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Andrási TB, Glück AC, Talipov I, Volevski L, Vasiloi I. Sequential composite BIMA grafting for 3v-CAD: factors that predict successful outcome of the one-inflow and two-inflow revascularization techniques. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02022-0. [PMID: 38509384 DOI: 10.1007/s11748-024-02022-0] [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: 11/01/2023] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The effect of one-inflow and two-inflow coronary surgical revascularization techniques inclosing skeletonized double mammary artery (BIMA) as T-graft on outcome is studied. METHODS Early ad mid-term outcome of complete BIMA revascularization (C-T-BIMA) versus left-sided BIMA with right-sided aorto-coronary bypass (L-T-BIMA + R-CABG) is quantified and analyzed by multivariate logistic regression, Cox-regression, and Kaplan-Meier analysis in a series of 204 consecutive patients treated for triple-vessel coronary disease (3v-CAD). RESULTS The L-T-BIMA + R-CABG technique (n = 104) enables higher number of total (4.02 ± 0.87 vs. 3.71 ± 0.69, p = 0.015) and right-sided (1.21 ± 0.43 vs. 1.02 ± 0.32, p = 0.001) coronary anastomoses, improves total bypass flow (125.88 ± 92.41 vs. 82.50 ± 49.26 ml, p < 0.0001) and bypass flow/anastomosis (31.83 ± 23.9 vs.22.77 ± 14.23, p = 0.001), and enhances completeness of revascularization (84% vs.69%, p = 0.014) compared to C-T-BIMA strategy (n = 100), respectively. Although the incidence of MACCE was comparable in the two groups (8% vs.1.2%, p = 0.055), the progression of functional mitral regurgitation (FMR) was significantly lower after L-T-BIMA + R-CABG, then after C-T-BIMA (47% vs.64%, p = 0.017). The use of C-T-BIMA-technique (HR = 4.2, p = 0.01) and preoperative RCA occlusion (HR = 3.006, p = 0.023) predicted FMR progression, whereas L-T-Graft + R-CABG technique protected against it (X2 = 14.04, p < 0.0001) independent of the anatomic and clinical complexity (Syntax score I: HR = 16.2, p = 0.156, Syntax score II: HR = 1.901, p = 0.751), of early- (0.96% vs.2%, p = 0.617) and mid-term mortality (5.8% vs.4%, p = 0.748) when compared to C-T-BIMA, respectively. CONCLUSIONS The two-inflow coronary revascularization by L-T-BIMA + R-CABG better protects against FMR progression without increasing MACCE and mortality. Older patients with RCA occlusion and reduced LV-EF benefit most from the two-inflow L-T-BIMA + R-CABG technique. Younger 3v-CAD patients with normal LV-EF can preferentially be managed with the one-inflow C-T-BIMA; however, long-term outcome remains to be revealed.
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Affiliation(s)
- Terézia B Andrási
- Department of Cardiac and Cardiovascular Surgery, Philipps University of Marburg, Baldingerstrasse 1, 35041, Marburg, Germany.
| | - Alannah C Glück
- Department of Cardiac and Cardiovascular Surgery, Philipps University of Marburg, Baldingerstrasse 1, 35041, Marburg, Germany
- School of Medicine, Philipps University of Marburg, Marburg, Germany
| | - Ildar Talipov
- Department of Cardiac and Cardiovascular Surgery, Philipps University of Marburg, Baldingerstrasse 1, 35041, Marburg, Germany
| | - Lachezar Volevski
- Department of Cardiac and Cardiovascular Surgery, Philipps University of Marburg, Baldingerstrasse 1, 35041, Marburg, Germany
- Department of Cardiac Surgery, Cardiac Center, Rotenburg an Der Fulda, Germany
- School of Medicine, Philipps University of Marburg, Marburg, Germany
| | - Ion Vasiloi
- Department of Cardiac Surgery, Cardiac Center, Rotenburg an Der Fulda, Germany
- School of Medicine, Philipps University of Marburg, Marburg, Germany
- Department of Cardiac Surgery, University of Basel, Basel, Switzerland
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What does complete revascularization mean in 2021? - Definitions, implications, and biases. Curr Opin Cardiol 2021; 36:748-754. [PMID: 34483299 DOI: 10.1097/hco.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Coronary revascularization is known to be an excellent treatment for coronary artery disease. However, whether incomplete myocardial revascularization compromises long-term outcomes, as compared to complete revascularization (CR), remains contentious. Herein, we review the concept of and evidence on CR/incomplete revascularization (ICR) and discuss future perspectives. RECENT FINDINGS When possible, achieving CR in coronary artery bypass grafting is desirable; nonetheless, ICR is also a reasonable option to balance the therapeutic benefits against the risks. SUMMARY Although angiography-based assessment currently remains the standard of care, fractional flow reserve guidance may reduce the number of lesions requiring revascularization, which may be helpful for an appropriate surgical revascularization strategy. In particular, utilizing this approach may refine hybrid revascularization procedures, especially among high-risk patients.
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Attia RQ, Katumalla E, Cyclewala S, Rochon M, Marczin N, Raja SG. Do in-hospital outcomes of isolated coronary artery bypass grafting vary between male and female octogenarians? Interact Cardiovasc Thorac Surg 2021; 34:958-965. [PMID: 34718583 PMCID: PMC9159460 DOI: 10.1093/icvts/ivab281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Female gender and advanced age are regarded as independent risk factors for adverse outcomes after isolated coronary artery bypass grafting (CABG). There is paucity of evidence comparing outcomes of CABG between male and female octogenarians. We aimed to analyse in-hospital outcomes of isolated CABG in this cohort. METHODS All octogenarians that underwent isolated CABG, from January 2000 to October 2017, were included. A retrospective analysis of a prospectively collected cardiac surgery database (PATS; Dendrite Clinical Systems, Oxford, UK) was performed. A propensity score was generated for each patient from a multivariable logistic regression model based on 25 pre-treatment covariates. A total of 156 matching pairs were derived. RESULTS Five hundred and sixty-seven octogenarians underwent isolated CABG. This included 156 females (mean age 82.1 [SD: 0.9]) and 411 males (mean age 82.4 [SD: 2.1 years]). More males were current smokers (P = 0.002) with renal impairment (P = 0.041), chronic obstructive pulmonary disease (P = 0.048), history of cerebrovascular accident (P = 0.039) and peripheral vascular disease (P = 0.027) while more females had New York Heart Association class 4 (P = 0.02), left ventricular ejection fraction 30-49% (P = 0.038) and left ventricular ejection fraction <30% (P = 0.049). On-pump, CABG was performed in 140 males and 52 females (P = 0.921). There was no difference in in-hospital mortality (5.4% vs 6.4%; P = 0.840), stroke (0.9% vs 1.3%; P = 0.689), need for renal replacement therapy (17.0% vs 13.5%; P = 0.732), pulmonary complications (9.5% vs 8.3%; P = 0.746) and sternal wound infection (2.7% vs 2.6%; P = 0.882). The outcomes were comparable for the propensity-matched cohorts. CONCLUSIONS No gender difference in outcomes was seen in octogenarians undergoing isolated CABG.
