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Wang C, Li P, Zhang F, Li J, Kong Q. Is hybrid coronary revascularization really beneficial in the long term? Eur J Cardiothorac Surg 2021; 60:1158-1166. [PMID: 34151954 DOI: 10.1093/ejcts/ezab161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This analysis aimed to compare both short- and long-term outcomes of hybrid coronary revascularization (HCR) with different techniques and coronary artery bypass grafting (CABG). METHODS Twenty-three studies were included, covering 10 468 different patients, among whom 2403 patients underwent HCR with either simultaneous or staged method and 8065 patients underwent CABG. RESULTS Compared with CABG, HCR had a statistically significant lower risk of stroke [odds ratio (OR) = 0.55, P = 0.049], major adverse cardiac and cerebrovascular events (OR = 0.69, P = 0.024) and blood transfusion (BT) (OR = 0.39, P < 0.001), whereas no significant differences were detected in mortality, myocardial infarction and repeat revascularization. A network meta-analysis showed that simultaneous HCR had significantly better outcomes in stroke (OR = 0.24, P = 0.01) and major adverse cardiac and cerebrovascular events (OR = 0.29, P < 0.001), and staged HCR had a significantly better outcome in BT (OR = 0.31, P < 0.001). According to the frequentist statistic results, simultaneous HCR had the highest probability of being the best treatment in terms of mortality (84%), stroke (97%), myocardial infarction (88%) and major adverse cardiac and cerebrovascular events (99%), whereas staged HCR had the highest probability of being the best in postoperative repeat revascularization (59%) and BT (83%). However, long-term results showed no significant difference between the HCR and CABG techniques. CONCLUSIONS HCR appears to be a feasible option for multivessel coronary artery disease patients. Compared to traditional CABG, HCR had lower risk of adverse events in the short term, but in the long term, survival rate and freedom from major adverse cardiac and cerebrovascular events rate were similar between groups.
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Affiliation(s)
- Chuan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ping Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fan Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingxing Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qingyu Kong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Guida GA, Guida GA, Bruno VD, Zakkar M, De Garate E, Pecchinenda MT, Homes A, Borzellino C, Mendoza P, Pecora G, Bonillo I, Benedetto U, Calafiore AM, Angelini GD, Guida MC. Left thoracotomy approach for off-pump coronary artery bypass grafting surgery: 15 years of experience in 2500 consecutive patients. Eur J Cardiothorac Surg 2021; 57:271-276. [PMID: 31209460 DOI: 10.1093/ejcts/ezz180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 04/02/2019] [Accepted: 05/03/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Our goal was to describe the experience at 2 centres with off-pump coronary artery bypass grafting using a left thoracotomy. METHODS From January 2002 to December 2017, a total of 2528 consecutive patients (578 women, mean age 62.3 ± 9.1 years) were operated on using this technique. Data were collected prospectively and analysed retrospectively. RESULTS There were no conversions to median sternotomy and 6 patients (0.2%) were converted to on-pump CABG. The mean number of grafts per patient was 2.8 ± 0. 9. The 30-day mortality rate was 1.0% (25 patients). Most patients were extubated in the operating theatre (97.3%), and 47 patients (1.9%) needed re-exploration for bleeding. Seven patients (0.3%) experienced a cerebrovascular event; 4 (0.3%) had a postoperative myocardial infarction; and 84 (3.4%) had new-onset atrial fibrillation. A total of 1510 patients (61.1%) were discharged from the hospital in the first 48 h after surgery. Long-term survival rates were 98.8%, 93.6% and 69.1% at 1, 5 and 10 years, respectively (central image). During the follow-up period, 60 patients (2.9%) were re-examined for recurrence of angina with a new coronary angiogram; of those, 24 (1.2%) required percutaneous coronary intervention and 11 (0.5%) had redo surgery. CONCLUSIONS A left thoracotomy is a safe alternative to a median sternotomy for coronary artery bypass grafting on the beating heart, with low early complications and good mid- and long-term results.
