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Zhou Z, Fu G, Huang S, Chen S, Liang M, Wu Z. Bilateral internal thoracic artery coronary grafting: risks and benefits in elderly patients. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:861-870. [PMID: 34958349 DOI: 10.1093/ehjqcco/qcab099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/05/2021] [Accepted: 12/22/2021] [Indexed: 12/29/2022]
Abstract
AIMS Whether bilateral internal thoracic artery (BITA) grafting benefits elderly patients in coronary artery bypass grafting (CABG) remains unclear since they tend to have a limited life expectancy and severe comorbidities. We aim to evaluate the outcomes of BITA vs. single internal thoracic artery (SITA) grafting in elderly patients. METHODS AND RESULTS A meta-analysis was performed by database searching until May 2021. Studies comparing BITA and SITA grafting among elderly patients were included. One randomized controlled trial, nine propensity score matching, and six unmatched studies were identified, with a total of 18 146 patients (7422 received BITA grafting and 10 724 received SITA grafting). Compared with SITA grafting, BITA grafting had a higher risk of deep sternal wound infection (DSWI) [odds ratio: 1.67; 95% confidence interval (CI): 1.22-2.28], and this risk could not be significantly reduced by the skeletonization technique. Meanwhile, BITA grafting was associated with a higher long-term survival [hazard ratio: 0.83; 95% CI: 0.77-0.90], except for the octogenarian subgroup. Reconstructed Kaplan-Meier survival curves revealed 4-year, 8-year, and 12-year overall survival rates of 85.5%, 66.7%, and 45.3%, respectively, in the BITA group and 79.3%, 58.6%, and 34.9%, respectively, in the SITA group. No significant difference was observed in early mortality, perioperative myocardial infarction, perioperative cerebral vascular accidents, or re-exploration for bleeding. CONCLUSION Compared with SITA grafting, BITA grafting could provide a long-term survival benefit for elderly patients, although this benefit remained uncertain in octogenarians. Meanwhile, elderly patients who received BITA were associated with a higher risk of DSWI and such a risk could not be eliminated by the skeletonization technique.
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Affiliation(s)
- Zhuoming Zhou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou 510080, China
| | - Guangguo Fu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou 510080, China
| | - Suiqing Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou 510080, China
| | - Sida Chen
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou 510080, China
| | - Mengya Liang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou 510080, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou 510080, China
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Ren X, Liu K, Zhang H, Meng Y, Li H, Sun X, Sun H, Song Y, Wang L, Wang W, Wang C, Wang Y, Hou Z, Gao Y, Yin W, Zheng Z, Lu B. Coronary Evaluation Before Heart Valvular Surgery by Using Coronary Computed Tomographic Angiography Versus Invasive Coronary Angiography. J Am Heart Assoc 2021; 10:e019531. [PMID: 34320820 PMCID: PMC8475662 DOI: 10.1161/jaha.120.019531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Coronary computed tomography angiography (CCTA) is a noninvasive, less expensive, low‐radiation alternative to invasive coronary angiography (ICA). ICA is recommended for coronary evaluation before heart valvular surgery, and the supporting evidence for CCTA is insufficient. Our study is a single‐center, prospective cohort study designed to evaluate the feasibility of CCTA instead of ICA in detection of coronary artery disease before surgery. Methods and Results Heart valvular surgery candidates were consecutively enrolled between April 2017 and December 2018. Nine hundred fifty‐eight patients in the CCTA group underwent CCTA primarily, and those with ≥50% coronary stenosis or uncertain diagnosis underwent subsequent ICA. One thousand five hundred twenty‐five patients in the ICA group underwent ICA directly before surgery. Coronary artery bypass grafting decision was made by surgeons according to CCTA or ICA results. Most of the patients (78.8%) in the CCTA group avoided invasive angiography. Thirty‐day mortality (0.7% versus 0.9%, P=0.821), myocardial infarction (6.4% versus 6.9%, P=0.680 ), and low cardiac output syndrome (4.2% versus 2.8%, P=0.085) were similar in the CCTA and ICA groups. Median duration of follow‐up was 19.3 months (interquartile range, 14.2–30.0 months), cumulative rates of mortality (2.6% versus 2.6%, P=0.882) and major adverse cardiac events (9.6% versus 9.0%, P=0.607) showed no difference between the 2 groups. Coronary evaluation expense was lower in the CCTA group ($149.6 versus $636.0, P<0.001). Conclusions The strategy of using CCTA as a doorkeeper in coronary evaluation before heart valvular surgery showed noninferiority in identification of candidates for coronary artery bypass grafting and postoperative safety.
