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Sohn SH, Kang Y, Kim JS, Choi JW, Hwang HY. The impact of perivascular tissue preservation on 5-year patency of saphenous vein composite grafts. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae069. [PMID: 38637939 PMCID: PMC11076921 DOI: 10.1093/icvts/ivae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES This retrospective study was conducted to evaluate the impact of saphenous vein (SV) harvesting with versus without perivascular tissue on the 5-year angiographic patency in coronary artery bypass grafting. METHODS Among the 944 patients who received coronary artery bypass grafting between 2010 and 2015, 579 patients who received off-pump coronary artery bypass grafting using 1 SV as a Y-composite graft based on the in situ left internal thoracic artery were enrolled. SV harvesting was performed using no-touch technique without perivascular tissue (the NoPVT group) in 342 patients and with perivascular tissue (the PVT group) in 237 patients. Follow-up duration was 84.0 months (interquartile range 66.5-105.4). Propensity score matching was performed, and long-term clinical outcomes and angiographic patency were compared. RESULTS The average number of distal anastomoses per patient was comparable between the groups, although more SV grafts were anastomosed to left anterior descending territory in the PVT group than in the NoPVT group. Overall survival and cumulative incidence of cardiac death were comparable between the groups, whereas cumulative incidence of target vessel revascularization (1.3% vs 4.3% at 5 year, P = 0.009) and that of major adverse cardiac events (7.3% vs 9.9% at 5 year, P = 0.035) were lower in the PVT group than in the NoPVT group. One-year and 5-year angiographic patency rates of the SV grafts were higher in the PVT group than in the NoPVT group [97.0% vs 91.7% (P = 0.004) and 96.3% vs 89.9% (P = 0.007), respectively]. CONCLUSIONS SV grafts harvested using no-touch technique with perivascular tissue further improved the 5-year patency of SV composite grafts compared with those without perivascular tissue.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Hwang HY, Lee Y, Sohn SH, Choi JW, Kim KB. Equivalent 10-year angiographic and long-term clinical outcomes with saphenous vein composite grafts and arterial composite grafts. J Thorac Cardiovasc Surg 2021; 162:1535-1543.e4. [DOI: 10.1016/j.jtcvs.2020.01.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022]
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Park SJ, Kim HJ, Kim JB, Jung SH, Choo SJ, Lee JW, Chung CH. Sequential Versus Individual Saphenous Vein Grafting During Coronary Arterial Bypass Surgery. Ann Thorac Surg 2019; 109:1165-1173. [PMID: 31539513 DOI: 10.1016/j.athoracsur.2019.07.094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/08/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although multiarterial grafting or bilateral mammary artery use is being increasingly emphasized for contemporary coronary artery bypass grafting (CABG) practice, saphenous vein graft (SVG) is still the most frequently used CABG conduit, and it accounts for 80% of all CABG conduits. Research focusing on modifiable surgical factors such as anastomosis technique, however, is scarce. This study aimed to compare clinical outcomes and graft patency according to anastomosis methods of vein grafting. METHODS From January 2005 through December 2016, patients who underwent CABG using SVG either by a sequential or an individual grafting technique were enrolled in this study. Graft patency was evaluated with coronary computed tomographic angiography. Propensity-score matching was used to compare the clinical outcomes and graft patency of these 2 grafting techniques to reduce treatment selection bias. RESULTS Overall 2515 eligible patients, 1,037 in the sequential SVG graft group (41.3%) and 1478 (58.8%) in the individual SVG graft group were enrolled. After propensity-score matching, 901 matched pairs of patients and 891 matched pairs of grafts were included in the final outcome analysis. There were no significant differences in unadjusted (P = .83) and adjusted overall mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.79 to 1.17; P = .67). The composite outcome of death, nonfatal myocardial infarction, and repeat revascularization also did not significantly differ between the sequential SVG and the individual SVG groups for both before (P = .20) and after matching (HR, 0.91; 95% CI, 0.75 to 1.09; P = .30). The sequential grafts showed superior patency as compared with the individual grafts for both before (P = .015) and after adjustment (HR, 0.61; 95% CI, 0.45 to 0.82; P < .001). CONCLUSIONS The sequential grafting technique of SVG showed fairly acceptable safety and efficacy with superior long-term graft patency than individual grafts. Sequential SVG grafts perhaps can be a reasonable option as a second graft in CABG in some clinical situations.