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Affiliation(s)
- Gustavo Antonio Guida
- Department of Cardiac Surgery, Fundacardio Foundation, Valencia, Venezuela.,Bristol Heart Institute, Bristol University, Bristol, UK
| | | | | | - Mustafa Zakkar
- Bristol Heart Institute, Bristol University, Bristol, UK
| | | | | | - Alfredo Homes
- Cardiac Surgery Service, Clinica Acosta Aortiz, Barquisimeto, Venezuela
| | | | - Pablo Mendoza
- Department of Cardiac Surgery, Fundacardio Foundation, Valencia, Venezuela
| | - Giuseppina Pecora
- Department of Cardiac Surgery, Fundacardio Foundation, Valencia, Venezuela
| | - Ivan Bonillo
- Department of Cardiac Surgery, Fundacardio Foundation, Valencia, Venezuela
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Long-Term Outcome of Patients Undergoing Minimally Invasive Direct Coronary Artery Bypass Surgery: A Single-Center Experience. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:23-28. [PMID: 29462051 DOI: 10.1097/imi.0000000000000466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary objective was to investigate the long-term survival of patients who underwent single-vessel coronary revascularization with minimally invasive direct coronary artery bypass surgery with or without hybrid revascularization. The secondary outcome measures were repeat revascularization either by coronary artery bypass grafting or by percutaneous coronary intervention and the incidence of myocardial infarction or recurrent angina. METHODS This is a retrospective study of prospectively collected data of patients who underwent minimally invasive direct coronary artery bypass procedure in our center between January 2001 and December 2015. Procedures were performed either through small left anterolateral thoracotomy or lower midline sternotomy. RESULTS A total of 182 patients were identified: 100 underwent minimally invasive direct coronary artery bypass to the left anterior descending artery and 82 underwent hybrid revascularization (percutaneous coronary intervention to coronary arteries other than the left anterior descending artery along with minimally invasive direct coronary artery bypass to the left anterior descending artery). The mean ± SD age was 62 ± 10.1 years. Preoperatively 82% were male, and 72.5% patients had good left ventricular function. The median follow-up period was 10.9 years. There was no in-hospital or 30-day mortality. The 10-year actuarial survival was 84.8%. Freedom from repeat revascularization was 98.9% at 1 year and 89.9% at 10 years. At follow-up, freedom from myocardial infarction was 96.7% whereas freedom from angina was 92.9%. CONCLUSIONS Within the limitations imposed by retrospective analyses, our study demonstrates excellent long-term outcome in patients undergoing minimally invasive direct coronary artery bypass with or without hybrid revascularization. For isolated left anterior descending artery disease minimally invasive direct coronary artery bypass should be considered, whereas hybrid revascularization (percutaneous coronary intervention and minimally invasive direct coronary artery bypass) should be considered for multivessel disease.
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Farid S, Ali JM, Stohlner V, Alam R, Schofield P, Nashef S, De Silva R. Long-Term Outcome of Patients Undergoing Minimally Invasive Direct Coronary Artery Bypass Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shakil Farid
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Jason M. Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Victoria Stohlner
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Ruhina Alam
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Peter Schofield
- Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Ravi De Silva
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
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Sardar P, Kundu A, Bischoff M, Chatterjee S, Owan T, Nairooz R, Giri J, Halkos ME, Liberman H, Douglas JS, Mukherjee D. Hybrid coronary revascularization versus coronary artery bypass grafting in patients with multivessel coronary artery disease: A meta-analysis. Catheter Cardiovasc Interv 2017; 91:203-212. [DOI: 10.1002/ccd.27098] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/16/2017] [Accepted: 03/23/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Partha Sardar
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Amartya Kundu
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | | | - Saurav Chatterjee
- Division of Cardiovascular Medicine; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Theophilus Owan
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Ramez Nairooz
- Division of Cardiovascular Medicine; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Jay Giri
- Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Michael E. Halkos
- Division of Cardiothoracic Surgery; Emory University School of Medicine; Atlanta Georgia
| | - Henry Liberman
- Clinical Research Unit, Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - John S. Douglas
- Clinical Research Unit, Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - Debabrata Mukherjee
- Division of Cardiovascular Medicine; Texas Tech University Health Sciences Center; El Paso Texas
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Giambruno V, Hafiz A, Fox SA, Jeanmart H, Cook RC, Khaliel FH, Teefy P, Sridhar K, Lavi S, Bagur R, Randhawa VK, Iglesias I, Jones PM, Harle CC, Bainbridge D, Chu MWA, Kiaii BB. Is the Future of Coronary Arterial Revascularization a Hybrid Approach? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vincenzo Giambruno
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Ahmad Hafiz
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie A. Fox
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Hugues Jeanmart
- Division of Cardiac Surgery, University of Montreal, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Richard C. Cook
- Division of Cardiac Surgery, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Feras H. Khaliel
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Patrick Teefy
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Kumar Sridhar
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Shahar Lavi
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Varinder K. Randhawa
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Ivan Iglesias
- Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Philip M. Jones
- Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher C. Harle
- Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Daniel Bainbridge
- Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Michael W. A. Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Bob B. Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
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Is the Future of Coronary Arterial Revascularization a Hybrid Approach? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:82-86. [DOI: 10.1097/imi.0000000000000355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Hybrid coronary revascularization offers and combines the advantages of both surgical and percutaneous revascularization and eliminates at the same time the disadvantages of both procedures. The objective of this study was to assess graft and stent patency at 6 months, rate of bleeding, intensive care unit and hospital stay, rate of reintervention, and long-term clinical follow-up. Methods From March 2004 to November 2015, a total of 203 patients underwent robotic-assisted minimally invasive direct coronary artery bypass graft of the left internal thoracic artery to the left anterior descending artery and PCI of a non-left anterior descending vessel in a single or two stage, at three different centers. Patients underwent 6-month angiographic follow-up. The mean ± SD clinical follow-up was 77.82 ±41.4 months. Results Successful hybrid coronary revascularization occurred in 196 of the 203 patients. One hundred forty-six patients underwent simultaneous surgical and percutaneous intervention. Nineteen patients underwent PCI before surgery, and 38 patient underwent PCI after surgery. No in-hospital mortality occurred. The mean ± SD ICU stay was 1 ± 1 days and the mean ± SD hospital stay was 5 ± 2 days. Only 13.3% of the patients required a blood transfusion. Six-month angiographic follow-up has been performed in the 95 patients, and it demonstrated a left internal thoracic artery anastomotic patency of 97.9% and stent patency of 92.6%. A total of 77.8 ± 41.4-month clinical follow-up demonstrated 95.1% survival, 92.6% freedom from angina, and 90.7% freedom from any form of coronary revascularization. Conclusions Hybrid coronary revascularization seems to be a promising and safe revascularization strategy. It provides selected patients with an alternative, functionally complete revascularization with minimal surgical trauma and good long-term clinical outcomes.