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Affiliation(s)
- Rizwan Q Attia
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | - Eve Katumalla
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | | | - Melissa Rochon
- Department of Quality & Safety (Surveillance section), Harefield Hospital, London, UK
| | - Nandor Marczin
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Anaesthesia, Harefield Hospital, London, UK
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, UK
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Rate of Incomplete Revascularization Following Coronary Artery Bypass Grafting at a Single Institution Between 2007 and 2017. Am J Cardiol 2021; 144:33-36. [PMID: 33383011 DOI: 10.1016/j.amjcard.2020.12.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/20/2022]
Abstract
Incomplete revascularization following coronary artery bypass grafting (CABG) is associated with increased repeat revascularization, myocardial infarction and death. Whether the rate of incomplete revascularization is increasing over time has not been previously described. All patients with multivessel coronary artery disease who underwent isolated and elective CABG at our Institution in 2007 (n = 291) were compared to patients who underwent CABG in 2017 (n = 290). A Revascularization Index Score was created to compare rates of incomplete revascularization between the 2 years based on the coronary anatomy and degree of stenosis. Comparison of the 2 years disclose that the rate of incomplete revascularization increased from 17.9% in 2007 to 28.3% in 2017 (p = 0.003) and was accompanied by a decline in the Revascularization Index Score from 0.73 to 0.67 (p = 0.005). Left ventricular function improved in both groups following CABG. Two-year cardiovascular mortality was significantly higher in the 2017 cohort compared to the 2007 cohort. These differences may be attributable to patient factors including more severe coronary artery disease associated with older age, greater incidence of smoking and previous percutaneous coronary intervention. In conclusion, the rate of incomplete revascularization following CABG significantly increased in 2017 compared to 2007 and was associated with higher cardiovascular mortality.
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To Pump or not to pump? CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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6
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Abusamra R, Król M, Milewski K, Kachel M, Abudaqa L, Jankowska-Sanetra J, Derbisz K, Sanetra K, Sobieszek A, Buszman PP, Wojakowski W, Buszman PE, Bochenek A, Cisowski M. Short and long-term results of endoscopic atraumatic coronary artery off-pump bypass grafting in patients with left anterior descending artery stenosis. Cardiol J 2019; 28:86-94. [PMID: 30701513 DOI: 10.5603/cj.a2019.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/07/2018] [Accepted: 01/08/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To perform a retrospective analysis of patients who underwent endoscopic atraumatic coronary artery off-pump bypass grafting (EACAB) in a single center over a period of 11 years. METHODS Data was acquired from the hospital registry and patient medical records. In order to determine changes in clinical profile, patients were subdivided into three groups regarding year of surgery: 1998-2002 (group 1), 2003-2005 (group 2), 2006-2009 (group 3). In-hospital analysis up to 30 days and long-term observation were conducted. RESULTS The study cohort consisted of 714 patients (581 male). Procedural success accounted for 99% of all patients. No mortality was observed up to 30 days. Complications in the early period included pleural effusion (7.6%), cardiac arrhythmias (3.6%), bleeding related revision (2.7%) and wound infection (1.6%). Mean follow-up was 6 years (2132 ± 1313 days; median: 1918.5). Nineteen (2.7%) patients died, of which 52.6% (10 patients) were due to heart related conditions. Overall frequency of major adverse cerebral and cardiovascular events (MACCE) was 10.8% (77 patients). The Kaplan-Meyer analysis defined survival rate and event-free survival in long-term observation of 96.1% and 85.3%, respectively. Ejection fraction (EF) < 50% was the only independent factor of mortality (OR: 3.35). Regarding cumulative MACCE, older age (OR: 1.72), lower EF (OR: 3.03), the history of percutaneous coronary intervention (OR: 2.13) and higher New York Heart Association class (OR: 2.63) influenced the incidence rate. CONCLUSIONS The presented short and very long-term results confirm that EACAB is an efficient alternative for patients requiring revascularization of the left anterior descending artery. The elimination of cardiopulmonary bypass significantly reduces the number of complications.
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Affiliation(s)
- Rafik Abusamra
- Al Zahra Hospital Sharjah, United Arab Emirates.,Medical University of Silesia, Katowice, Poland
| | - Marek Król
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.,The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Mateusz Kachel
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.
| | | | - Justyna Jankowska-Sanetra
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Kamil Derbisz
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Krzysztof Sanetra
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Anna Sobieszek
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Piotr P Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | | | - Paweł E Buszman
- Medical University of Silesia, Katowice, Poland.,Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Andrzej Bochenek
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.,Medical University of Silesia, Katowice, Poland
| | - Marek Cisowski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.,Medical University of Silesia, Katowice, Poland
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Suarez-Pierre A, Crawford TC, Fraser CD, Zhou X, Lui C, Taylor B, Wehberg K, Conte JV, Whitman GJ, Salenger R. Off-pump coronary artery bypass in octogenarians: results of a statewide, matched comparison. Gen Thorac Cardiovasc Surg 2018; 67:355-362. [DOI: 10.1007/s11748-018-1025-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/13/2018] [Indexed: 11/29/2022]
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8
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Schwann TA, Yammine MB, El-Hage-Sleiman AKM, Engoren MC, Bonnell MR, Habib RH. The effect of completeness of revascularization during CABG with single versus multiple arterial grafts. J Card Surg 2018; 33:620-628. [PMID: 30216551 DOI: 10.1111/jocs.13810] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Incomplete coronary revascularization is associated with suboptimal outcomes. We investigated the long-term effects of Incomplete, Complete, and Supra-complete revascularization and whether these effects differed in the setting of single-arterial and multi-arterial coronary artery bypass graft (CABG). METHODS We analyzed 15-year mortality in 7157 CABG patients (64.1 ± 10.5 years; 30% women). All patients received a left internal thoracic artery to left anterior descending coronary artery graft with additional venous grafts only (single-arterial) or with at least one additional arterial graft (multi-arterial) and were grouped based on a completeness of revascularization index (CRI = number of grafts minus the number of diseased principal coronary arteries): Incomplete (CRI ≤ -1 [N = 320;4.5%]); Complete (CRI = 0 [N = 2882;40.3%]; reference group); and two Supra-complete categories (CRI = +1[N = 3050; 42.6%]; CRI ≥ + 2 [N = 905; 12.6%]). Risk-adjusted mortality hazard ratios (AHR) were calculated using comprehensive propensity score adjustment by Cox regression. RESULTS Incomplete revascularization was rare (4.5%) but associated with increased mortality in all patients (AHR [95% confidence interval] = 1.53 [1.29-1.80]), those undergoing single-arterial CABG (AHR = 1.27 [1.04-1.54]) and multi-arterial CABG (AHR = 2.18 [1.60-2.99]), as well as in patients with 3-Vessel (AHR = 1.37 [1.16-1.62]) and, to a lesser degree, with 2-Vessel (AHR = 1.67 [0.53-5.23]) coronary disease. Supra-complete revascularization was generally associated with incrementally decreased mortality in all patients (AHR [CRI = +1] = 0.94 [0.87-1.03]); AHR [CRI ≥ +2] = 0.74 [0.64-0.85]), and was driven by a significantly decreased mortality risk in single-arterial CABG (AHR [CRI = +1] = 0.90 [0.81-0.99]; AHR [CRI ≥ +2] = 0.64 [0.53-0.78]); and 3-Vessel disease patients (AHR [CRI = +1] = 0.94 [0.86-1.04]; and AHR [CRI ≥ +2] = 0.75 [0.63-0.88]) with no impact in multi-arterial CABG (AHR [CRI = +1] = 1.07 [0.91-1.26]; AHR [CRI ≥ +2] = 0.93 [0.73-1.17]). CONCLUSIONS Incomplete revascularization is associated with decreased late survival, irrespective of grafting strategy. Alternatively, supra-complete revascularization is associated with improved survival in patients with 3-Vessel CAD, and in single-arterial but not multi-arterial CABG.