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Affiliation(s)
- Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Kulik A, Abreu AM, Boronat V, Ruel M. Intensive versus moderate statin therapy and early graft occlusion after coronary bypass surgery: The Aggressive Cholesterol Therapy to Inhibit Vein Graft Events randomized clinical trial. J Thorac Cardiovasc Surg 2019; 157:151-161.e1. [DOI: 10.1016/j.jtcvs.2018.05.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/24/2018] [Accepted: 05/21/2018] [Indexed: 01/21/2023]
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Kulik A, Abreu AM, Boronat V, Kouchoukos NT, Ruel M. Impact of ticagrelor versus aspirin on graft patency after CABG: Rationale and design of the TARGET (ticagrelor antiplatelet therapy to reduce graft events and thrombosis) randomized controlled trial (NCT02053909). Contemp Clin Trials 2018; 68:45-51. [PMID: 29551675 DOI: 10.1016/j.cct.2018.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 02/04/2023]
Abstract
RATIONALE Saphenous vein graft disease remains a major limitation of coronary artery bypass graft surgery (CABG). Up to 20% of vein grafts will occlude within the first year after CABG despite standard aspirin antiplatelet therapy. However, more potent postoperative platelet inhibition with ticagrelor may improve graft patency. The goal of this study will be to evaluate the efficacy of ticagrelor, as compared to aspirin, for the prevention of saphenous vein graft occlusion following CABG. STUDY DESIGN The Ticagrelor Antiplatelet Therapy to Reduce Graft Events and Thrombosis (TARGET) study is a multi-center double-blind randomized controlled trial enrolling patients who have undergone multi-vessel CABG with at least one saphenous vein graft. Patients are being randomized to receive either aspirin 81 mg twice per day or ticagrelor 90 mg twice per day for 2 years starting within 7 days after surgery. The projected enrollment is 150 patients in each arm (300 total patients). Patients will undergo computed tomography (CT) coronary angiography at 1 and 2 years after surgery to assess the incidence of vein graft occlusion and stenosis. CONCLUSION To our knowledge, this trial is the first prospective study to evaluate the impact of early postoperative ticagrelor on 1- and 2-year graft patency after CABG. Furthermore, it is also the first trial to use a novel antiplatelet agent as a standalone, without aspirin, after CABG. Should ticagrelor reduce the incidence of postoperative graft occlusion, the results of this study will redefine modern antiplatelet management following coronary bypass surgery (ClinicalTrials.govNCT02053909).
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Affiliation(s)
- Alexander Kulik
- Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States.