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Mendes M. Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? There is No Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting. Circulation 2017; 133:2538-43. [PMID: 27297346 DOI: 10.1161/circulationaha.115.017800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Miguel Mendes
- From West Lisbon Hospital Center, Hospital de Santa Cruz, Portugal; and Nova Medical School/Faculdade de Ciências Médicas, Lisbon, Portugal.
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Short-term clinical outcomes after hybrid coronary revascularization versus off-pump coronary artery bypass for the treatment of multivessel or left main coronary artery disease: a meta-analysis. Coron Artery Dis 2016; 26:526-34. [PMID: 26018329 PMCID: PMC4520736 DOI: 10.1097/mca.0000000000000265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Hybrid coronary revascularization (HCR) and off-pump coronary artery bypass grafting (OPCABG) are both feasible, less invasive techniques for coronary revascularization. Although both techniques utilize the left internal mammary artery to left anterior descending artery graft, HCR uses drug-eluting stents instead of saphenous vein bypass. It remains unclear whether HCR is equal to, better or worse than OPCABG. Methods and results A meta-analysis was carried out using a random-effects model. Seven observational studies were included. There was no significant difference either in in-hospital mortality [relative risk (RR) 0.57, 95% confidence interval (CI) 0.13–2.59, P=0.47] or in the MACCE rate (RR 0.63, 95% CI 0.24–1.64, P=0.34) between the HCR group and the OPCABG group. A significant difference was observed between the two groups in the length of hospitalization (RR 0.55, 95% CI 0.13–0.97, P=0.01), length of ICU stay (RR 0.45, 95% CI 0.10–0.80, P<0.05), intubation time (RR 0.48, 95% CI 0.13–0.84, P<0.01), need for red blood transfusion (RR 0.67, 95% CI 0.56–0.82, P<0.001), and total in-hospital costs (RR 0.90, 95% CI 0.39–1.42, P<0.01). Conclusion Compared with OPCABG, HCR did not improve early survival but decreased the length of hospitalization, length of ICU stay, intubation time, and need for red blood transfusion, and increased total in-hospitalcosts.
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Completeness of coronary revascularization and survival: Impact of age and off-pump surgery. J Thorac Cardiovasc Surg 2014; 148:1307-1315.e1. [DOI: 10.1016/j.jtcvs.2013.12.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/11/2013] [Accepted: 12/30/2013] [Indexed: 01/26/2023]
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Repossini A, Tespili M, Saino A, Di Bacco L, Giroletti L, Rosati F, Bisleri G, Muneretto C. Hybrid Coronary Revascularization in 100 Patients With Multivessel Coronary Disease. Ann Thorac Surg 2014; 98:574-80; discussion 580-1. [DOI: 10.1016/j.athoracsur.2014.04.101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/15/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
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Abstract
The elderly represent a rapidly growing and substantially under-treated sector in industrialized countries, with coronary artery disease and degenerative aortic stenosis rampant. The proportion of elderly patients undergoing cardiac surgery is rising steadily and outcomes continue to improve with the refinement of operative techniques and perioperative care. Advanced risk stratification models, such as the logistic European System for Cardiac Operative Risk Evaluation now offer validated prediction of operative mortality in these high-risk patients. Current trends towards off-pump coronary artery surgery, hybrid revascularization and mitral repair may have advantages in the elderly, who often have more diffuse cardiovascular disease and a lower tolerance to intervention. Recent advances may also provide surgical options for the emerging epidemics of cardiovascular disease affecting the elderly, atrial fibrillation and heart failure.
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Affiliation(s)
- Nigel E Drury
- Papworth Hospital, Department of Cardiac Surgery, Cambridge CB3 8RE, UK.
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Abstract
The introduction of drug-eluting stents (DES) to interventional cardiology practice has resulted in a significant improvement in the long-term efficacy of percutaneous coronary interventions. DES successfully combine mechanical benefits of bare-metal stents and stabilizing the lumen, with direct delivery and the controlled elution of a pharmacologic agent to the injured vessel wall to suppress further neointimal proliferation. The dramatic reduction in restenosis has resulted in the implementation of DES in clinical practice, and has rapidly expanded the whole spectrum of successfully treatable coronary conditions, particularly in high-risk patients and complex lesions. In this review the authors present current data on DES. Currently, two types of DES are available in the USA: sirolimus-eluting stents (SES) CYPHER (Cordis Corp., FL, USA) and paclitaxel-eluting stents (PES) TAXUS (Boston Scientific, MA, USA), and many more are on the way to approval. In addition to sirolimus and paclitaxel, several other drugs have been successfully used in DES. Everolimus and ABT-578 are both analogs of sirolimus that also have immunosuppressive and antiproliferative properties. Another approach in the development of DES is to use drugs that can accelerate re-endothelialization and restore normal endothelial function following vascular injury. Recent advances in vascular gene transfer have also demonstrated potential new treatment modalities for cardiovascular disease, particularly in the treatment of vascular restenosis.