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Affiliation(s)
- Xinshuang Ren
- Department of Radiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Kun Liu
- Department of Radiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Heng Zhang
- Department of Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Ying Meng
- Department of Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Haojie Li
- Department of Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiaogang Sun
- Department of Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hansong Sun
- Department of Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yunhu Song
- Department of Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Liqing Wang
- Department of Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Wei Wang
- Department of Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Chuangshi Wang
- Medical Research and Biometrics Center State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yang Wang
- Medical Research and Biometrics Center State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Zhihui Hou
- Department of Radiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yang Gao
- Department of Radiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Weihua Yin
- Department of Radiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Zhe Zheng
- Department of Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Bin Lu
- Department of Radiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Navia D, Espinoza J, Vrancic M, Piccinini F, Camporrotondo M, Dorsa A, Seoane L. Bilateral internal thoracic artery grafting in elderly patients: Any benefit in survival? J Thorac Cardiovasc Surg 2020; 164:542-549. [DOI: 10.1016/j.jtcvs.2020.09.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 11/16/2022]
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4
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Bianco V, Kilic A, Gleason TG, Aranda-Michel E, Wang Y, Navid F, Sultan I. Midterm Outcomes for Isolated Coronary Artery Bypass Grafting in Octogenarians. Ann Thorac Surg 2020; 109:1184-1193. [DOI: 10.1016/j.athoracsur.2019.07.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/07/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
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5
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Zhang G, Gao Q, Chen S, Chen Y. OPCAB experience in octogenarians: A comparison of perioperative events and long-term survival between patients aged 75 to 80 years and patients aged ≥80 years. J Card Surg 2019; 34:948-956. [PMID: 31376213 DOI: 10.1111/jocs.14154] [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
INTRODUCTION The advantages of off-pump coronary artery bypass grafting (OPCAB) in octogenarians are still undetermined. METHODS We retrospectively collected the data of 338 patients aged ≥75 with at least two coronary-artery diseases who underwent OPCAB. Then, the two groups were divided into follow-up survival and follow-up death subgroups. The baseline and perioperative data were compared for the younger and octogenarian groups, as well as for the subgroups. Moreover, long-term survival rates in the follow-up survival and follow-up death subgroups were compared; a Cox regression model was built to explore the independent risk factors that influence long-term survival. RESULTS NYNA ≥ III (39.4% vs 23.2%, P = .006), AMI (45.1% vs 24.3%, P = .001), and three diseased vessels with LM disease (38.0% vs 25.8%, P = .043) were more prevalent among octogenarians. Octogenarians required more intraoperative (11.3% vs 0.40%, P = .000) and postoperative (9.9% vs 2.2%, P = .003) IABP insertions and more ventilation time (P = .053), and they spent a longer time in the ICU (174.1 ± 34.9 vs 81.0 ± 6.4 hours, P = .010), had a longer total hospital stay (32.7 ± 3.1 vs 24.6 ± 0.8 days, P = .015), and had a longer postoperative hospital stay (20.5 ± 2.5 vs 14.5 ± 0.7 days, P = .021); however, fewer LIMA grafts were used among octogenarians (71.8% vs 90.3%, P = .000). The mortality and the postoperative complications between the two groups were similar. Long-term survival at 1, 5, and 10 years were satisfactory at 98.4 vs 91.5%, 89.7 vs 82.8%, and 61.1 vs 52.1% for the younger group and the octogenarians, respectively (P = .440). The Cox regression analysis results suggest that malignant ventricular arrhythmias (HR 4.058, CI, 1.760-9.358, P = .001; HR 7.256, CI, 2.112-24.932, P = .001) and reintubation (HR 3.593, CI, 1.646-7.845, P = .001; HR 4.252, CI, 1.797-10.060, P = .001) were independent risk factors that affect the long-term survival in both overall OPCAB patients and in the younger patient group. CONCLUSIONS OPCAB can be safely performed, with acceptable operative mortality and complication rates and satisfactory survival outcomes. The Cox regression analysis results demonstrated that malignant ventricular arrhythmia and reintubation were independent risk factors that affect long-term survival in both overall OPCAB patients and in the younger group of patients.