| | - Amy M Abreu
- Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Viviana Boronat
- Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Nicholas T Kouchoukos
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St. Louis, MO, United States
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, ON, Canada
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Gaemperli O. Are the differences clinically relevant? The European Perspective. J Nucl Cardiol 2018; 25:521-525. [PMID: 29235063 DOI: 10.1007/s12350-017-1134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Oliver Gaemperli
- University Heart Center Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Kulik A, Abreu AM, Boronat V, Ruel M. Intensive versus moderate atorvastatin therapy and one-year graft patency after CABG: Rationale and design of the ACTIVE (Aggressive Cholesterol Therapy to Inhibit Vein Graft Events) randomized controlled trial (NCT01528709). Contemp Clin Trials 2017; 59:98-104. [DOI: 10.1016/j.cct.2017.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/04/2017] [Accepted: 06/09/2017] [Indexed: 11/28/2022]
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Equivalency of Saphenous Vein and Arterial Composite Grafts: 5-Year Angiography and Midterm Clinical Follow-Up. Ann Thorac Surg 2016; 102:580-8. [DOI: 10.1016/j.athoracsur.2016.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/12/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
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Chan M, Ridley L, Dunn DJ, Tian DH, Liou K, Ozdirik J, Cheruvu C, Cao C. A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol 2016; 221:898-905. [PMID: 27439070 DOI: 10.1016/j.ijcard.2016.06.264] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/04/2016] [Accepted: 06/27/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE The present meta-analysis aimed to compare the diagnostic accuracy of more recent computed tomography coronary angiography (CTCA) with invasive coronary angiography (ICA) in the assessment of graft patency after coronary artery bypass graft surgery (CABG). MATERIAL AND METHODS A systematic review was performed using nine electronic databases from their dates of inception to July 2015. Predefined inclusion criteria included studies reporting on comparative outcomes using ≥64 slice multidetector computed tomography (MDCT) and ICA. The primary endpoints included graft occlusion and significant graft stenosis ≥50%. Secondary analyses included the comparison of arterial versus venous graft conduits, and the use of different MDCT techniques. RESULTS Thirty-one studies were identified according to selection criteria, involving 1975 patients with 5364 assessed grafts. Combined assessment of stenosis and occlusion for all grafts demonstrated a sensitivity of 96.1% [95% confidence interval (CI) 94.3-97.4%] and specificity of 96.3% (95% CI 95.1-97.3%). CTCA assessment of venous grafts demonstrated higher sensitivity compared to arterial grafts, when testing for both occlusion and stenosis (97.6% vs 89.2%, p=0.004). CONCLUSION Results of this study demonstrated that CTCA had a relatively high pooled sensitivity, specificity and negative predictive value compared to ICA. However, patient baseline characteristics varied between studies, and the results should be interpreted with caution. Nonetheless, our results indicate that CTCA should be recognized as an accurate and non-invasive investigation for graft patency in symptomatic patients after CABG.
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Affiliation(s)
- Michael Chan
- Department of Radiology, Concord Repatriation and General Hospital, Sydney, Australia
| | - Lloyd Ridley
- Department of Radiology, Concord Repatriation and General Hospital, Sydney, Australia
| | | | - David H Tian
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Kevin Liou
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Jessica Ozdirik
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Chaitu Cheruvu
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Christopher Cao
- The Collaborative Research Group, Macquarie University, Sydney, Australia.
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Andreasen JJ, Vadmann H, Oddershede L, Tilsted HH, Frøkjær JB, Jensen SE. Decreased patency rates following endoscopic vein harvest in coronary artery bypass surgery. SCAND CARDIOVASC J 2015; 49:286-92. [DOI: 10.3109/14017431.2015.1060354] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jan J. Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Denmark
| | - Henrik Vadmann
- Department of Cardiology, Aalborg University Hospital, Denmark
| | - Lars Oddershede
- Department for University Hospital Affairs, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jens B. Frøkjær
- Department of Clinical Medicine, Aalborg University Hospital, Denmark
- Department of Radiology, Aalborg University Hospital, Denmark
| | - Svend E. Jensen
- Department of Cardiology, Aalborg University Hospital, Denmark
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Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015; 16:251-85. [PMID: 25741189 PMCID: PMC4347263 DOI: 10.3348/kjr.2015.16.2.251] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/03/2015] [Indexed: 01/07/2023] Open