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Affiliation(s)
- Nicholas N Kipshidze
- Department of Interventional Cardiac and Vascular Services, Lenox Hill Hospital, New York, NY 10021, USA.
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Adams C, Burns DJ, Chu MW, Jones PM, Shridar K, Teefy P, Kostuk WJ, Dobkowski WB, Romsa J, Kiaii B. Single-stage hybrid coronary revascularization with long-term follow-up†. Eur J Cardiothorac Surg 2013; 45:438-42; discussion 442-3. [DOI: 10.1093/ejcts/ezt390] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thuesen L, Modrau IS, Nielsen PH, Boetker HE. Hybrid coronary revascularization: a mainstream revascularization strategy in the future? Interv Cardiol 2013. [DOI: 10.2217/ica.13.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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An open randomized controlled trial of median sternotomy versus anterolateral left thoracotomy on morbidity and health care resource use in patients having off-pump coronary artery bypass surgery: The Sternotomy Versus Thoracotomy (STET) trial. J Thorac Cardiovasc Surg 2013; 146:306-16.e1-9. [PMID: 22944093 DOI: 10.1016/j.jtcvs.2012.04.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/21/2012] [Accepted: 04/06/2012] [Indexed: 11/22/2022]
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Zhou S, Fang Z, Xiong H, Hu S, Xu B, Chen L, Wang W. Effect of one-stop hybrid coronary revascularization on postoperative renal function and bleeding: a comparison study with off-pump coronary artery bypass grafting surgery. J Thorac Cardiovasc Surg 2013; 147:1511-1516.e1. [PMID: 23879931 DOI: 10.1016/j.jtcvs.2013.05.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 04/17/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Although 1-stop hybrid coronary revascularization offers potential benefits for selected patients with multivessel coronary artery disease, the exposure to contrast dye and potent antiplatelet drugs could increase the risk of postoperative acute kidney injury and coagulopathy. The goal of the present study was to compare the measures of renal function, postoperative bleeding, and transfusion requirements in patients undergoing hybrid revascularization compared with off-pump coronary artery bypass grafting (CABG). METHODS We retrospectively analyzed the data from 141 consecutive patients who had undergone 1-stop hybrid coronary revascularization from June 2007 to January 2011. Propensity score matching with 141 off-pump CABG patients from our surgical database was performed for comparison. The change in renal function, cumulative chest tube drainage, and clinical outcome parameters were compared between the 2 groups. RESULTS Compared with off-pump CABG, patients undergoing hybrid revascularization had significantly less chest tube drainage at 12 hours after surgery (P = .04) and for the total amount during the postoperative period (P < .001) and required fewer blood transfusions (P = .001). The hybrid group had a higher incidence of acute kidney injury, but this did not reach statistical significance (25.2% vs 17.6%, P = .13). The hybrid group required less inotropic and vasoactive support, had fewer respiratory complications, required a shorter time of mechanical support, and had a decreased length of intensive care unit stay. CONCLUSIONS Compared with off-pump CABG, 1-stop hybrid coronary revascularization was associated with benefits such as less postoperative bleeding and blood transfusion requirements without significantly increasing the additional risk of acute kidney injury.
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Affiliation(s)
- Shan Zhou
- Department of Anesthesiology, State Key Laboratory of Translational Cardiovascular Medicine, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Zhongrong Fang
- Department of Anesthesiology, State Key Laboratory of Translational Cardiovascular Medicine, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Hui Xiong
- Department of Surgery, State Key Laboratory of Translational Cardiovascular Medicine, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Shengshou Hu
- Department of Surgery, State Key Laboratory of Translational Cardiovascular Medicine, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Bo Xu
- Department of Cardiology, State Key Laboratory of Translational Cardiovascular Medicine, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Lei Chen
- Department of Anesthesiology, State Key Laboratory of Translational Cardiovascular Medicine, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Weipeng Wang
- Department of Anesthesiology, State Key Laboratory of Translational Cardiovascular Medicine, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
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Planned Simultaneous Beating-heart Totally Endoscopic Coronary Artery Bypass (TECAB) and Percutaneous Intervention in a Single Operative Setting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 1:239-42. [PMID: 22436751 DOI: 10.1097/01.imi.0000235470.96825.c9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND : Staged hybrid revascularization integrated with minimally invasive coronary artery bypass grafting (CABG) and arrested heart totally endoscopic CABG has been reported. We report the first case of planned simultaneous hybrid coronary revascularization, integrating beating-heart TECAB, and percutaneous intervention (PCI) in the same operative setting. METHODS : A 73-year-old woman with symptoms of angina and a history of diabetes was found to have 2-vessel coronary artery disease involving the left anterior descending (LAD) and the right coronary artery (RCA). Left internal thoracic artery (LITA) to the LAD grafting was done on a beating heart in a totally endoscopic manner using the da Vinci robotic system through 4 ports. Immediately after LITA to LAD TECAB, percutaneous angioplasty and stent placement was done through the right femoral artery using the OEC 9800 mobile C-arm in the operating room. RESULTS : There was no stenosis noted in the RCA after the intervention. LITA angiography showed a completely patent anastomosis. The total operative time for both procedures was 165 minutes. Occlusion and anastomotic times were 14 and 8 minutes, respectively. Total PCI and fluoroscopy times were 10 and 3 minutes, respectively. The patient received clopidogrel (Plavix) and aspirin in the immediate postoperative period and was discharged home on the second postoperative day. CONCLUSION : This planned hybrid approach involving a beating-heart single-vessel TECAB and simultaneous angioplasty-stent in a single operative setting achieved complete coronary artery revascularization in a less invasive way.