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Affiliation(s)
- Thomas A Schwann
- College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio.,Mercy Saint Vincent Medical Center, Toledo, Ohio
| | - Maroun B Yammine
- Department of Internal Medicine, Outcomes Research Unit, Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| | - Abdul-Karim M El-Hage-Sleiman
- Department of Internal Medicine, Outcomes Research Unit, Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| | - Milo C Engoren
- Mercy Saint Vincent Medical Center, Toledo, Ohio.,Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Mark R Bonnell
- College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio
| | - Robert H Habib
- Department of Internal Medicine, Outcomes Research Unit, Vascular Medicine Program, American University of Beirut, Beirut, Lebanon.,Society of Thoracic Surgery Research Center, Chicago, Illinois
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Melina G, Angeloni E, Refice S, Benegiamo C, Lechiancole A, Matteucci M, Roscitano A, Bianchini R, Capuano F, Comito C, Spitaleri P, Tonelli E, Speciale G, Pristipino C, Monti F, Serdoz R, Paneni F, Sinatra R. Residual SYNTAX score following coronary artery bypass grafting. Eur J Cardiothorac Surg 2017; 51:547-553. [PMID: 28007880 DOI: 10.1093/ejcts/ezw356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
Objectives To quantify residual coronary artery disease measured using the SYNTAX score (SS) and its relation to outcomes after coronary artery bypass grafting (CABG). Methods We conducted a retrospective analysis on a consecutive series of 1608 patients [mean age 68 years, standard deviation (SD): 7, F:M, 242:1366] undergoing first-time isolated CABG from 2004 to 2015. The baseline SS was retrospectively determined from preoperative angiograms, and the residual SS (rSS) was measured during assessment of the actual operative report for each patient after CABG. Patients were then stratified according to tercile cut points of low (rSS low 0-11, N = 537), intermediate (rSS mid >11-18.5, N = 539) and high residual SS (rSS high >18.5, N = 532). The Cox regression model was used to investigate the impact of rSS on major adverse cardiac and cerebrovascular events (MACCE) at 1 year. Results The mean preoperative SS was 26.6 (SD: 9.4) (range 10.1-53), and the residual SS after CABG was 15.3 (SD: 8.4) (range 0-34) ( P < 0.001 versus preoperative). At 1 year, cumulative incidence of MACCE in the low rSS was 1.5% ( N = 8/537), 4.5% ( N = 24/539) in the intermediate and 8.8% ( N = 47/532) in the high rSS group. Kaplan-Meier analysis showed a statistically significant difference of MACCE-free survival between the three groups (log-rank test, P < 0.001). The estimated MACCE-free survival rate at 1 year was 98.1% [standard error (SE): 1.6] for the rSS low , 95.5% (SE: 1.9) for the rSS mid , and 90.5% (SE: 1.3) for the rSS high group, respectively. After multivariable adjustment, the rSS high group was independently associated with a higher incidence of MACCE at 1 year (hazard ratio 1.92, 95% confidence interval 1.21-3.23) compared to the rSS low group. Conclusions These unanticipated findings suggest that a residual SS may be a useful tool for risk stratification of patients undergoing isolated first-time CABG. Our study may set the stage for further investigations addressing this important clinical question.
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Affiliation(s)
- Giovanni Melina
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | | | - Simone Refice
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | | | | | - Maria Matteucci
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | | | | | - Fabio Capuano
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Cosimo Comito
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Pietro Spitaleri
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Euclide Tonelli
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Giulio Speciale
- Catheterization Laboratory, Ospedale San Filippo Neri, Rome, Italy
| | | | - Francesco Monti
- Department of Cardiology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Roberto Serdoz
- Department of Cardiology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Riccardo Sinatra
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
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Schwann TA. The Surgical Treatment of Coronary Artery Occlusive Disease: Modern Treatment Strategies for an Age Old Problem. Surg Clin North Am 2017; 97:835-865. [PMID: 28728719 DOI: 10.1016/j.suc.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Coronary artery disease remains a formidable challenge to clinicians. Percutaneous interventions and surgical techniques for myocardial revascularization continue to improve. Concurrently, in light of emerging data, multiple practice guidelines have been published guiding clinicians in their therapeutic decisions. The multidisciplinary Heart Team concept needs to be embraced by all cardiovascular providers to optimize patient outcomes.
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Affiliation(s)
- Thomas A Schwann
- Department of Surgery, University of Toledo College of Medicine & Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA.
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11
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Pyka Ł, Hawranek M, Gąsior M. Revascularization in ischemic heart failure with reduced left ventricular ejection fraction. The impact of complete revascularization. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2017; 14:37-42. [PMID: 28515747 PMCID: PMC5404126 DOI: 10.5114/kitp.2017.66928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022]
Abstract
Heart failure is a growing problem worldwide, with coronary artery disease being the underlying cause of over two-thirds of cases. Revascularization in this group of patients may potentially inhibit the progressive damage to the myocardium and lead to improved outcomes, but data in this area are scarce. This article emphasizes the role of qualification for revascularization and selection of method (percutaneous coronary intervention vs. coronary artery bypass grafting) and subsequently focuses on the issue of completeness of revascularization in this group of patients.