Abstract
The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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Barone-Rochette G, Jankowski A, Rodiere M. Apport de l’IRM et du scanner cardiaque en pratique clinique courante. Rev Med Interne 2014; 35:742-51. [DOI: 10.1016/j.revmed.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 05/07/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
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Yu Y, Zhang F, Gao MX, Li HT, Li JX, Song W, Huang XS, Gu CX. The application of intraoperative transit time flow measurement to accurately assess anastomotic quality in sequential vein grafting. Interact Cardiovasc Thorac Surg 2013; 17:938-43. [PMID: 24000314 DOI: 10.1093/icvts/ivt398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Intraoperative transit time flow measurement (TTFM) is widely used to assess anastomotic quality in coronary artery bypass grafting (CABG). However, in sequential vein grafting, the flow characteristics collected by the conventional TTFM method are usually associated with total graft flow and might not accurately indicate the quality of every distal anastomosis in a sequential graft. The purpose of our study was to examine a new TTFM method that could assess the quality of each distal anastomosis in a sequential graft more reliably than the conventional TTFM approach. METHODS Two TTFM methods were tested in 84 patients who underwent sequential saphenous off-pump CABG in Beijing An Zhen Hospital between April and August 2012. In the conventional TTFM method, normal blood flow in the sequential graft was maintained during the measurement, and the flow probe was placed a few centimetres above the anastomosis to be evaluated. In the new method, blood flow in the sequential graft was temporarily reduced during the measurement by placing an atraumatic bulldog clamp at the graft a few centimetres distal to the anastomosis to be evaluated, while the position of the flow probe remained the same as in the conventional method. This new TTFM method was named the flow reduction TTFM. Graft flow parameters measured by both methods were compared. RESULTS Compared with the conventional TTFM, the flow reduction TTFM resulted in significantly lower mean graft blood flow (P < 0.05); in contrast, yielded significantly higher pulsatility index (P < 0.05). Diastolic filling was not significantly different between the two methods and was >50% in both cases. Interestingly, the flow reduction TTFM identified two defective middle distal anastomoses that the conventional TTFM failed to detect. Graft flows near the defective distal anastomoses were improved substantially after revision. CONCLUSIONS In this study, we found that temporary reduction of graft flow during TTFM seemed to enhance the sensitivity of TTFM to less-than-critical anastomotic defects in a sequential graft and to improve the overall accuracy of the intraoperative assessment of anastomotic quality in sequential vein grafting.
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Affiliation(s)
- Yang Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital of Capital Medical University, Beijing, China
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Khedr SA, Hassaan MA, Allam MH. Diagnostic value of MDCT angiography in assessment of coronary artery bypass graft. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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 RY, 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. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.07.012] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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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. 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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17
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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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18
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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; 126:3097-137. [PMID: 23166210 DOI: 10.1161/cir.0b013e3182776f83] [Citation(s) in RCA: 274] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Soon K, Wong C. Coronary computed tomography angiography: a new wave of cardiac imaging. Intern Med J 2012; 42 Suppl 5:22-9. [DOI: 10.1111/j.1445-5994.2012.02901.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jinzaki M, Tanami Y, Yamada M, Kuribayashi S. Progress and Current State of Coronary CT. Ann Vasc Dis 2011; 4:7-18. [PMID: 23555421 DOI: 10.3400/avd.di.10.10006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2010] [Indexed: 01/15/2023] Open
Abstract
The recent appearance of multislice computed tomography (CT) has enabled noninvasive imaging of the coronary artery. Particularly, the appearance of 64-row CT has rapidly promoted its spread into routine medical practice. In this report, progress and current state of coronary CT employing multislice CT are outlined.