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Repossini A, Tespili M, Saino A, Kotelnikov I, Moggi A, Di Bacco L, Muneretto C. Hybrid revascularization in multivessel coronary artery disease. Eur J Cardiothorac Surg 2013; 44:288-93; discussion 293-4. [PMID: 23444407 DOI: 10.1093/ejcts/ezt016] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Minimally invasive hybrid revascularization (MIHR) by means of the left mammary artery on the left anterior descending artery [minimally invasive direct coronary artery bypass (MIDCAB)] combined with percutaneous coronary interventions (PCI) stenting may be an alternative to conventional coronary artery bypass grafting through sternotomy or multiple PCI. The purpose of this study is to retrospectively evaluate the long-term outcomes of this strategy. METHODS Since May 1997 up to January 2011, 810 MIDCAB have been performed as isolated revascularization in 644 patients. Since 2004, MIDCAB, as a part of hybrid revascularization, was associated with PCI in 166 patients. RESULTS In the MIDCAB group, mean age was 64.6 ± 12.0, with 83.8% males. Two-vessel disease was 62.4%, three-vessel disease 37.6%. Overall mortality was 0.24%, perioperative acute myocardial infarction-1.6%, early reoperation-0.74%, reopening for bleeding-1.2%, case rate of haemotrasfusion-3.1%, with a mean hospital postoperative stay of 4 ± 2.5 days. Postoperative angiographic control prior to PCI and in symptomatic patients showed patent left internal mammary artery in 100% of cases. PCI was performed in 166 patients, 64.2% before MIDCAB and 35.8% after surgery (interval 2.2 ± 1.3 months). The mean follow-up in the MIDCAB group was 8.4 ± 3.2 years. In the MIHR group, at the mean follow-up of 4.5 ± 2.3 years, freedom from related cardiac death was 93% with freedom from cardiac reintervention of 83%. CONCLUSIONS Our 13-year experience with MIDCAB demonstrates that the operation is safe and associated with a very low incidence of early and late complications. The hybrid approach provided excellent long-term outcome in terms of freedom from cardiac death and reoperation. Accurate patient selection, as well the timing of the hybrid procedure, is mandatory to optimize surgical and PCI results.
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Affiliation(s)
- Alberto Repossini
- Department of Cardiac Surgery, University of Brescia, Brescia, Italy.
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Clinical outcomes after hybrid coronary revascularization versus off-pump coronary artery bypass: a prospective evaluation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 4:299-306. [PMID: 22437225 DOI: 10.1097/imi.0b013e3181bbfa96] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : Hybrid coronary revascularization is offered as an alternative strategy for patients with multivessel coronary artery disease (CAD). We present our experience and provide a comparative analysis to off-pump coronary artery bypass grafting (OPCAB). METHODS : Ninety-one patients with multivessel CAD underwent minimally invasive left internal mammary artery to left anterior descending grafting in combination with percutaneous coronary intervention of nonleft anterior descending targets (HYBRID). The primary end point of this study was major adverse cardiac and cerebrovascular events (MACCE), defined as death, stroke, and nonfatal myocardial infarction. MACCE in the HYBRID group were compared with 4175 contemporaneously performed OPCAB operations by logistic (30-day outcomes) and Cox proportional hazards (long-term survival) regression methods. Propensity scoring was used to adjust for potential selection bias. RESULTS : The 30-day MACCE (death/stroke/nonfatal myocardial infarction) rate was 1.1% for the HYBRID group (0%/0%/1.1%) and 3.0% for the OPCAB group (1.8%/1.1%/0.5%) (odds ratio = 0.47, P = 0.48). Angiographic left internal mammary artery evaluation was obtained in 95.6% of patients (87 of 91) revealing FitzGibbon A patency in 98.0% (96 of 98). The reintervention rate at 1 year for the HYBRID group was 5.5% (5 of 91) and was limited to repeat percutaneous coronary intervention. Three-year survival was statistically similar for the two groups (hazard ratio = 0.44, P = 0.18, see Kaplan-Meier figure). CONCLUSIONS : Hybrid coronary revascularization may be noninferior to OPCAB with respect to early MACCE and 3-year survival in the treatment of multivessel CAD.