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Affiliation(s)
- Łukasz Pyka
- 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Michał Hawranek
- 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Mariusz Gąsior
- 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
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12
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Melby SJ, Saint LL, Balsara K, Itoh A, Lawton JS, Maniar H, Pasque MK, Damiano Jr RJ, Moon MR. Complete Coronary Revascularization Improves Survival in Octogenarians. Ann Thorac Surg 2016; 102:505-11. [DOI: 10.1016/j.athoracsur.2016.01.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/19/2015] [Accepted: 01/04/2016] [Indexed: 11/24/2022]
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13
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Hoffmann G, Friedrich C, Barrabas M, Petzina R, Haneya A, Panholzer B, Berndt R, Cremer J. Short- and long-term follow-up after minimally invasive direct coronary artery bypass in octogenarians. Interact Cardiovasc Thorac Surg 2016; 23:377-82. [PMID: 27209534 DOI: 10.1093/icvts/ivw149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/09/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Demographic changes lead to a rising incidence of octogenarians undergoing surgical revascularization of coronary artery disease. Minimally invasive direct coronary artery bypass (MIDCAB) represents a surgical treatment with reduced trauma and without the use of cardiopulmonary bypass. The aim of this study was to evaluate short- and long-term outcomes after MIDCAB in octogenarians. METHODS Between 1998 and 2012, 1060 patients underwent MIDCAB at our department. Among them, 72 patients (6.8%) were older than 80 years at the time of operation. Incidence of major adverse cardiac and cerebrovascular events (MACCEs) was compared between octogenarians [median age 82 (81; 85) years, 63.9% male] and younger MIDCAB patients [median age 64 (56; 70) years, 70.7% male] after 30 days and during follow-up. The impact of demographics and preoperative comorbidities on mortality during follow-up was analysed. RESULTS At baseline, the elderly group presented with a statistically significant higher logistic EuroSCORE I (9.2 vs 2.2%, P < 0.001). Within 30 days, octogenarians showed a mortality rate of 5.6% (younger patients 0.8%, P = 0.006) and an MACCE rate of 5.6% (younger patients 1.3%, P = 0.024). The median follow-up time of 30-day survivors was 5.5 (2.9; 7.6) years and follow-up completeness reached 96.9%. In the elderly group, 1-, 3- and 5-year survival rates were 89, 78 and 63% in comparison with 97, 94 and 90% in the younger group (P < 0.001), respectively. The estimated median survival time in octogenarians was 6.7 (CI 4.854; 8.629) years. Logistic regression showed preoperative renal impairment, peripheral arterial occlusive disease and pulmonary hypertension to have a stronger impact on mortality during follow-up than age above 80 years. CONCLUSIONS MIDCAB represents a safe treatment option in octogenarians and is associated with a good perioperative outcome and satisfying long-term results in octogenarians.
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Affiliation(s)
- Grischa Hoffmann
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christine Friedrich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Moritz Barrabas
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rainer Petzina
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Bernd Panholzer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rouven Berndt
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
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The effects of using a radial artery in patients already receiving bilateral internal mammary arteries during coronary bypass grafting: 30-day outcomes and 14-year survival in a propensity-matched cohort. Eur J Cardiothorac Surg 2015; 49:203-10. [DOI: 10.1093/ejcts/ezv176] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 04/02/2015] [Indexed: 11/14/2022] Open
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Zimarino M, Ricci F, Romanello M, Di Nicola M, Corazzini A, De Caterina R. Complete myocardial revascularization confers a larger clinical benefit when performed with state-of-the-art techniques in high-risk patients with multivessel coronary artery disease: A meta-analysis of randomized and observational studies. Catheter Cardiovasc Interv 2015; 87:3-12. [DOI: 10.1002/ccd.25923] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/08/2015] [Indexed: 01/17/2023]
Affiliation(s)
- Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging; “G, d'Annunzio” University; Chieti Italy
| | - Fabrizio Ricci
- Institute of Cardiology and Center of Excellence on Aging; “G, d'Annunzio” University; Chieti Italy
| | - Mattia Romanello
- Institute of Cardiology and Center of Excellence on Aging; “G, d'Annunzio” University; Chieti Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics; Department of Experimental and Clinical Science; “G, d'Annunzio” University; Chieti Italy
| | - Alessandro Corazzini
- Institute of Cardiology and Center of Excellence on Aging; “G, d'Annunzio” University; Chieti Italy
| | - Raffaele De Caterina
- Institute of Cardiology and Center of Excellence on Aging; “G, d'Annunzio” University; Chieti Italy
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Sebastianski M, Narasimhan S, Graham MM, Toleva O, Shavadia J, Abualnaja S, Tsuyuki RT, McMurtry MS. Usefulness of the ankle-brachial index to predict high coronary SYNTAX scores, myocardium at risk, and incomplete coronary revascularization. Am J Cardiol 2014; 114:1745-9. [PMID: 25306553 DOI: 10.1016/j.amjcard.2014.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 01/18/2023]
Abstract
Peripheral artery disease (PAD) is strongly associated with coronary artery disease and poor outcomes after coronary revascularization. The aim of this study was to test the hypothesis that patients with PAD diagnosed by a low ankle-brachial index (ABI; ≤0.90) have more complex coronary artery disease and more myocardium at risk than patients with normal ABIs (1.00 to 1.40) and that subsequent coronary revascularization is less complete. Adults referred for coronary angiography underwent ABI measurement using a standard Doppler ultrasound technique. Blinded reviewers calculated SYNTAX scores and Duke jeopardy scores at baseline and 3 months after angiography. Of 814 patients, 8% had PAD (ABI ≤0.90), 9% had borderline PAD (ABI 0.91 to 0.99), 77% were normal (ABI 1.00 to 1.40), and 7% had vascular calcification artifact (ABI >1.40). Patients with PAD were more likely to have high SYNTAX scores (≥33), with an odds ratio of 4.3 (95% confidence interval 1.2 to 14.9), compared with those with normal ABIs after adjustment for traditional cardiovascular risk factors. Similarly, there was a positive association between baseline high Duke jeopardy score (≥8) and PAD (adjusted odds ratio 3.5, 95% confidence interval 1.7 to 7.1). Postrevascularization high Duke jeopardy scores (≥5) were also positively associated with PAD (adjusted odds ratio 3.0, 95% confidence interval 1.1 to 8.8). In conclusion, PAD is associated with higher SYNTAX scores, more myocardium at risk, and less complete coronary revascularization than in patients with normal ABIs. More complex coronary artery disease and incomplete revascularization may contribute to worse cardiovascular outcomes in patients with PAD.
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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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Barsoum EA, Azab B, Shah N, Patel N, Shariff MA, Lafferty J, Nabagiez JP, McGinn JT. Long-term mortality in minimally invasive compared with sternotomy coronary artery bypass surgery in the geriatric population (75 years and older patients). Eur J Cardiothorac Surg 2014; 47:862-7. [PMID: 24994756 DOI: 10.1093/ejcts/ezu267] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 05/21/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Ischaemic heart disease is the leading cause of death in the elderly population. Coronary artery bypass graft (CABG) surgery via sternotomy remains the standard of care for patients with multivessel coronary artery disease (CAD). Minimally invasive cardiac surgery (MICS)-CABG via left thoracotomy has been used as an alternative to sternotomy. The aim of our study was to assess the overall survival after MICS-CABG and sternotomy-CABG in elderly patients with CAD. METHODS This observational study included patients who underwent coronary bypass from 2005 to 2008. Patients 75 years and older (n = 159) were included in the final analysis. Each arm was further divided into the MICS-CABG group or sternotomy-CABG group. Primary outcome and overall survival were obtained from our records and the social security death index. RESULTS Among patients 75 years and older (159 patients), MICS-CABG had a significantly lower 5-year all-cause mortality than sternotomy-CABG (19.7 vs 47.7%, P < 0.001). Similarly, Kaplan-Meier curves showed significantly higher overall survival in the MICS-CABG group compared with sternotomy-CABG (log-rank P = 0.014). After adjusting for confounders, MICS-CABG demonstrated a lower mortality than sternotomy-CABG (HR 0.51, 95% confidence interval 0.26-0.97, P = 0.04). For patients less than 75 years old, MICS and sternotomy groups had similar survival according to both uni- and multivariate analyses. CONCLUSIONS The adjusted models demonstrated that MICS-CABG has a significantly better long-term survival than sternotomy-CABG despite slightly differing baseline characteristics. Further studies are needed to compare the short- and long-term outcomes of the two approaches among the elderly population.