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Affiliation(s)
- Masahiro Jinzaki
- Departoment of Diagnostic Radiology, Laboratory in Research Park, Keio University School of Medicine, Tokyo, Japan
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Radial artery versus saphenous vein conduits for coronary artery bypass surgery: forty years of competition--which conduit offers better patency? A systematic review and meta-analysis. Eur J Cardiothorac Surg 2010; 40:208-20. [PMID: 21167726 DOI: 10.1016/j.ejcts.2010.11.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/30/2010] [Accepted: 11/04/2010] [Indexed: 11/23/2022] Open
Abstract
The internal thoracic artery is the most effective conduit for coronary artery bypass surgery; however, most patients have multivessel disease and require additional saphenous vein or radial artery grafts. In this systematic review of the literature and meta-analysis, we aim to compare reported patency rates for these conduits and explore if differences are homogeneous across follow-up intervals. A literature search was performed using Embase, Medline, Cochrane Library, Google Scholar and randomised controlled trial databases to identify studies published between 1965 and October 2009. All studies reporting angiographic comparison of saphenous vein and radial artery conduit patency were included, irrespective of language. The end point was angiographic graft patency stratified over different follow-up intervals. Meta-analysis was performed according to recommendations from the Cochrane Collaboration and Meta-analysis Of Observational Studies in Epidemiology guidelines. We used a random-effect model and the odds ratio as the summary statistic. A total of 35 studies were identified. They reported early patency (≤ 1 year, 6795 grafts), medium-term patency (1-5 years, 3232 grafts) and long-term patency (>5 years, 1157 grafts). Significant variation of comparative patency existed across different follow-up intervals. Early saphenous vein patency was similar to radial artery patency with odds ratio of 1.04 (95% confidence interval 0.68-1.61). Medium-term saphenous vein patency, however, deteriorated significantly (odds ratio 2.06, 95% confidence interval 1.29-3.29). Similarly, long-term patency was better for radial artery conduits (odds ratio 2.28, 95% confidence interval 1.32-3.94). Heterogeneity was due to angiographic patency characteristics and related to risk of bias. In conclusion, the findings of this systematic review of the published literature and meta-analysis support the use of radial artery in preference to saphenous vein conduits for coronary artery bypass surgery.
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Srivastava S, Gadasalli S, Agusala M, Kolluru R, Barrera R, Quismundo S, Kreaden U, Jeevanandam V. Beating Heart Totally Endoscopic Coronary Artery Bypass. Ann Thorac Surg 2010; 89:1873-9; discussion 1879-80. [DOI: 10.1016/j.athoracsur.2010.03.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 03/02/2010] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
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Diagnostic accuracy meta-analysis: A review of the basic principles of interpretation and application. Int J Cardiol 2010; 140:138-44. [DOI: 10.1016/j.ijcard.2009.05.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 05/08/2009] [Accepted: 05/30/2009] [Indexed: 11/17/2022]
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Gluckman TJ, Segal JB, Schulman SP, Shapiro EP, Kickler TS, Prechel MM, Conte JV, Walenga JM, Shafique I, Rade JJ. Effect of anti-platelet factor-4/heparin antibody induction on early saphenous vein graft occlusion after coronary artery bypass surgery. J Thromb Haemost 2009; 7:1457-64. [PMID: 19552638 PMCID: PMC3004149 DOI: 10.1111/j.1538-7836.2009.03526.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Antibodies to complexes of heparin and platelet factor 4 (PF4) are capable of causing heparin-induced thrombocytopenia (HIT). Recent evidence suggests that anti-PF4/heparin antibodies may be prothrombogenic even in the absence of thrombocytopenia and clinically-recognized HIT. OBJECTIVES To determine if induction of anti-PF4/heparin antibodies is an independent risk factor for early saphenous vein graft (SVG) occlusion or adverse clinical outcome after coronary artery bypass graft (CABG) surgery. PATIENTS/METHODS Anti-PF4/heparin antibody titers were measured in 368 patients prior to and then 4 days, 6 weeks and 6 months after CABG surgery. Serotonin release assay (SRA) and antibody isotype analysis were also performed on 6-week samples. SVG patency was determined in 297 patients 6 months after surgery by multidetector computed tomography coronary angiography. RESULTS Six weeks after surgery, 52% of patients were anti-PF4/heparin seropositive and 9% were SRA positive. Six months after surgery, neither the percentage of occluded SVG (19% vs. 20%, P = NS), the percentage of patients with an occluded SVG (33% vs. 33%, P = NS) nor the incidence of adverse clinical events (21% vs. 24%, P = NS) differed between seropositive and seronegative groups. Neither IgG isotype nor SRA positivity was additionally predictive of SVG occlusion or adverse clinical outcome. CONCLUSION Induction of anti-PF4/heparin antibodies, even those capable of heparin-dependent platelet activation, is not independently associated with early SVG occlusion or adverse clinical outcomes after CABG surgery.