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Complete Versus Incomplete Revascularization With Coronary Artery Bypass Graft or Percutaneous Intervention in Stable Coronary Artery Disease. Circ Cardiovasc Interv 2012; 5:597-604. [DOI: 10.1161/circinterventions.111.965509] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Fedakar A, Taşar M, Rabus MB, Alsalehi S, Toker ME, Balkanay M. Hybrid Coronary Revascularization for the Treatment of Left Main Coronary Artery Disease in High-Risk Patients. Heart Surg Forum 2012; 15:E51-5. [DOI: 10.1532/hsf98.20111116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p><b>Objective:</b> Hybrid coronary revascularization is an alternative for treatment for high-risk patients with coronary artery disease. We evaluated the efficacy of staged hybrid coronary revascularization for the treatment of unprotected left main coronary artery disease in high-risk patients.</p><p><b>Methods:</b> Patients with left main or proximal left anterior descending coronary artery stenosis who are not good candidates for percutaneous coronary intervention and who had suitable lesions in the right coronary and circumflex arteries were considered for staged hybrid therapy if they had poor left ventricular functions (ejection fraction <0.40) and comorbid illnesses. From January 2008 through December 2010, 11 patients (8 men, 3 women; mean age: 66.1 � 9.1 years) were treated with off-pump coronary artery bypass grafting combined with staged percutaneous coronary intervention. Nine patients had left main coronary artery stenosis together with circumflex or right coronary artery stenosis, and 2 patients had proximal left anterior descending artery stenosis and right coronary artery stenosis.</p><p><b>Results:</b> After off-pump coronary artery bypass grafting, procedure-related complications did not occur, and there was no in-hospital death. Coronary re-angiography after a median of 16 days revealed patent and functioning left internal mammarian artery grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty and occasional stenting (n = 14), a total of 14 lesions were treated successfully. Procedure related complications did not occur. All patients remained angina-free, and no stress electrocardiographic changes were recorded.</p><p><b>Conclusion:</b> Our preliminary results indicate that a "staged hybrid" approach to the treatment of left main coronary artery disease in high-risk patients is safe and effective. Hybrid coronary revascularization enables complete revascularization and may be an alternative method of treating left main coronary artery disease in selected high-risk patients.</p>
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Rab ST, Douglas JS, Lyons E, Puskas JD, Bansal D, Halkos ME, Guyton RA, Vassiliades TA. Hybrid coronary revascularization for the treatment of left main coronary stenosis: A feasibility study. Catheter Cardiovasc Interv 2011; 80:238-44. [DOI: 10.1002/ccd.23312] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 07/05/2011] [Indexed: 11/06/2022]
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Iribarne A, Easterwood R, Chan EYH, Yang J, Soni L, Russo MJ, Smith CR, Argenziano M. The golden age of minimally invasive cardiothoracic surgery: current and future perspectives. Future Cardiol 2011; 7:333-46. [PMID: 21627475 DOI: 10.2217/fca.11.23] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Over the past decade, minimally invasive cardiothoracic surgery (MICS) has grown in popularity. This growth has been driven, in part, by a desire to translate many of the observed benefits of minimal access surgery, such as decreased pain and reduced surgical trauma, to the cardiac surgical arena. Initial enthusiasm for MICS was tempered by concerns over reduced surgical exposure in highly complex operations and the potential for prolonged operative times and patient safety. With innovations in perfusion techniques, refinement of transthoracic echocardiography and the development of specialized surgical instruments and robotic technology, cardiac surgery was provided with the necessary tools to progress to less invasive approaches. However, much of the early literature on MICS focused on technical reports or small case series. The safety and feasibility of MICS have been demonstrated, yet questions remain regarding the relative efficacy of MICS over traditional sternotomy approaches. Recently, there has been a growth in the body of published literature on MICS long-term outcomes, with most reports suggesting that major cardiac operations that have traditionally been performed through a median sternotomy can be performed through a variety of minimally invasive approaches with equivalent safety and durability. In this article, we examine the technological advancements that have made MICS possible and provide an update on the major areas of cardiac surgery where MICS has demonstrated the most growth, with consideration of current and future directions.