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Affiliation(s)
- Emad A Barsoum
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Basem Azab
- Department of Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Neeraj Shah
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Nileshkumar Patel
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Masood A Shariff
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - James Lafferty
- Department of Cardiology, Staten Island University Hospital, Staten Island, NY, USA
| | - John P Nabagiez
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Joseph T McGinn
- Department of Surgery, Staten Island University Hospital, Staten Island, NY, USA Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
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Arterial grafts balance survival between incomplete and complete revascularization: a series of 1000 consecutive coronary artery bypass graft patients with 98% arterial grafts. J Thorac Cardiovasc Surg 2013; 147:75-83. [PMID: 24084283 DOI: 10.1016/j.jtcvs.2013.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 07/02/2013] [Accepted: 08/09/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Coronary artery bypass grafting (CABG) with incomplete revascularization (ICR) is thought to decrease survival. We studied the survival of patients with ICR undergoing total arterial grafting. METHODS In a consecutive series of all-comer 1000 patients with isolated CABG, operative and midterm survival were assessed for patients undergoing complete versus ICR, with odds ratios and hazard ratios, adjusted for European System for Cardiac Operative Risk Evaluation category, CABG urgency, age, and comorbidities. RESULTS In this series of 1000 patients with 98% arterial grafts (2922 arterial, 59 vein grafts), 73% of patients with multivessel disease received bilateral internal mammary artery grafts. ICR occurred in 140 patients (14%). Operative mortality was 3.8% overall, 8.6% for patients with ICR, and 3.2% for patients with complete revascularization (P = .008). For operative mortality using multivariable logistic regression, after controlling for European System for Cardiac Operative Risk Evaluation category (P < .001) and CABG urgency (P = .03), there was no evidence of a statistically significant increased risk of death due to ICR (odds ratio, 1.73; 95% confidence interval, 0.80-3.77). For midterm follow-up (median, 54 months [interquartile range, 27-85 months]), after controlling for European System for Cardiac Operative Risk Evaluation category (P < .001) and comorbidities (P = .017) there was a significant interaction between age ≥ 80 years and ICR (P = .017) in predicting mortality. The adjusted hazard ratio associated with ICR for patients older than age 80 years was 5.7 (95% confidence interval, 1.8-18.0) versus 1.2 (95% confidence interval, 0.7-2.1) for younger patients. CONCLUSIONS This is the first study to suggest that ICR in patients with mostly arterial grafts is not associated with decreased survival perioperatively and at midterm in patients younger than age 80 years. Arterial grafting, because of longevity, may balance survival between complete revascularization and ICR.
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Detection of gender differences in incomplete revascularization after coronary artery bypass surgery varies with classification technique. BIOMED RESEARCH INTERNATIONAL 2013; 2013:108475. [PMID: 23936769 PMCID: PMC3722773 DOI: 10.1155/2013/108475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 06/10/2013] [Accepted: 06/13/2013] [Indexed: 11/17/2022]
Abstract
Background. Incomplete revascularization negatively affects survival after coronary artery bypass surgery (CABG). Since gender and classification technique might impact outcome and reporting, we investigated their effect on revascularization patterns and mortality. Methods. A cohort of bypass patients
(N = 1545, 23% women) was enrolled prospectively. The degree of revascularization was determined as mathematical difference between affected vessels upon diagnosis and number of grafts or the surgeon's rating on the case file. Results. Although men displayed more triple-vessel disease, they obtained complete revascularization more frequently than women (85% versus 77%, P < 0.001). The two calculation methods identified analogous percentages of incompletely revascularized patients, yet there was only a 50% overlap between the two groups. Mathematically, more women, older patients, and patients with NYHA class III/IV appeared incompletely revascularized, while the surgeons identified more patients undergoing technically challenging procedures. Regardless of the definition, incompleteness was a significant risk factor for mortality in both genders (mathematical calculation: HR 2.62, 95% CI 1.76–3.89, P < 0.001; surgeon: HR 2.04, 95% CI 1.35–3.89, P = 0.001). Conclusions. Given the differences in identification patterns, we advise that the mathematical calculation be performed after-procedure in all patients regardless of the surgeons' rating to uncover additional subjects at increased risk.
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Affiliation(s)
- Harold L. Lazar
- From the Department of Cardiothoracic Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA
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Malkin CJ, George V, Ghobrial MS, Krishnan A, Siotia A, Raina T, Morton AC, Gunn J. Residual SYNTAX score after PCI for triple vessel coronary artery disease: quantifying the adverse effect of incomplete revascularisation. EUROINTERVENTION 2013; 8:1286-95. [DOI: 10.4244/eijv8i11a197] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Malkin CJ, Ghobrial MSA, Raina T, Siotia A, Morton AC, Gunn J. Impact of incomplete revascularization in patients undergoing PCI for unprotected left main stem stenosis. Catheter Cardiovasc Interv 2013; 81:939-46. [PMID: 23074075 DOI: 10.1002/ccd.24695] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 10/05/2012] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Percutaneous revascularization of patients with multivessel and left main stem (LMS) disease may be incomplete and the impact of this is not well reported and may influence outcome. In this study we assessed the role of completeness of revascularization upon outcome after PCI for unprotected left main stem (uLMS) PCI in the "real world." MATERIALS AND METHOD Consecutive patients (n = 353) with uLMS disease were treated by PCI by a single operator with a policy of maximal feasible revascularization between 2000 and 2011. The SYNTAX score was calculated before and after PCI (residual SYNTAX score) to gauge the completeness of revascularization. The endpoints were mortality and repeat revascularization. RESULTS Mean age was 69 ± 11 years, baseline SYNTAX score was 33.4 ± 15, 53% were nonelective, 10% were in cardiogenic shock, and 45% were not surgical candidates. LMS bifurcation was involved in 74% and 2.0 ± 0.9 other vessels were diseased. Complete revascularization was achieved in 49% and was associated with reduced mortality compared with incomplete, at 30 days [5(2.9%) v 23(13%)], 1 year [9(5%) v 34(19%)], and 3 years [14(8%) v 46(26%)]; all P < 0.0001). Median rSYNTAX score was 1(0-11), 1-year survival for the lowest, middle and highest tertiles of rSYNTAX were 1.7%, 3.1% and 7.3% (P < 0.0001), respectively. In multivariate analysis postprocedure rSYNTAX score independently predicted outcome but preprocedural SYNTAX score did not. CONCLUSIONS For unselected patients with uLMS treated by PCI, completeness of revascularization is associated with superior survival. The rSYNTAX score, a novel index of completeness of revascularization, independently predicts survival. Baseline SYNTAX score does not.