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Affiliation(s)
- Guodong Zhang
- Cardiac Surgery Department, Peking University People's Hospital, Bejing, China
| | - Qing Gao
- Cardiac Surgery Department, Peking University People's Hospital, Bejing, China
| | - Shenglong Chen
- Cardiac Surgery Department, Peking University People's Hospital, Bejing, China
| | - Yu Chen
- Cardiac Surgery Department, Peking University People's Hospital, Bejing, China
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Lloyd D, Luc JGY, Indja BE, Leung V, Wang N, Phan K. Transcatheter, sutureless and conventional aortic-valve replacement: a network meta-analysis of 16,432 patients. J Thorac Dis 2019; 11:188-199. [PMID: 30863588 DOI: 10.21037/jtd.2018.12.27] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Minimally invasive surgical techniques pose alternatives to conventional surgery for the treatment of aortic stenosis (AS). We present a Bayesian network analysis comparing Valve Academic Research Consortium-2 clinical outcomes between transcatheter aortic valve implantation (TAVI), sutureless (SL-AVR) and conventional aortic valve replacement (CAVR). Methods Electronic searches of databases were conducted and seven two-arm randomized-controlled trials and 25 propensity-score-matched studies comparing clinical outcomes of TAVI, SL-AVR and CAVR for treatment of AS were identified. Bayesian Markov chain Monte Carlo modelling was used to analyze clinical outcomes. Results The analysis included 16,432 patients who underwent TAVI [7,056], SL-AVR [1,238] or CAVR [8,138]. Compared to CAVR, TAVI and SL-AVR were associated with reduced postoperative major bleeding of 59% (OR 0.41, 95% CI: 0.28-0.59) and 44% (OR 0.56, 95% CI: 0.30-0.99) respectively. TAVI had a 41% reduction in postoperative myocardial infarction (OR 0.59, 95% CI: 0.40-0.86) and SL-AVR had a 40% reduction in postoperative acute kidney injury (AKI) (OR 0.62, 95% CI: 0.42-0.86). Compared to TAVI, CAVR and SL-AVR had a reduction in moderate/severe paravalvular regurgitation of 89% (OR 0.11, 95% CI: 0.07-0.16) and 92% (OR 0.08, 95% CI: 0.03-0.17). CAVR had a 67% decreased postoperative permanent pacemaker (PPM) implantation compared to TAVI (OR 0.33, 95% CI: 0.24-0.45) and a 63% reduction compared to SL-AVR (OR 0.37, 95% CI: 0.22-0.61). There were no differences in 30-day mortality or postoperative stroke between the groups. Conclusions In selected patients, minimally invasive surgical interventions including TAVI and SL-AVR for severe AS are viable alternatives to conventional surgery. However, TAVI is associated with increased paravalvular regurgitation, whereas TAVI and SL-AVR are associated with increased conduction disturbances compared to CAVR.
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Affiliation(s)
- Declan Lloyd
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben Elias Indja
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Vannessa Leung
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nelson Wang
- Faculty of Medicine, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kevin Phan
- Faculty of Medicine, University of Sydney, Sydney, Australia.,Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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Preoperative atrial fibrillation portends poor outcomes after coronary bypass graft surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2018; 155:1524-1533.e2. [DOI: 10.1016/j.jtcvs.2017.11.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/30/2017] [Accepted: 11/16/2017] [Indexed: 11/20/2022]
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8
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Alzahrani A, Ruddy TD. Stress myocardial perfusion imaging in the elderly. J Nucl Cardiol 2018; 25:72-74. [PMID: 27457524 DOI: 10.1007/s12350-016-0585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Atif Alzahrani
- Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H1220, Ottawa, ON, K1Y 4W7, Canada
| | - Terrence D Ruddy
- Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H1220, Ottawa, ON, K1Y 4W7, Canada.
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9
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Luc JGY, Graham MM, Norris CM, Al Shouli S, Nijjar YS, Meyer SR. Predicting operative mortality in octogenarians for isolated coronary artery bypass grafting surgery: a retrospective study. BMC Cardiovasc Disord 2017; 17:275. [PMID: 29096604 PMCID: PMC5667481 DOI: 10.1186/s12872-017-0706-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/18/2017] [Indexed: 12/16/2022] Open
Abstract
Background Available cardiac surgery risk scores have not been validated in octogenarians. Our objective was to compare the predictive ability of the Society of Thoracic Surgeons (STS) score, EuroSCORE I, and EuroSCORE II in elderly patients undergoing isolated coronary artery bypass grafting surgery (CABG). Methods All patients who underwent isolated CABG (2002 – 2008) were identified from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry. All patients aged 80 and older (n = 304) were then matched 1:2 with a randomly selected control group of patients under age 80 (n = 608 of 4732). Risk scores were calculated. Discriminatory accuracy of the risk models was assessed by plotting the areas under the receiver operator characteristic (AUC) and comparing the observed to predicted operative mortality. Results Octogenarians had a significantly higher predicted mortality by STS Score (3 ± 2% vs. 1 ± 1%; p < 0.001), additive EuroSCORE (8 ± 3% vs. 4 ± 3%; p < 0.001), logistic EuroSCORE (15 ± 14% vs. 5 ± 6%; p < 0.001), and EuroSCORE II (4 ± 3% vs. 2 ± 2%; p < 0.001) compared to patients under age 80 years. Observed mortality was 2% and 1% for patients age 80 and older and under age 80, respectively (p = 0.323). AUC revealed areas for STS, additive and logistic EuroSCORE I and EuroSCORE II, respectively, for patients age 80 and older (0.671, 0.709, 0.694, 0.794) and under age 80 (0.829, 0.750, 0.785, 0.845). Conclusion All risk prediction models assessed overestimated surgical risk, particularly in octogenarians. EuroSCORE II demonstrated better discriminatory accuracy in this population. Inclusion of new variables into these risk models, such as frailty, may allow for more accurate prediction of true operative risk.
