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Calafiore AM, Torregrossa G, Salerno TA, Prapas S, Benetti F, Angelini GD, Lima RDC, Di Mauro M, Taggart D, Gaudino M, Puskas JD. Controversy. On pump or off pump: what will I do when I grow up? A narrative systematic review. Eur J Cardiothorac Surg 2024; 66:ezae256. [PMID: 38941506 DOI: 10.1093/ejcts/ezae256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/31/2024] [Accepted: 06/27/2024] [Indexed: 06/30/2024] Open
Abstract
The transition from the second to the third millennium happened to be a turning point in the history of myocardial revascularization on a beating heart, which moved from technical development to critical evaluation. This article describes how the initial acceptance and spread of off-pump coronary artery bypass grafting (OPCABG) was followed by the general perception that the technique could not fulfill the expectations placed in it and provides some insight on what should we do with the know-how of OPCABG in the present and the future of coronary surgical revascularization.
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Affiliation(s)
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
| | - Tomas A Salerno
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Sotirios Prapas
- 1st Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece
| | | | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Ricardo De Carvalho Lima
- Department of Cardiovascular Surgery, Faculty of Medical Science, University of Pernambuco, Recife, Brazil
| | - Michele Di Mauro
- Department of Cardiothoracic Surgery, Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, Pierangeli Hospital, Pescara, Italy
| | - David Taggart
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Torre T, Pozzoli A, Valgimigli M, Leo LA, Toto F, Muretti M, Birova S, Ferrari E, Pedrazzini G, Demertzis S. Minimally Invasive Isolated and Hybrid Surgical Revascularization for Multivessel Coronary Disease: A Single-Center Long-Term Follow-Up. J Pers Med 2024; 14:528. [PMID: 38793110 PMCID: PMC11122097 DOI: 10.3390/jpm14050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Some evidence suggests that surgical minimally invasive (MIDCAB) and hybrid coronary revascularization (HCR) are safe and potentially effective at short-term follow-up. Data on long-term outcomes are more limited and inconclusive. METHODS Between February 2013 and December 2023, a total of 1997 patients underwent surgical coronary artery revascularization at our institution, of whom, 92 (4.7%) received left anterior mini-thoracotomy access (MIDCAB), either isolated (N = 78) or in combination with percutaneous coronary intervention (N = 14, HCR group). RESULTS After a median follow-up of 75 months (range 3.1: 149 months), cardiac mortality was 0% while overall mortality was 3%, with one in-hospital mortality and two additional late deaths. Conversion to sternotomy happened in two patients (2.1%), and surgical re-explorations occurred in five patients (4.6%), of whom three for bleeding and two for graft failure. All patients received left internal mammary (LIMA) to left anterior descending artery (LAD) grafting (100%). In the HCR group, 10 patients (72%) showed percutaneous revascularization (PCI) after MIDCAB, showing PCI on a mean of 1.6 ± 0.6 vessels and implanting 2.1 ± 0.9 drug-eluting stents. CONCLUSIONS MIDCAB, in isolation or in association with hybrid coronary revascularization, is associated with encouraging short- and long-term results in selected patients discussed within a dedicated heart-team.
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Affiliation(s)
- Tiziano Torre
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Marco Valgimigli
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Laura Anna Leo
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
| | - Francesca Toto
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Mirko Muretti
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Sara Birova
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Enrico Ferrari
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Faculty of Medicine, University of Zurich (UZH), 8032 Zurich, Switzerland
| | - Giovanni Pedrazzini
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Stefanos Demertzis
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Faculty of Medicine, University of Bern, 3010 Bern, Switzerland
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Babayiğit E, Görenek B. Hybrid Coronary Revascularization: Has Everything Clearly Described? Am J Cardiol 2024; 218:1. [PMID: 38428711 DOI: 10.1016/j.amjcard.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Erdi Babayiğit
- Cardiology Department, Eskişehir Osmangazi University, Health, Practice and Research Hospital, Eskişehir, Türkiye
| | - Bülent Görenek
- Cardiology Department, Eskişehir Osmangazi University, Health, Practice and Research Hospital, Eskişehir, Türkiye
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Jaswaney R, Arora S. Hybrid Coronary Revascularization: Insights of Long-Term Outcomes. Am J Cardiol 2024; 212:135-136. [PMID: 38101462 DOI: 10.1016/j.amjcard.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Rahul Jaswaney
- Department of Cardiology, Temple University Hospital Heart and Vascular Center, Philadelphia, Pennsylvania
| | - Shilpkumar Arora
- University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio.
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