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Affiliation(s)
- Chris J Malkin
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012. [PMID: 23182125 DOI: 10.1016/j.jacc.2012.07.013] [Citation(s) in RCA: 1227] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:e354-471. [PMID: 23166211 DOI: 10.1161/cir.0b013e318277d6a0] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Rosato S, Biancari F, Maraschini A, D’Errigo P, Seccareccia F. Identification of very high risk octogenarians undergoing coronary artery bypass surgery: results of a multicenter study. Heart Vessels 2012; 28:684-9. [DOI: 10.1007/s00380-012-0302-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/05/2012] [Indexed: 11/24/2022]
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Girerd N, Magne J, Rabilloud M, Charbonneau E, Mohamadi S, Pibarot P, Voisine P, Baillot R, Doyle D, Dumont E, Dagenais F, Mathieu P. The Impact of Complete Revascularization on Long-Term Survival Is Strongly Dependent on Age. Ann Thorac Surg 2012; 94:1166-72. [DOI: 10.1016/j.athoracsur.2012.05.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 04/30/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
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Ariyaratnam P, Javangula K, Papaspyros S, McCrum-Gardner E, Nair RU. Long-term survival from 801 adjunctive coronary endarterectomies in diffuse coronary artery disease. Eur J Cardiothorac Surg 2012; 42:e140-5. [DOI: 10.1093/ejcts/ezs510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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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Gössl M, Holmes DR. Interventional cardiology: Don't neglect the octogenarians--DES for everyone!? Nat Rev Cardiol 2012; 9:189-90. [PMID: 22371109 DOI: 10.1038/nrcardio.2012.22] [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] [Indexed: 11/09/2022]
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Nicolini F, Molardi A, Verdichizzo D, Gallazzi MC, Spaggiari I, Cocconcelli F, Budillon AM, Borrello B, Rivara D, Beghi C, Gherli T. Coronary artery surgery in octogenarians: evolving strategies for the improvement in early and late results. Heart Vessels 2011; 27:559-67. [PMID: 22045151 DOI: 10.1007/s00380-011-0198-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 09/30/2011] [Indexed: 10/16/2022]
Abstract
The purpose of this study was to investigate retrospectively early and late outcomes of coronary artery bypass grafting (CABG) in a large series of octogenarians. We retrospectively reviewed the data of 241 octogenarian patients who underwent CABG between April 2002 and April 2009 at our institution. Mean age was 84.7 ± 1.8 years. Patients affected by concomitant coexistent organic aortic, mitral, or tricuspid valve disease were excluded from the study. Patients with functional secondary ischemic mitral incompetence were included in the study. The majority of the patients were male. Angina pectoris functional class III/IV accounted for 164 patients (68%). Left ventricular ejection fraction ≤35% was diagnosed in 38 patients (15.8%). Early mortality rate was 5.8% (14 patients). Causes of death were cardiac related in 10 patients. Preoperative independent predictors of in-hospital mortality obtained with multivariate analysis were extracardiac arteriopathy, New York Heart Association class III/IV, and previous percutaneous transluminal coronary angioplasty (PTCA). The overall mean follow-up was 41.6 ± 25.9 months (range 1-87.6 months). Among the 222 contacted survivors, there were 16 (7.2%) deaths during the follow-up. The actuarial survival was 91.9% at 1 year and 83.5% at 5 years. On multivariate analysis, time to late death was adversely affected by preoperative extracardiac arteriopathy and previous PTCA. Advanced age alone should not be a deterrent for CABG if it has been determined that the benefits outweigh the potential risk. A careful selection of optimal candidates, based on the evaluation of their systemic comorbidities, appears mandatory in order to obtain the greatest benefit for these high-risk patients.
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Affiliation(s)
- Francesco Nicolini
- Heart Surgery Section, University of Parma Medical School, Via A. Gramsci 14, 43100, Parma, Italy.
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Gowdak LHW, Schettert IT, Rochitte CE, Lisboa LAF, Dallan LAO, César LAM, de Oliveira SA, Krieger JE. Early increase in myocardial perfusion after stem cell therapy in patients undergoing incomplete coronary artery bypass surgery. J Cardiovasc Transl Res 2011; 4:106-13. [PMID: 21061106 DOI: 10.1007/s12265-010-9234-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 10/22/2010] [Indexed: 11/29/2022]
Abstract
Incomplete revascularization is associated with worse long-term outcomes. Autologous bone marrow cells (BMC) have recently been tested in patients with severe coronary artery disease. We tested the hypothesis that intramyocardial injection of autologous BMC increases myocardial perfusion in patients undergoing incomplete coronary artery bypass grafting (CABG). Twenty-one patients (19 men), 59 ± 7 years old, with limiting angina and multivessel coronary artery disease (CAD), not amenable to complete CABG were enrolled. BMC were obtained prior to surgery, and the lymphomonocytic fraction separated by density gradient centrifugation. During surgery, 5 mL containing 2.1 ± 1.3 × 108 BMC (CD34+ = 0.8 ± 0.3%) were injected in the ischemic non-revascularized myocardium. Myocardial perfusion was assessed by magnetic resonance imaging (MRI) at baseline and 1 month after surgery. The increase in myocardial perfusion was compared between patients with <50% (group A, n = 11) with that of patients with >50% (group B, n = 10) of target vessels (stenosis ≥ 70%) successfully bypassed. Injected myocardial segments included the inferior (n = 12), anterior (n = 7), and lateral (n = 2) walls. The number of treated vessels (2.3 ± 0.8) was significantly smaller than the number of target vessels (4.2 ± 1.0; P < 0.0001). One month after surgery, cardiac MRI showed a similar reduction (%) in the ischemic score of patients in group A (72.5 ± 3.2), compared to patients in group B (78.1 ± 3.2; P = .80). Intramyocardial injection of autologous BMC may help increase myocardial perfusion in patients undergoing incomplete CABG, even in those with fewer target vessels successfully treated. This strategy may be an adjunctive therapy for patients suffering from a more advanced (diffuse) CAD not amenable for complete direct revascularization.
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Affiliation(s)
- Luís Henrique Wolff Gowdak
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-000 São Paulo, SP, Brazil.
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Eighteen-year follow-up demonstrates prolonged survival and enhanced quality of life for octogenarians after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2011; 141:394-9, 399.e1-3. [DOI: 10.1016/j.jtcvs.2010.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 01/23/2010] [Accepted: 05/05/2010] [Indexed: 11/18/2022]
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Sarno G, Garg S, Onuma Y, Gutiérrez-Chico JL, van den Brand MJBM, Rensing BJWM, Morel MA, Serruys PW. Impact of completeness of revascularization on the five-year outcome in percutaneous coronary intervention and coronary artery bypass graft patients (from the ARTS-II study). Am J Cardiol 2010; 106:1369-75. [PMID: 21059423 DOI: 10.1016/j.amjcard.2010.06.069] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 12/27/2022]
Abstract
The aim of this study was to compare clinical outcome at 5 years in patients with complete and incomplete revascularization treated with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents. Baseline and procedural angiograms and surgical case-record forms were centrally assessed for completeness of revascularization. Patients treated with PCI for incomplete revascularization were stratified according to Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score tertiles. Complete revascularization was achieved in 360 of 588 patients (61.2%) in the PCI with sirolimus-eluting stent group and 477 of 567 patients (84.1%) in the CABG group (p <0.05). There was no significant difference in 5-year survival without major adverse cardiac and cerebrovascular events (MACCEs; death, cerebrovascular accident, myocardial infarction, and any revascularization) between patients with complete and incomplete revascularization treated with PCI or CABG. Survival free from MACCEs in patients with incomplete revascularization treated with PCI was significantly lower than those with complete revascularization treated with CABG (hazard ratio 1.66, 0.96 to 1.80, log-rank p = 0.001). The 5-year MACCE-free survival in patients with incomplete revascularization treated with PCI stratified according to SYNTAX score tertiles showed a significantly lower MACCE survival in the higher SYNTAX tertile compared to the low (hazard ratio 0.56, 0.32 to 0.96, log-rank p = 0.04) and intermediate (hazard ratio 0.50, 0.28 to 0.91, log-rank p = 0.02) tertiles, whereas survival between the low and intermediate SYNTAX tertiles was not significantly different (hazard ratio 1.13, 0.60 to 2.13, log-rank p = 0.71). In conclusion, this study suggests that patients with complex coronary disease, in whom complete revascularization cannot be achieved with PCI, should be offered surgical revascularization. However, in those patients with less complex disease, PCI is a valid alternative even if complete revascularization cannot be achieved.