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Affiliation(s)
- Jessica G Y Luc
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Michelle M Graham
- Mazankowski Alberta Heart Institute, Edmonton, Canada.,Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Colleen M Norris
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Canada.,Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Sadek Al Shouli
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - Yugmel S Nijjar
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Steven R Meyer
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. .,Mazankowski Alberta Heart Institute, Edmonton, Canada.
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Davierwala PM. Current outcomes of off-pump coronary artery bypass grafting: evidence from real world practice. J Thorac Dis 2016; 8:S772-S786. [PMID: 27942395 DOI: 10.21037/jtd.2016.10.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery bypass grafting (CABG) can be performed conventionally using cardiopulmonary bypass (CPB) and aortic clamping or on a beating heart (BH) without the use of CPB, the so-called off-pump CABG. Some surgeons, who are proponents of off-pump CABG, preferentially use this technique for the majority of operations, whereas others use it only in certain situations which warrant avoidance of CPB. Ever since the conception of off-pump CABG, the never-ending debate about which technique of CABG is safe and efficacious continues to date. Several randomized controlled trials (RCTs) have been conducted that have either favored on-pump CABG or have failed to show a significant difference in outcomes between the two techniques. However, these RCTs have been fraught with claims that they do not represent the majority of patients undergoing CABG in real world practice. Therefore, assessment of the benefits and drawbacks of each technique through observational and registry studies would be more representative of patients encountered in daily practice. The present review examines various retrospective studies and meta-analyses of observational studies that compare the early and long-term outcomes of off- and on-pump CABG, which assesses their safety and efficacy. Additionally, their outcomes in older patients, females, and those with diabetes mellitus, renal dysfunction, presence of ascending aortic disease, and/or acute coronary syndrome (ACS) have also been discussed separately. The general consensus is that early results of off-pump CABG are comparable to or in some cases better than on-pump CABG. However, on-pump CABG provides a survival benefit in the long term according to a majority of publications in literature.
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Affiliation(s)
- Piroze M Davierwala
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
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11
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O'Neill DE, Knudtson ML, Kieser TM, Graham MM. Considerations in Cardiac Revascularization for the Elderly Patient: Age Isn't Everything. Can J Cardiol 2016; 32:1132-9. [DOI: 10.1016/j.cjca.2016.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 02/04/2023] Open
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12
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Thorsteinsson K, Andreasen JJ, Mortensen RN, Kragholm K, Torp-Pedersen C, Gislason G, Køber L, Fonager K. Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: a nationwide cohort study. Interact Cardiovasc Thorac Surg 2016; 22:792-8. [PMID: 26969738 DOI: 10.1093/icvts/ivw045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/26/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Data on nursing home admission in patient's ≥80 years after isolated coronary artery bypass grafting (CABG) are scarce. The purpose of this study was to evaluate longevity and subsequent admission to a nursing home stratified by age in a nationwide CABG cohort. METHODS All patients who underwent isolated CABG from 1996 to 2012 in Denmark were identified through nationwide registers. The cumulative incidence of admission to a nursing home after CABG was estimated. A Cox regression model was constructed to identify predictors for living in a nursing home 1 year after CABG. Kaplan-Meier estimates were used for survival analysis. Subanalysis on home care usage was performed in the period 2008-2012. RESULTS A total of 38 487 patients were included. The median age was 65.4 ± 9.5 years (1455 > 80 years) and 80% were males. The 30-day mortality rate was 2.8%, increasing with age (1.2% in patients <60 years and 7.8% in patients ≥80 years). The mortality rate at 1 year was 2.2% among patients aged <60 and 14.1% among patients ≥80 years. At the 1-year follow-up, 4.2% of patients <60 years, 7.9% of patients 60-70 years, 14.4% of patients 70-74 years, 18.5% of patients 75-79 years and 29.1% of patients ≥80 years