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Affiliation(s)
- T J Gluckman
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
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Pernès JM, Sirol M, Chabbert V, Christiaens L, Alison D, Hamon M, Caussin C. Les indications actuelles du scanner cardiaque. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2009. [DOI: 10.1016/s1878-6480(09)70351-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Is There an Indication for Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Coronary Artery Bypass Grafts? J Comput Assist Tomogr 2009; 33:317-27. [DOI: 10.1097/rct.0b013e3181807a5e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee DH, Youn HJ, Shim SB, Lee SH, Jung JI, Jung SE, Choi YS, Park CS, Oh YS, Chung WS, Kim JH. The measurement of opening angle and orifice area of a bileaflet mechanical valve using multidetector computed tomography. Korean Circ J 2009; 39:157-62. [PMID: 19949605 PMCID: PMC2771814 DOI: 10.4070/kcj.2009.39.4.157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 11/13/2008] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to assess mechanical valve function using 64-slice multidetector computed tomography (MDCT). SUBJECTS AND METHODS In 20 patients (mean age, 50+/-12 years; male-to-female ratio, 10:10), 30 St. Jude bileaflet mechanical valves (15 aortic and 15 mitral valves) were evaluated using MDCT. We selected images vertical and parallel to the mechanical valve. The valve orifice area (OA) and valve length were determined by manual tracing and the opening and closing angles were measured using a protractor. The OA and length of the mechanical valves were compared with the manufacturer's values. RESULTS The geometric orifice areas (GOAs) based on the manufacturer's values and the OAs determined by MDCT were 3.4+/-0.2 cm(2) and 3.4+/-0.3 cm(2) for the mitral valves and 2.1+/-0.3 cm(2) and 2.1+/-0.4 cm(2) for the aortic valves, respectively. The correlation coefficients between the OA measures were 0.433 for the mitral valves and 0.874 for the aortic valves (both p<0.001). The lengths based on the manufacturer's values and determined by MDCT were 29.3+/-1.99 mm and 29.6+/-1.65 mm for the mitral valves and 21.5+/-2.1 mm and 20.7+/-2.3 mm for the aortic valves, respectively. The correlation coefficients between the measures were 0.651 for the mitral valve and 0.846 for the aortic valve (both p<0.001). The opening and closing angles determined by MDCT were 10.9+/-0.6 degrees and 131.1+/-3.2 degrees for the mitral valves and 11.1+/-0.9 degrees and 120.6+/-1.7 degrees for the aortic valves, respectively. CONCLUSION MDCT is an accurate modality with which to assess the function and morphology of bileaflet mechanical valves.
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Affiliation(s)
- Dong-Hyeon Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT: Part 2, CT Angiography, Cardiac Function Assessment, and Noncoronary and Extracardiac Findings. AJR Am J Roentgenol 2009; 192:584-98. [DOI: 10.2214/ajr.08.1178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cardiac CT for acute chest pain in the emergency department: advantages of prospective triggering. Int J Cardiovasc Imaging 2009. [DOI: 10.1007/s10554-008-9419-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Doi H, Koshima R, Suzuki M, Takahashi K, Yokoyama H, Yoshida N. Can 64-Row Computed Tomography Replace Angiography after Coronary Bypass? Asian Cardiovasc Thorac Ann 2008; 16:444-9. [DOI: 10.1177/021849230801600603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multi-detector (64-row) computed tomography has become an alternative to coronary angiography to diagnose graft occlusion and stenosis after coronary artery bypass. We compared the power of evaluation of multi-detector computed tomography with that of conventional coronary angiography in 60 patients who underwent coronary artery bypass with 135 grafts and 210 graft anastomoses. The diagnostic power of multi-detector computed tomography for graft occlusion was: 100% (2/2) sensitivity, 98.5% (131/133) specificity, 50% (2/4) positive predictive value, and 100% (133/133) negative predictive value; there were no significant differences in rates of occlusion among the different types of graft. The diagnostic power of multi-detector computed tomography for stenosis of the graft anastomosis was: 100% (2/2) sensitivity, 95.1% (194/204) specificity, 16.6% (2/12) positive predictive value, and 100% (194/194) negative predictive value, with no significant differences among grafts. Multi-detector computed tomography permits evaluation of bypass grafts and is much less invasive for the patients.