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Affiliation(s)
- Giovanna Sarno
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Coronary bypass surgery in a 105-year-old patient with cardiopulmonary bypass. Case Rep Med 2010; 2010:725173. [PMID: 20592988 PMCID: PMC2892694 DOI: 10.1155/2010/725173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 04/08/2010] [Accepted: 05/26/2010] [Indexed: 12/03/2022] Open
Abstract
Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution.
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Off-pump coronary artery bypass may increase late mortality: a meta-analysis of randomized trials. Ann Thorac Surg 2010; 89:1881-8. [PMID: 20494043 DOI: 10.1016/j.athoracsur.2010.03.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 02/27/2010] [Accepted: 03/01/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although a lot of randomized trials of off-pump coronary artery bypass grafting (CABG) versus on-pump CABG were conducted, the majority of them reported only early outcomes. Previous meta-analyses of a few randomized trials found no differences for 1-year to 2-year mortality. METHODS We focused late (> or = 1 year) all-cause mortality and performed a meta-analysis of randomized controlled trials of off-pump versus on-pump CABG. The MEDLINE, the EMBASE, and the Cochrane Central Register of Controlled Trials were searched using PubMed and OVID. For each study, data regarding all-cause mortality in both the off-pump and on-pump groups were used to generate risk ratios (RRs) and 95% confidence intervals. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic RRs in both fixed-effects and random-effects models. RESULTS Our search identified 11 results of 12 randomized trials (4,326 patients) of off-pump versus on-pump CABG. Pooled analysis demonstrated a statistically significant increase in midterm all-cause mortality by a factor of 1.37 with off-pump relative to on-pump CABG (RR, 1.373; 95% confidence interval, 1.043 to 1.808). Exclusion of any single result, except for the largest (>2,000 patients) trial, from the analysis did not substantively alter the overall result of our analysis. Eliminating the largest trial demonstrated a statistically nonsignificant benefit of on-pump over off-pump CABG for midterm all-cause mortality (RR, 1.344; 95% confidence interval, 0.952 to 1.896). CONCLUSIONS The results of our analysis suggest that off-pump CABG may increase late all-cause mortality by a factor of 1.37 over on-pump CABG. Longer term mortality from randomized trials of off-pump versus on-pump CABG is needed.
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Nissinen J, Wistbacka JO, Loponen P, Korpilahti K, Teittinen K, Virkkilä M, Tarkka M, Biancari F. Coronary Artery Bypass Surgery in Octogenarians: Long-Term Outcome Can Be Better Than Expected. Ann Thorac Surg 2010; 89:1119-24. [DOI: 10.1016/j.athoracsur.2009.12.063] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 12/24/2009] [Accepted: 12/30/2009] [Indexed: 11/27/2022]
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Agostini M, Fino C, Torchio P, Vado A, Bertora M, Lugli E, Grossi C. Impact of Incomplete Revascularization Following OPCAB Surgery. J Card Surg 2009; 24:650-6. [DOI: 10.1111/j.1540-8191.2009.00881.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marco Agostini
- Cardiovascular Department, S. Croce e Carle Hospital, Cuneo, Italy
| | - Carlo Fino
- Cardiovascular Department, S. Croce e Carle Hospital, Cuneo, Italy
| | | | - Antonello Vado
- Cardiovascular Department, S. Croce e Carle Hospital, Cuneo, Italy
| | - Marco Bertora
- Cardiovascular Department, S. Croce e Carle Hospital, Cuneo, Italy
| | - Elisa Lugli
- Cardiovascular Department, S. Croce e Carle Hospital, Cuneo, Italy
| | - Claudio Grossi
- Cardiovascular Department, S. Croce e Carle Hospital, Cuneo, Italy
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Aziz A, Lee AM, Pasque MK, Lawton JS, Moazami N, Damiano RJ, Moon MR. Evaluation of revascularization subtypes in octogenarians undergoing coronary artery bypass grafting. Circulation 2009; 120:S65-9. [PMID: 19752388 DOI: 10.1161/circulationaha.108.844316] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent data suggest that octogenarians' long-term survival after complete coronary artery bypass graft revascularization is superior to incomplete revascularization. Discriminating between variable definitions of "complete" complicates interpretation of survival data. We aimed to clarify octogenarian long-term survival rates by stratifying revascularization subtypes. METHODS AND RESULTS From 1986 to 2007, 580 patients 80 to 94 years of age underwent coronary artery bypass graft. Functional complete revascularization was defined as at least 1 graft to all diseased coronary vessels with >50% stenosis. Traditional complete revascularization was defined as 1 graft to each major arterial system with at least 50% stenosis. Incomplete revascularization was defined as leaving diseased, ungrafted regions. Revascularization was functional in 279 (48%), traditional in 181 (31%), and incomplete in 120 (21%). Long-term survival was evaluated by Kaplan-Meier analysis. Of 537 operative survivors, there were 402 late deaths. Cumulative long-term survival totaled 2890 patient-years. Late survival (Kaplan-Meier) was similar between functional (mean, 6.8 years) and traditional (6.7 years) groups (P=0.51), but diminished with incomplete (4.2 years) revascularization (P=0.007). Survival by group at 5 years was: 59+/-3% functional, 57+/-4% traditional, and 45+/-5% incomplete. Survival at 8 years was: 40+/-3% functional, 37+/-4% traditional, and 26+/-5% incomplete. To minimize selection bias in patients with limited life expectancy, Kaplan-Meier analysis was repeated including only patients with survival >12 months. Survival was again impaired with incomplete revascularization (P=0.04), and there was no difference between functional and traditional complete revascularization (P=0.73). CONCLUSIONS Bypassing all diseased arterial vessels after revascularization does not afford significant long-term survival advantage compared to a traditional approach. Incomplete revascularization, related to more extensive disease, is associated with an 18% decline in survival. These data suggest that it is important to avoid incomplete revascularization in octogenarians, but the supplementary endeavor required to perform functional complete revascularization does not improve survival.