had received home care. The proportion of patients admitted to a nursing home at 1, 5 and 10 years after CABG was 0.1, 0.4 and 1.0% (<60 years), and 1.4, 7.5 and 16.8% (≥80 years), respectively. Main predictors for living in a nursing home 1 year postoperatively were: age ≥80 years [hazard ratio (HR) 17.8, 95% confidence interval (CI) 7.4-42.8], female sex (HR 1.7, 95% CI 1.1-2.6), previous heart failure (HR 1.6, 95% CI 1.0-2.4), previous myocardial infarction (HR 2.0, 95% CI 1.3-3.2) and previous stroke (HR 3.3, 95% CI 2.1-4.9). Neither urgent nor emergency surgeries were significant predictors for living in a nursing home 1 year postoperatively. CONCLUSIONS The majority of all patients selected for CABG surgery in Denmark between 1996-2012, including the elderly, were able to live independently at home without the need of home care for many years after CABG. The risk of nursing home admission was small and dependent on the patient's age, sex and preoperative comorbidities.
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Affiliation(s)
- Kristinn Thorsteinsson
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan J Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rikke N Mortensen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Kragholm
- Department of Anesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark The Danish Heart Foundation, Copenhagen, Denmark The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Fonager
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
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Saxena A, Newcomb AE, Dhurandhar V, Bannon PG. Application of Clinical Databases to Contemporary Cardiac Surgery Practice: Where are We now? Heart Lung Circ 2016; 25:237-42. [DOI: 10.1016/j.hlc.2015.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 01/10/2015] [Accepted: 01/13/2015] [Indexed: 12/01/2022]
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14
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Dhurandhar V, Saxena A, Parikh R, Vallely MP, Wilson MK, Butcher JK, Black DA, Tran L, Reid CM, Bannon PG. Comparison of the Safety and Efficacy of On-Pump (ONCAB) versus Off-Pump (OPCAB) Coronary Artery Bypass Graft Surgery in the Elderly: A Review of the ANZSCTS Database. Heart Lung Circ 2015; 24:1225-32. [DOI: 10.1016/j.hlc.2015.04.162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/24/2015] [Accepted: 04/04/2015] [Indexed: 11/29/2022]
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Singh AK, Maslow AD, Machan JT, Fingleton JG, Feng WC, Schwartz C, Rotenberg FA, Bert AA. Long-term survival after use of internal thoracic artery in octogenarians is gender related. J Thorac Cardiovasc Surg 2015; 150:891-9. [DOI: 10.1016/j.jtcvs.2015.07.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/01/2015] [Accepted: 07/18/2015] [Indexed: 11/30/2022]
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Crudeli E, Stefàno P, Gensini GF, Valente S. Author's Reply to Comment on "Age as a Prognostic Factor in Patients with Acute Coronary Syndrome Undergoing Urgent/Emergency Cardiac Surgery". Heart Lung Circ 2015; 24:1234-5. [PMID: 26263847 DOI: 10.1016/j.hlc.2015.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Elena Crudeli
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Pierluigi Stefàno
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gian Franco Gensini
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Serafina Valente
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Deschka H, Müller D, Dell'Aquila A, Matthäus M, Erler S, Wimmer-Greinecker G. Non-elective cardiac surgery in octogenarians: Do these patients benefit in terms of clinical outcomes and quality of life? Geriatr Gerontol Int 2015; 16:416-23. [DOI: 10.1111/ggi.12484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Heinz Deschka
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery; University Hospital Münster; Münster Germany
| | - Dirk Müller
- Department of Cardiology; Heart & Vessel Center Bad Bevensen; Bad Bevensen Germany
| | - Angelo Dell'Aquila
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery; University Hospital Münster; Münster Germany
| | - Martin Matthäus
- Department of Cardiothoracic Surgery; Heart & Vessel Center Bad Bevensen; Bad Bevensen Germany
| | - Stefan Erler
- Department of Cardiothoracic Surgery; Heart & Vessel Center Bad Bevensen; Bad Bevensen Germany
