgeon preference to avoid the inherent risks of CPB and cardioplegic arrest including hemodilution, nonpulsatile arterial flow, global myocardial ischemia, atherosclerotic embolization from aortic manipulation, and systemic inflammatory response. Although OPCAB grafting is a well-established surgical myocardial revascularization strategy, its actual benefits in terms of morbidity and mortality remain questionable in the general population. In the higher risk octogenarian patients, however, there is a potential for more tangible clinical benefits when CPB is avoided. This review article provides an overview of the impact of OPCAB grafting on postoperative mortality and morbidity in octogenarians.
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Affiliation(s)
- Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, UK
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126
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Taggart DP. Off-pump coronary artery bypass grafting (OPCABG)-a 'personal' European perspective. J Thorac Dis 2016; 8:S829-S831. [PMID: 27942402 DOI: 10.21037/jtd.2016.10.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although popularised over two decades ago off-pump coronary artery bypass grafting (OPCABG) has seen a decrease in utilisation especially over the last decade. This has been due to publication of a number of trials which suggested inferior outcomes with OPCABG. However, the validity of the findings in these trials has been questioned on the basis of doubts over operator experience as witnessed by large numbers of cross-overs. Two more recent large randomised trials have shown very similar outcomes between on and off-pump surgery up to 1- and 5-year outcomes are imminently due. Furthermore several meta-analyses have reported that OPCABG reduces mortality, myocardial infarction and major morbidity in higher risk patients. Consequently there is a clear rationale for OPCABG in certain cohorts of patients and especially when combined with a no touch aortic technique in those with significant disease of the ascending aorta. The article discusses the importance of routine performance of OPCABG if it is to produce high quality results and especially in higher risk patients.
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Affiliation(s)
- David P Taggart
- Department of Cardiovascular Surgery, University of Oxford, Oxford, UK
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127
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On- vs. off-pump coronary artery bypass grafting: A systematic review and meta-analysis. Int J Cardiol 2016; 223:201-211. [DOI: 10.1016/j.ijcard.2016.08.250] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/25/2022]
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128
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Risk of stroke with “no-touch” — As compared to conventional off-pump coronary artery bypass grafting. An updated meta-analysis of observational studies. Int J Cardiol 2016; 222:769-771. [DOI: 10.1016/j.ijcard.2016.08.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
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129
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Pinho-Gomes AC, Taggart DP. Coronary artery bypass grafting for left main disease and the risk of stroke: Incidence, aetiology and prevention. Surgeon 2016; 15:155-160. [PMID: 27720167 DOI: 10.1016/j.surge.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/04/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022]
Abstract
This review explores the association between left main disease and the increased risk of perioperative stroke following coronary artery bypass grafting, specifically addressing the potential underlying mechanisms and its potential prevention. In particular, this correlation appears stronger for patients with left main disease when compared to patients with isolated triple vessel disease. Even though evidence on this topic is limited and of modest quality, there appears to be a significant association between ascending aorta atherosclerosis and coronary artery disease. Furthermore, there seems to be a relationship between the severity and extent of carotid artery stenosis and coronary artery disease. Carotid artery disease is itself associated with atherosclerosis of the ascending aorta, a well-recognised risk factor for postoperative atheroembolic stroke. The association between left main disease, ascending aorta atherosclerosis and carotid artery stenosis may reflect an increased systemic atherosclerotic burden and hence explain, at least partially, the higher risk of perioperative cerebrovascular events. Potential pre-, intra- and post-operative strategies for stroke prevention are discussed.