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Affiliation(s)
- Abdulhameed Aziz
- Washington University School of Medicine, St. Louis, MO 63110-1013, USA
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Chu D, Bakaeen FG, Wang XL, Coselli JS, LeMaire SA, Huh J. The impact of placing multiple grafts to each myocardial territory on long-term survival after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2009; 137:60-4. [PMID: 19154904 DOI: 10.1016/j.jtcvs.2008.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 08/14/2008] [Accepted: 09/07/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Incomplete myocardial revascularization decreases survival for patients undergoing coronary artery bypass grafting. The effects of constructing multiple grafts to each major diseased artery territory are unknown. We aimed to determine the impact on long-term survival after coronary artery bypass grafting of placing multiple grafts to each myocardial territory. METHODS We reviewed data from 1129 consecutive patients who underwent coronary artery bypass grafting at our institution between 1997 and 2007 and compared outcomes between patients who received multiple grafts to each major diseased artery territory (n = 549) with those of patients who received single grafts to each territory (n = 580). We assessed long-term survival with Kaplan-Meier curves generated by log-rank tests, adjusting for confounding factors with Cox proportional hazards regression analysis. RESULTS Patients who received multiple grafts to each major diseased artery territory had longer cardiopulmonary bypass and aortic crossclamp times than patients who received single grafts per territory. Patient groups had similar early outcomes, including 30-day mortalities (1.3% vs 1.4%, P > .999) and incidences of major adverse cardiac events (2.9% vs 2.2%, P = .57). Cox regression 10-year survival curves were also similar between groups (adjusted hazard ratio 0.94, 95% confidence interval 0.67-1.34, P = .74). CONCLUSION Patients who received multiple grafts to each major diseased artery territory had early outcomes similar to those who received single grafts per territory. Constructing multiple grafts to each major diseased artery territory increases operative time and does not improve long-term survival.
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Affiliation(s)
- Danny Chu
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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McKellar SH, Brown ML, Frye RL, Schaff HV, Sundt TM. Comparison of coronary revascularization procedures in octogenarians: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2008; 5:738-46. [PMID: 18825133 DOI: 10.1038/ncpcardio1348] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 08/01/2008] [Indexed: 11/09/2022]
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Kogan A, Ghosh P, Preisman S, Tager S, Sternik L, Lavee J, Kasiff I, Raanani E. Risk Factors for Failed “Fast-Tracking” After Cardiac Surgery in Patients Older Than 70 Years. J Cardiothorac Vasc Anesth 2008; 22:530-5. [DOI: 10.1053/j.jvca.2008.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Indexed: 11/11/2022]
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Brueck M, Bandorski D, Kramer W, Vogt PR, Heidt MC. The late open infarct-related artery hypothesis: evidence-based medicine or not? Clin Cardiol 2008; 30:541-5. [PMID: 17847042 PMCID: PMC6653108 DOI: 10.1002/clc.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Randomized clinical trials have clearly shown that early reperfusion of coronary arteries is the established treatment of myocardial infarction preserving left ventricular function and reducing mortality. However, late patency of the infarct-related artery is an independent predictor of survival leading to the late open-artery hypothesis. This concept implies restoration of antegrade blood flow of the infarct-related artery in patients with myocardial infarction to improve survival by mechanisms less time-dependent or even time-independent. Possible explanations for this benefit include improved left ventricular function and electrical stability by perfusion of hibernating myocardium, accelerated infarct healing and limitation of ventricular remodeling. This review focuses on the evidence of late recanalization of occluded infarct-related arteries in patients with coronary artery disease.
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Affiliation(s)
- Martin Brueck
- Department of Cardiology, Hospital of Wetzlar, Wetzlar, Geramny.
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Onorati F, Pezzo F, Esposito A, Impiombato B, Comi MC, Polistina M, Renzulli A. Single versus sequential saphenous vein grafting of the circumflex system: a flowmetric study. SCAND CARDIOVASC J 2007; 41:265-71. [PMID: 17680515 DOI: 10.1080/14017430701283864] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We sought to evaluate if patients with proximal critical circumflex (CX) lesions did better with single SV-CABG on the best obtuse marginal (OM), or with sequential SV-CABG on two OM branches. DESIGN Ninety patients were prospectively randomised to single SV-CABG on the best OM (sSV-CABG-45 patients; Group A) or to sequential SV-CABG on 2 OM (seqSV-CABG 45 patients; Group B). Transit-time flowmetry (TTF), and graft flow reserve were evaluated. Recurrent angina, acute myocardial infarction, readmission for coronary reintervention were defined "treatment failure" during follow-up. RESULTS SeqSV-CABG showed better intraoperative maximum (119.1+/-57.5 ml/min vs. sSV-CABG 62.4+/-29.6; p=0.001), mean (56.3+/-31.5 ml/min vs. 30.8+/-12.8; p=0.0001), minimum flow (22.8+/-9.2 ml/min vs. 11.8+/-8.9; p=0.001) and P.I. (0.71+/-0.4 vs.1.46+/-0.9; p=0.006). Graft flow reserve also proved to be higher (95.4+/-29.7 ml/min mean flow vs. sSV-CABG 42.3+/-15.2 ml/min mean flow; p=0.0001; flow reserve 1.72+/-0.99 vs 1.32+/-1.09; p=0.001) as well as freedom from treatment failure (97.5+/-0.5% vs 88.7+/-0.4%; p=0.05). CONCLUSIONS SeqSV-CABG showed higher TTF flows, with no incremental risk for perioperative morbidity. Higher flows and graft flow reserve may allow lower treatment failure at mid-term follow-up.
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Affiliation(s)
- Francesco Onorati
- Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.
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Gao G, Wu Y, Grunkemeier GL, Furnary AP, Starr A. Long-Term Survival of Patients After Coronary Artery Bypass Graft Surgery: Comparison of the Pre-Stent and Post-Stent Eras. Ann Thorac Surg 2006; 82:806-10. [PMID: 16928488 DOI: 10.1016/j.athoracsur.2006.04.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 04/07/2006] [Accepted: 04/11/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although coronary artery bypass graft surgery (CABG) has long been the "gold standard" for treatment of multivessel coronary artery disease, current percutaneous interventional technologies are challenging that claim. We sought to determine long-term survival after isolated CABG to establish a baseline for comparison with interventional patients. METHODS From 1968 through 2003, 20,835 patients underwent 22,378 isolated CABG procedures by a single surgical team. The intermittent fibrillation technique without use of cardioplegia was consistently utilized as a method of myocardial protection, using cardiopulmonary bypass. Patients were prospectively followed with direct contact at annual intervals. Age stratified survival was analyzed. Long-term survival was compared between pre-stent era patients and post-stent era patients. RESULTS Operative mortality was 2.5% (95% confidence interval: 2.2% to 2.7%) and remained approximately constant since 1974 despite increasing patient age and comorbidities. Follow-up was 84% complete with 172,773 patient-years. Overall 5-, 15-, 25-, and 35-year survival was 86% +/- 0.3%, 48% +/- 0.5%, 19% +/- 0.6%, and 7% +/- 1.2%. By Cox regression, older age, prior myocardial infarction, hypertension, diabetes mellitus, and history of CABG were risk factors for long-term survival. Surgery performed during the post-stent era was a protective factor for long-term survival. CONCLUSIONS This study presents the long-term survival of a large series of patients after CABG performed by a single surgical team with intermittent fibrillation technique. There was no difference in observed survival up to 8 years between the pre-stent and post-stent eras. This study establishes a baseline of long-term CABG survival that could be used for comparison with other methods of surgical, or nonsurgical coronary revascularization.
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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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