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Crudeli E, Lazzeri C, Stefàno P, Chiostri M, Blanzola C, Rossi A, Olivo G, Pace SD, Gensini GF, Valente S. Age as a Prognostic Factor in Patients with Acute Coronary Syndrome undergoing Urgent/Emergency Cardiac Surgery. Heart Lung Circ 2015; 24:845-53. [PMID: 25769662 DOI: 10.1016/j.hlc.2015.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/09/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients presenting with acute coronary syndrome (ACS) who require urgent/emergency coronary artery bypass grafting (CABG) are increasing, as is the complexity of their clinical characteristics, one of which is advanced age. We evaluated the prognostic role of age in patients undergoing urgent/emergency cardiac surgery for ACS. METHODS From January to December 2013, 452 consecutive patients underwent CABG at our institution. Among these, 213 presented with ACS, were enrolled in the study and divided into tertiles of age: First: 40-65 years old (n=73), Second: 66-74 (n=70), Third: 75-89 (n=70). Patients were followed post-operatively for 30 days. RESULTS No differences between tertiles were found for baseline clinical and angiographic characteristics. Off-pump interventions were 67.6%. Older patients more frequently required an associate intervention to CABG for a mechanical complication of ACS. Overall 30-day all-cause mortality was 4.7% (n=10); 0.6% (n=1) in patients undergoing isolated CABG (n=168, 78.9%). The STEMI diagnosis was an independent risk factor for 30-day mortality, and age was not. CONCLUSIONS The 30-day mortality rate of older ACS patients who undergo urgent/emergency CABG is comparable to that of younger ones. Pre-operative risk assessment should rely on evaluation of the clinical complexity of each patient independent of their chronological age, to customise the therapeutic strategy.
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Affiliation(s)
- Elena Crudeli
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Chiara Lazzeri
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pierluigi Stefàno
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Chiostri
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Claudio Blanzola
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessandra Rossi
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuseppe Olivo
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Del Pace
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gian Franco Gensini
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Serafina Valente
- Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Preoperative atrial fibrillation is an independent predictor of worse early and late outcomes after isolated coronary artery bypass graft surgery. J Cardiol 2015; 65:224-9. [DOI: 10.1016/j.jjcc.2014.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/13/2014] [Accepted: 06/05/2014] [Indexed: 11/20/2022]
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Thorsteinsson K, Fonager K, Mérie C, Gislason G, Køber L, Torp-Pedersen C, Mortensen RN, Andreasen JJ. Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass surgery: a nationwide study. Eur J Cardiothorac Surg 2015; 49:391-7. [PMID: 25698155 DOI: 10.1093/ejcts/ezv060] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/14/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG. METHODS All patients who underwent isolated CABG surgery between January 1996 and December 2012 in Denmark were included. Patients were identified through nationwide administrative registers. Age was categorized into five different groups and time into three periods to see if mortality and preoperative comorbidity had changed over time. Predictors of 30-day mortality were analysed in a multivariable Cox proportional-hazard models and survival at 1 and 5 years was estimated by Kaplan-Meier curves. RESULTS A total of 38 830 patients were included; the median age was 65.4 ± 9.5 years, increasing over time to 66.6 ± 9.5 years. Males comprised 80%. The number of octogenarians was 1488 (4%). The median survival was 14.7 years (60-69 years), 10.7 years (70-74 years), 8.9 years (75-79 years) and 7.2 years (≥80 years). The 30-day mortality rate was 3%, increasing with age (1% in patients <60 years, 8% in octogenarians). The long-term mortality rate at 1 and 5 years was 2 and 7% (age <60 years) and 14 and 36% (age >80 years), respectively. The proportion of patients >75 years increased from 10 to 20% during the study period as well as the proportion of patients undergoing urgent or emergency surgery. The burden of comorbidities increased over time, e.g. congestive heart failure 13-17%, diabetes 12-21%, stroke 9-11%, in all age groups. Age and emergency surgery were the main predictors of 30-day mortality: age >80 years [hazard ratio (HR): 5.75, 95% confidence interval (CI): 4.41-7.50], emergency surgery (HR: 5.23, 95% CI: 4.38-6.25). CONCLUSION Patients are getting older at the time of surgery and have a heavier burden of comorbidities than before. The proportion of patients undergoing urgent or emergency surgery increased with age and over time. Despite this, the 30-day mortality decreased over time and long-term survival increased, except in octogenarians where it was stable. Octogenarians had substantially higher 30-day mortality compared with younger patients but surgery can be performed with acceptable risks and good long-term outcomes.