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Affiliation(s)
| | - David P Taggart
- Department of Cardiac Surgery, Oxford University Hospitals Trust, Oxford, United Kingdom
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130
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Anastasiadis K, Antonitsis P, Vranis K, Kleontas A, Asteriou C, Grosomanidis V, Tossios P, Argiriadou H. Effectiveness of prophylactic levosimendan in patients with impaired left ventricular function undergoing coronary artery bypass grafting: a randomized pilot study. Interact Cardiovasc Thorac Surg 2016; 23:740-747. [PMID: 27378790 DOI: 10.1093/icvts/ivw213] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/01/2016] [Accepted: 05/10/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Perioperative low cardiac output syndrome occurs in 3-14% of patients undergoing isolated coronary artery bypass grafting (CABG), leading to significant increase in major morbidity and mortality. Considering the unique pharmacological and pharmacokinetic properties of levosimendan, we conducted a prospective, double-blind, randomized pilot study to evaluate the effectiveness of prophylactic levosimendan in patients with impaired left ventricular function undergoing CABG. METHODS Thirty-two patients undergoing CABG with low left ventricular ejection fraction (LVEF ≤ 40%) were randomized to receive either a continuous infusion of levosimendan at a dose of 0.1 μg/kg/min for 24 h without a loading dose or a placebo. The primary outcome of the study was the change in the LVEF assessed with transthoracic echocardiography on the seventh postoperative day. Secondary outcomes included the physiological and clinical effects of levosimendan. RESULTS All patients tolerated preoperative infusion of levosimendan well. The LVEF improved in both groups; this increase was statistically significant in the levosimendan group (from 35.8 ± 5% preoperatively to 42.8 ± 7.8%, P = 0.001) compared with the control group (from 37.5 ± 3.4% preoperatively to 41.2 ± 8.3%, P = 0.1). The cardiac index, SvO2, pulmonary capillary wedge pressure and right ventricular stroke work index showed a similar trend, which was optimized in patients treated with levosimendan. Moreover, an increase in extravascular lung water was noticed in this group during the first 24 h after surgery. CONCLUSIONS This pilot study shows that prophylactic levosimendan infusion is safe and effective in increasing the LVEF postoperatively in patients with impaired cardiac function undergoing coronary surgery. This finding may be translated to 'optimizing' patients' status before surgery.
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MESH Headings
- Cardiac Output, Low/etiology
- Cardiotonic Agents/administration & dosage
- Coronary Artery Bypass/adverse effects
- Coronary Artery Disease/complications
- Coronary Artery Disease/diagnosis
- Coronary Artery Disease/surgery
- Dose-Response Relationship, Drug
- Double-Blind Method
- Female
- Finland/epidemiology
- Follow-Up Studies
- Humans
- Hydrazones/administration & dosage
- Incidence
- Infusions, Intravenous
- Male
- Middle Aged
- Pilot Projects
- Postoperative Complications/epidemiology
- Postoperative Complications/prevention & control
- Prospective Studies
- Pyridazines/administration & dosage
- Simendan
- Stroke Volume/drug effects
- Stroke Volume/physiology
- Survival Rate/trends
- Tomography, Emission-Computed, Single-Photon
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/drug therapy
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left/drug effects
- Ventricular Function, Left/physiology
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131
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Abstract
For the year 2015, almost 19,000 published references can be found in PubMed when entering the search term "cardiac surgery". The last year has been again characterized by lively discussions in the fields where classic cardiac surgery and modern interventional techniques overlap. Lacking evidence in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery has been added. As in the years before, CABG remains the gold standard for the revascularization of complex stable triple-vessel disease. Plenty of new information has been presented comparing the conventional to transcatheter aortic valve implantation (TAVI) demonstrating similar short- and mid-term outcomes at high and low risk, but even a survival advantage with transfemoral TAVI at intermediate risk. In addition, there were many relevant and interesting other contributions from the purely operative arena. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While the article does not have the expectation of being complete and cannot be free of individual interpretation, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.