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Affiliation(s)
- Alexander Iribarne
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
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Delhaye C, Sudre A, Lemesle G, Vanesson L, Koussa M, Fayad G, Bauters C, Lablanche JM, Modine T. Hybrid revascularization, comprising coronary artery bypass graft with exclusive arterial conduits followed by early drug-eluting stent implantation, in multivessel coronary artery disease. Arch Cardiovasc Dis 2010; 103:502-11. [DOI: 10.1016/j.acvd.2010.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Revised: 08/20/2010] [Accepted: 09/17/2010] [Indexed: 10/18/2022]
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Popma JJ, Nathan S, Hagberg RC, Khabbaz KR. Hybrid myocardial revascularization: An integrated approach to coronary revascularization. Catheter Cardiovasc Interv 2010; 75 Suppl 1:S28-34. [DOI: 10.1002/ccd.22402] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Vassiliades TA, Kilgo PD, Douglas JS, Babaliaros VC, Block PC, Samady H, Cates CU, Rab ST, Morris DC. Clinical Outcomes after Hybrid Coronary Revascularization versus Off-Pump Coronary Artery Bypass. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009. [DOI: 10.1177/155698450900400602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas A. Vassiliades
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA USA
| | - Patrick D. Kilgo
- Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, GA USA
| | - John S. Douglas
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA
| | | | - Peter C. Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA
| | | | - S. Tanveer Rab
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA
| | - Douglas C Morris
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA
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Vassiliades T. Enabling Technology for Minimally Invasive Coronary Artery Bypass Grafting. Semin Thorac Cardiovasc Surg 2009; 21:237-44. [DOI: 10.1053/j.semtcvs.2009.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2009] [Indexed: 11/11/2022]
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Zhao DX, Leacche M, Balaguer JM, Boudoulas KD, Damp JA, Greelish JP, Byrne JG. Routine Intraoperative Completion Angiography After Coronary Artery Bypass Grafting and 1-Stop Hybrid Revascularization. J Am Coll Cardiol 2009; 53:232-41. [DOI: 10.1016/j.jacc.2008.10.011] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 10/09/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022]
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Weerasinghe DP, Yusuf F, Parr NJ. Trends in percutaneous coronary interventions in new South Wales, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:232-245. [PMID: 19440280 PMCID: PMC2672343 DOI: 10.3390/ijerph6010245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 01/08/2009] [Indexed: 12/01/2022]
Abstract
This is the first detailed study on percutaneous coronary intervention (PCI) in New South Wales (NSW), Australia. Hospital data for PCIs carried out between 1 July 1990 and 30 June 2002 are analysed. The study explores trends in PCI rates by selected socio-demographic factors, the utilisation of angioplasties vis-a-vis stents, emergency admissions, and selected coexisting conditions which determine the disease status of PCI patients. Logistic regression models are used to study the medical conditions that require both PCI and coronary artery bypass graft (CABG). The PCI rate has grown rapidly at 12.1% per annum, with a particularly rapid increase for persons aged 75+. The rate of multiple stent utilisation increased at 4.6% per annum. Pacific-born and Middle-Eastern-born patients are more than twice as likely as the Australian-born to have diabetes. Factors affecting failure of PCI requiring CABG include perforation and multi-vessel disease. PCI services in public hospitals need to be increased to facilitate the availability of these procedures to all segments of the population, as do targeted community-level programmes to educate high-risk groups in the control of heart diseases.
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Affiliation(s)
- Daminda P. Weerasinghe
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Farhat Yusuf
- Faculty of Business and Economics, Macquarie University, North Ryde, NSW, Australia; E-mails:
(F. Y.);
(N. J. P.)
| | - Nicholas J. Parr
- Faculty of Business and Economics, Macquarie University, North Ryde, NSW, Australia; E-mails:
(F. Y.);
(N. J. P.)
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Holzhey DM, Jacobs S, Mochalski M, Merk D, Walther T, Mohr FW, Falk V. Minimally Invasive Hybrid Coronary Artery Revascularization. Ann Thorac Surg 2008; 86:1856-60. [PMID: 19021994 DOI: 10.1016/j.athoracsur.2008.08.034] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Revised: 08/12/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
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Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg 2008; 248:829-35. [PMID: 18936577 DOI: 10.1097/sla.0b013e31818a15b5] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Minimally invasive coronary artery bypass grafting (miniCABG) decreases in-hospital morbidity versus traditional sternotomy CABG. We performed a prospective cohort study (NCT00481806) to assess the impact of miniCABG on costs and metrics that influence quality of life after hospital discharge. METHODS One hundred consecutive miniCABG cases performed using internal mammary artery (IMA) grafting +/- coronary stenting were compared with a matched group of 100 sternotomy CABG patients using IMA and saphenous veins, both treating equivalent number of target coronaries (2.7 vs. 2.9), off-pump. We compared perioperative costs, time to return to work/normal activity, and risk of major adverse cardiac/cerebrovascular events (MACCE) at 1 year: myocardial infarction (elevated troponin or EKG changes), target vessel occlusion (CT angiography at 1 year), stroke, or death. RESULTS For miniCABG, robotic instruments and stents increased intraoperative costs; postoperative costs were decreased from significantly less intubation time (4.80 +/- 6.35 vs. 12.24 +/- 6.24 hours), hospital stay (3.77 +/- 1.51 vs. 6.38 +/- 2.23 days), and transfusion (0.16 +/- 0.37 vs. 1.37 +/- 1.35 U) leading to no significant differences in total costs. Undergoing miniCABG independently predicted earlier return to work after adjusting for confounders (t = -2.15; P = 0.04), whereas sternotomy CABG increased MACCE (HR, 3.9; 95% CI, 1.4-7.6), largely from lower target-vessel patency. CONCLUSIONS MiniCABG shortens patient recovery time, minimizes MACCE risk at 1 year, and showed superior quality and outcome metrics versus standard-of-care CABG. These findings occurred without increasing costs and with superior target vessel graft patency.