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Affiliation(s)
- Kristinn Thorsteinsson
- Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Gentofte, Denmark
| | - Charlotte Mérie
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Rikke N Mortensen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jan J Andreasen
- Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Kolat P, Ried M, Haneya A, Philipp A, Kobuch R, Hirt S, Hilker M, Schmid C, Diez C. Impact of age on early outcome after coronary bypass graft surgery using minimized versus conventional extracorporeal circulation. J Cardiothorac Surg 2014; 9:143. [PMID: 25185963 PMCID: PMC4243947 DOI: 10.1186/s13019-014-0143-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/04/2014] [Indexed: 02/04/2023] Open
Abstract
Background Objective of this study was to evaluate the impact of age on comparative early outcomes after coronary artery bypass graft surgery (CABG) with minimized (MECC) and conventional extracorporeal circulation (CECC). Methods A retrospective age-, gender- and operation-matched cohort analysis between January 2005 and December 2010 with a total of 2274 patients undergoing CABG with MECC (n = 1137; 50%) or CECC was performed. Patients were stratified into 4 groups according to age: <59 years, 60–69 years, 70–79 years, and 80 years of age or older. Outcomes were compared within each age group. Patients with preoperative dialysis were excluded from analysis. Primary endpoint was 30-day mortality. Results Patients treated with CECC had a significantly higher mean logistic EuroSCORE (6.3% vs. 5.0%; p < 0.001), a slightly lower rate of preoperative myocardial infarction (46% vs. 51%; p = 0.01) and a higher rate of impaired renal function (eGFR < 60 mL/min/1.73 m2: 24% vs. 20%; p = 0.01) compared to MECC-patients. Left internal mammary artery was significantly used more often in MECC patients (93% vs. 86%; p < 0.001). Cardiopulmonary bypass and aortic-cross clamping time were significantly lower in the MECC group (p < 0.001). Overall 30-day mortality was significantly higher in patients treated with CECC (4.4% vs. 2.2%; p = 0.002). Within the different age groups mortality rates were not significantly different except for patients aged 60–69 years (4.5% vs. 1.8%; p = 0.03). Postoperative requirement of renal replacement therapy (4% vs. 2.2%; p = 0.01), respiratory insufficiency (9.9% vs. 6.6%; P = 0.004) and incidence of low cardiac output syndrome (3% vs. 1.2%; p = 0.003) were significantly increased in patients with CECC. Multivariate analysis identified age (p = 0.005; 95% CI 1.01 to 1.08; OR 1.05) among other parameters as an independent risk factor, whereas conventional extracorporeal circulation itself did not present as an independent risk factor for 30-day mortality. Conclusions In this matched study sample early outcome was significantly better in patients with MECC compared to CECC, irrespective of age. Prior myocardial infarction estimated GFR < 60 mL and waiving the use of LIMA were independent risk factors for 30-day mortality, which were more present in the CECC group.
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Shan L, Saxena A, McMahon R. A Systematic Review on the Quality of Life Benefits after Percutaneous Coronary Intervention in the Elderly. Cardiology 2014; 129:46-54. [DOI: 10.1159/000360603] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
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Predicting Adverse Outcomes in Elective Coronary Artery Bypass Graft Surgery using Pre-operative Troponin I Levels. Heart Lung Circ 2014; 23:711-6. [DOI: 10.1016/j.hlc.2014.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 02/28/2014] [Accepted: 03/05/2014] [Indexed: 11/22/2022]
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Correlation between comprehensive evaluation of coronary artery lesion severity and long-term clinical outcomes in Chinese octogenarians with acute coronary syndrome. Heart Lung Circ 2014; 23:1125-31. [PMID: 25070683 DOI: 10.1016/j.hlc.2014.04.260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 03/30/2014] [Accepted: 04/18/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is little known about long-term outcome data regarding acute coronary syndrome (ACS) in Chinese octogenarians (> 80 years old). Long-term outcomes of octogenarians with ACS may be associated with increased complicated coronary artery lesion severity. METHODS We classified 536 consecutive octogenarians with ACS into four groups based on Gensini score. Survival and major adverse cardiac event (MACE) rates were calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify mortality predictors. The follow-up period was 27 (IQR15-36) months. RESULTS The overall long-term mortality rate was 9.1% and increased from 3.0% in group 1 to 16.7% in group 4. Increasing coronary artery lesion severity was associated with increased long-term mortality and MACE rates. ROC curve analysis showed that the predictive cut-off value of Gensini score for mortality was 53. Gensini score provided significant reclassification of mortality (net reclassification index 0.195, P<0.01). Age, gender, heart rate, SBP, chronic renal failure, e-GFR, GRACE score, Gensini score, and ACS type were different between surviving and deceased patients. Notably, chronic renal failure (OR=2.55, P=0.036), GRACE score (OR=1.10, P=0.006), and Gensini score(OR=1.11, P=0.003) were the independent predictors of long-term mortality. CONCLUSIONS Long-term mortality of octogenarians with ACS was associated with increased comprehensive coronary artery lesion severity. Gensini score was an effective parameter for evaluation of long-term mortality.