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132
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Pawliszak W, Kowalewski M, Raffa GM, Malvindi PG, Kowalkowska ME, Szwed KA, Borkowska A, Kowalewski J, Anisimowicz L. Cerebrovascular Events After No-Touch Off-Pump Coronary Artery Bypass Grafting, Conventional Side-Clamp Off-Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta-Analysis. J Am Heart Assoc 2016; 5:JAHA.115.002802. [PMID: 26892526 PMCID: PMC4802438 DOI: 10.1161/jaha.115.002802] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Off‐pump coronary artery bypass (OPCAB) has been shown to reduce the risk of neurologic complications as compared to coronary artery bypass grafting performed with cardiopulmonary bypass. Side‐clamping of the aorta while constructing proximal anastomoses, however, still carries substantial risk of cerebral embolization. We aimed to perform a comprehensive meta‐analysis of studies assessing 2 clampless techniques: aortic “no‐touch” and proximal anastomosis devices (PAD) for OPCAB. Methods and Results PubMed, CINAHL, CENTRAL, and Google Scholar databases were screened for randomized controlled trials and observational studies comparing “no‐touch” and/or PAD with side‐clamp OPCAB and reporting short‐term (≤30 days) outcomes: cerebrovascular accident and all‐cause mortality. A total of 18 studies (3 randomized controlled trials) enrolling 25 163 patients were included. Aortic “no‐touch” was associated with statistically lower risk of cerebrovascular accident as compared to side‐clamp OPCAB: risk ratio 95% CI: 0.41 (0.27–0.61); P<0.01; I2=0%. Event rates were 0.36% and 1.28% for “no‐touch” and side‐clamp OPCAB, respectively. No difference was seen between PAD and side‐clamp OPCAB: 0.71 (0.33–1.55); P=0.39; I2=39%. A trend towards increased 30‐day all‐cause mortality with PAD and no difference with “no‐touch” were observed when compared to side‐clamp OPCAB. In a subset analysis, “no‐touch” consistently reduced the risk of cerebrovascular accident regardless of patients’ baseline risk characteristics. A benefit with PAD was observed in low‐risk patients. Conclusions Aortic “no‐touch” technique was associated with nearly 60% lower risk of postoperative cerebrovascular events as compared to conventional side‐clamp OPCAB with effect consistent across patients at different risk.
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Affiliation(s)
- Wojciech Pawliszak
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland Division of Ergonomics and Physical Effort, Department of Hygiene, Epidemiology and Ergonomics, Collegium Medicum UMK, Bydgoszcz, Poland
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Pietro Giorgio Malvindi
- Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Magdalena Ewa Kowalkowska
- Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Collegium Medicum, Bydgoszcz, Poland
| | - Krzysztof Aleksander Szwed
- Department of Clinical Neuropsychology, Collegium Medicum, Bydgoszcz, Poland Nicolaus Copernicus University, Toruń, Poland
| | - Alina Borkowska
- Department of Clinical Neuropsychology, Collegium Medicum, Bydgoszcz, Poland Nicolaus Copernicus University, Toruń, Poland
| | - Janusz Kowalewski
- Lung Cancer and Thoracic Surgery Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Lech Anisimowicz
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
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133
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Coronary Artery Bypass Graft Should Be Considered in Octogenarians With Multivessel Coronary Disease. Can J Cardiol 2016; 32:1045.e1-3. [PMID: 27020583 DOI: 10.1016/j.cjca.2016.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 12/16/2022] Open
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134
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Anastasiadis K, Antonitsis P, Bauer A, Carrel T. Minimal invasive extracorporeal circulation should become the standard practice in coronary revascularization surgery. Eur J Cardiothorac Surg 2016; 50:189. [PMID: 26834234 DOI: 10.1093/ejcts/ezw004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/07/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Kyriakos Anastasiadis
- Cardiothoracic Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Adrian Bauer
- Department of Cardiovascular Surgery, MediClin Heartcenter, Coswig, Germany
| | - Thierry Carrel
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
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135
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Kurlansky P. Preoperative carotid ultrasound through the looking glass: Curiouser and curiouser! J Thorac Cardiovasc Surg 2015; 151:410-1. [PMID: 26589537 DOI: 10.1016/j.jtcvs.2015.10.079] [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: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Paul Kurlansky
- Department of Surgery, Columbia University, New York, NY.
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136
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Meta-analysis of the messenger: The price of small trials diverting our attention from the real target. J Thorac Cardiovasc Surg 2015; 151:78-9. [PMID: 26383003 DOI: 10.1016/j.jtcvs.2015.08.057] [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: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 11/23/2022]
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