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Affiliation(s)
| | | | | | | | - Hiroichi Yokoyama
- Department of Diagnostic Radiology, Cardiovascular Center, Hokkaido Ohno Hospital, Hokkaido, Japan
| | - Naoya Yoshida
- Department of Diagnostic Radiology, Cardiovascular Center, Hokkaido Ohno Hospital, Hokkaido, Japan
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Jones CM, Chin KY, Yang GZ, Hamady M, Darzi A, Athanasiou T. Coronary Artery Bypass Graft Imaging with 64-Slice Multislice Computed Tomography: Literature Review. Semin Ultrasound CT MR 2008; 29:204-13. [DOI: 10.1053/j.sult.2008.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Buxton BF, Skillington P. Invited Commentary. Ann Thorac Surg 2008; 85:1245-6. [DOI: 10.1016/j.athoracsur.2008.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 01/01/2008] [Accepted: 01/03/2008] [Indexed: 10/22/2022]
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Rubinshtein R, Halon DA, Gaspar T, Jaffe R, Goldstein J, Karkabi B, Flugelman MY, Kogan A, Shapira R, Peled N, Lewis BS. Impact of 64-slice cardiac computed tomographic angiography on clinical decision-making in emergency department patients with chest pain of possible myocardial ischemic origin. Am J Cardiol 2007; 100:1522-6. [PMID: 17996512 DOI: 10.1016/j.amjcard.2007.06.052] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Revised: 06/17/2007] [Accepted: 06/17/2007] [Indexed: 01/30/2023]
Abstract
To examine the impact of contrast enhanced multidetector computed tomography (MDCT) on clinical decision-making in patients who present to the emergency department (ED) with chest pain of possible ischemic origin, we studied 58 consecutive patients (age 56 +/- 10 years, 36% female) with chest pain, intermediate risk, and no ischemic electrocardiographic changes or increased biomarker measurements. After standard ED patient assessment including cardiology consultation, a diagnosis of acute coronary syndrome was made in 41 patients (71%), hospitalization was recommended in 47 (81%), and 32 (55%) were scheduled for an early invasive strategy. Patients underwent 64-slice contrast agent-enhanced MDCT with image reconstruction in multiple formats using retrospective electrocardiographic gating, which revealed normal (no or trivial atheroma) coronary vasculature in 15 patients, nonobstructive atheroma in 20 patients, and obstructive coronary disease (> or =1 luminal narrowing of > or =50%) in 23 patients. After MDCT, the diagnosis of acute coronary syndrome was revised in 18 of 41 patients (44%; 16 normal MDCT/widely patent stents, 2 alternative diagnoses), planned hospitalization canceled in 21 of 47 patients (45%; 13 normal MDCT/patent stent, 8 minor branch vessel disease), and planned early invasive strategy altered in 25 of 58 patients (43%; unnecessary in 20 of 32, advisable in 5 of 26 others). Effect of MDCT on clinical decisions was greater in the 36 patients without known preceding coronary disease. In 32 patients discharged from the ED (11 after initial triage, 21 patients after MDCT), there were no major adverse cardiac events (e.g., death, myocardial infarction, unplanned revascularization) during a 12-month follow-up period. In conclusion, contrast agent-enhanced 64-slice cardiac MDCT was a valuable diagnostic tool in the ED triage of patients with chest pain of possible ischemic origin and decreased the need for hospitalization by almost half in this patient cohort.
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