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Kiaii B, McClure RS, Stewart P, Rayman R, Swinamer SA, Suematsu Y, Fox S, Higgins J, Albion C, Kostuk WJ, Almond D, Sridhar K, Teefy P, Jablonsky G, Diamantouros P, Dobkowski WB, Jones P, Bainbridge D, Iglesias I, Murkin J, Cheng D, Novick RJ. Simultaneous integrated coronary artery revascularization with long-term angiographic follow-up. J Thorac Cardiovasc Surg 2008; 136:702-8. [DOI: 10.1016/j.jtcvs.2008.02.081] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Revised: 01/25/2008] [Accepted: 02/15/2008] [Indexed: 10/21/2022]
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Ishikawa S, Kawasaki A, Neya K, Wada S, Kito H, Ueda K. Initial Impact of Drug-Eluting Stents on Coronary Artery Bypass Grafting. Int Heart J 2007; 48:455-61. [PMID: 17827817 DOI: 10.1536/ihj.48.455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The impact of drug-eluting stents (DES) on the characteristics and operative results of patients referred for coronary artery bypass grafting (CABG) was studied. We reviewed data from isolated CABG patients 24 months before (group A, n = 134) and 24 months after (group B, n = 98) the introduction of DES for clinical use at Teikyo University Hospital in Tokyo. Group B patients were significantly older than those of group A (66 +/- 9 versus 69 +/- 9 years old). The number of diseased vessels was significantly larger in group B (2.5 +/- 0.6 versus 2.7 +/- 0.5) and left main trunk disease decreased in group B (27% versus 17%). Preoperative IABP support was more frequent in group B (9% versus 17%) and beating heart surgery was significantly more frequent in group B (26% versus 59%). The number of grafts was similar in the 2 groups (3.2 +/- 1.4 versus 3.0 +/- 1.1). The operative mortality rates were 0.7% and 4.1% in group A and B, respectively. Incomplete revascularization followed by postoperative percutaneous coronary intervention (PCI) was performed in 11% and 12%, respectively, and all the patients survived surgery. The operative mortality rates for arrested heart and beating heart surgery were 2% and 2%, respectively. In conclusion, after the introduction of DES, more clinically ill patients were referred to CABG. Combination therapy consisting of CABG and PCI (Hybrid) may be a treatment of choice in critical patients.
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Affiliation(s)
- Susumu Ishikawa
- Department of Cardiovascular Surgery, Teikyo University School of Medicine, Kaga, Tokyo, Japan
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Ooi OC, Mullany CJ, Rihal CS. Revascularization Options for Ischemic Heart Disease: Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50014-0] [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: 11/28/2022] Open
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Srivastava S, Gadasalli S, Tijerina O, Barrera R, Quismundo S, Srivastava V. Planned Simultaneous Beating-heart Totally Endoscopic Coronary Artery Bypass (TECAB) and Percutaneous Intervention in a Single Operative Setting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2006. [DOI: 10.1177/155698450600100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Suresh Gadasalli
- Departments of Cardiovascular Surgery and Cardiology, Anesthesiology, Alliance Hospital, Odessa, TX
| | - Orlando Tijerina
- Departments of Cardiovascular Surgery and Cardiology, Anesthesiology, Alliance Hospital, Odessa, TX
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Ong ATL, Serruys PW. Complete revascularization: coronary artery bypass graft surgery versus percutaneous coronary intervention. Circulation 2006; 114:249-55. [PMID: 16847164 DOI: 10.1161/circulationaha.106.614420] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew T L Ong
- Department of Interventional Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, Netherlands
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Vassiliades TA, Douglas JS, Morris DC, Block PC, Ghazzal Z, Rab ST, Cates CU. Integrated coronary revascularization with drug-eluting stents: Immediate and seven-month outcome. J Thorac Cardiovasc Surg 2006; 131:956-62. [PMID: 16678575 DOI: 10.1016/j.jtcvs.2005.10.058] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Revised: 08/25/2005] [Accepted: 10/04/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to demonstrate the safety and feasibility of an integrated coronary revascularization strategy that combines minimally invasive left internal thoracic artery to left anterior descending coronary artery anastomosis with drug-eluting stent implantation to non-left anterior descending coronary artery lesions. METHODS Over 18 months, 47 consecutive patients with multivessel coronary artery disease underwent thoracoscopic harvesting of the left internal thoracic artery to graft the left anterior descending coronary artery. Anastomoses were constructed by hand, off-pump, and under direct vision through a 4-cm non-rib-spreading, muscle-sparing chest incision. Non-left anterior descending coronary artery lesions were then treated percutaneously using sirolimus- or paclitaxel-eluting stents. Angiographic follow-up was performed in all patients. RESULTS Within the first 90 days of hospitalizations, there were no deaths, myocardial infarctions, neurologic events, or wound complications. Forty patients underwent left internal thoracic artery to left anterior descending coronary artery grafting, and 7 patients underwent left internal thoracic artery to left anterior descending coronary artery/diagonal sequential grafting for a total of 54 anastomoses. Angiographic patency scores were FitzGibbon A 96.2% (52/54) and FitzGibbon A + B 100% (54/54). A total of 65 drug-eluting stents were implanted in 61 non-left anterior descending coronary artery coronary lesions of which 49.1% (30/61) were type B2 or C lesions, including 5 left main lesions. Diabetes was present in 53.2% of patients (25/47). At a mean follow-up time of 7.0 +/- 4.8 months, the target lesion or vessel repeat revascularization rate was 6.6% (4/61) for drug-eluting stents and 1.9% (1/54) for left internal thoracic artery to left anterior descending coronary artery grafting. One anastomosis required balloon dilation, but no patients have required repeat coronary artery bypass grafting. CONCLUSIONS Integrated coronary revascularization using drug-eluting stents is feasible and safe. There are sufficient data to justify a randomized comparison of integrated coronary revascularization with standard coronary artery bypass grafting.
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Affiliation(s)
- Thomas A Vassiliades
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga, USA.
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