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Affiliation(s)
- Leonard Shan
- Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria (L.S., A.S., A.N.); Cardiology Unit, South Eastern Sydney and Illawarra Health Network, Wollongong, NSW (A.S., R.M.); and University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (A.N.)
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Fu Z, Xue H, Guo J, Chen L, Dong W, Gai L, Liu H, Sun Z, Chen Y. Long-term prognostic impact of cystatin C on acute coronary syndrome octogenarians with diabetes mellitus. Cardiovasc Diabetol 2013; 12:157. [PMID: 24182196 PMCID: PMC4176996 DOI: 10.1186/1475-2840-12-157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 10/20/2013] [Indexed: 12/22/2022] Open
Abstract
Objective Cystatin C (Cys C) is a marker of renal dysfunction. Prior studies have shown that blood Cys C is related to the prognosis of coronary heart disease. The aim of the present study was to evaluate the long-term prognostic impact of Cys C on acute coronary syndrome (ACS) octogenarians with diabetes mellitus (DM). Methods We enrolled 660 consecutive ACS octogenarians who underwent coronary angiography and were classified into two groups based on diabetes. The baseline characters and Cys C level were measured on admission. Survival curve was calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of mortality and of major adverse cardiac events (MACE) rate. Results There were 223 and 398 patients in groups DM and non-DM who fulfilled the follow-up. The average follow-up period was 28 (IQR 16–38) months. Diastolic blood pressure (DBP) was lower, ratios of hypertension and chronic renal failure (CRF), fasting blood glucose, HbA1c and Cys C levels were higher in DM group than those in non-DM group (P<0.01). The cumulative survival of DM group was significantly lower than that of non-DM group in the long term (P = 0.018). All cause mortality and MACE of DM group were higher than those of non-DM group (P<0.05). The plasma Cys C concentration (OR = 3.32, 95% CI = 1.18-10.92, P = 0.023) was the uniqueness independent predictor for long-term all cause mortality. The plasma Cys C concentration (OR = 2.47, 95% CI = 1.07-7.86, P = 0.029) and Genesis score (OR = 1.01, 95% CI = 1.00-1.03, P = 0.043) were independent predictors for MACE in DM group. ROC curve analysis showed that the predictive cut-off value of Cys C for mortality of DM group was 1.605 (0.718, 0.704). Conclusions Cys C is an independent predictor for long-term mortality and MACE of ACS octogenarians with DM.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yundai Chen
- Department of Cardiology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, Haidian District 100853, People's Republic of China.
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Saxena A, Dinh DT, Reid CM, Smith JA, Shardey GC, Newcomb AE. Does Preoperative Atrial Fibrillation Portend a Poorer Prognosis in Patients Undergoing Isolated Aortic Valve Replacement? A Multicentre Australian Study. Can J Cardiol 2013; 29:697-703. [DOI: 10.1016/j.cjca.2012.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 08/18/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022] Open
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Impact of smoking status on early and late outcomes after isolated coronary artery bypass graft surgery. J Cardiol 2013; 61:336-41. [DOI: 10.1016/j.jjcc.2013.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/27/2012] [Accepted: 01/07/2013] [Indexed: 11/20/2022]
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Fosbøl EL, Zhao Y, Shahian DM, Grover FL, Edwards FH, Peterson ED. Repeat Coronary Revascularization After Coronary Artery Bypass Surgery in Older Adults. Circulation 2013; 127:1656-63. [DOI: 10.1161/circulationaha.113.001882] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background—
A major advantage of coronary artery bypass graft surgery (CABG) relative to percutaneous coronary intervention is its durability, yet there is a paucity of information on rates and predictors of repeat coronary revascularization after CABG in the modern era.
Methods and Results—
We included patients ≥65 years from the Society of Thoracic Surgeons’ National Adult Cardiac Surgery Database who were undergoing first-time isolated CABG from 1991 to 2007 (n=723 134, median age 73 years). After linking to Medicare claims data, long-term outcomes of CABG (up to 18 years after surgery) were examined by use of cumulative incidence curves. Multivariable Cox proportional hazard analysis was used to identify factors associated with 1- and 5-year repeat revascularization trends and variability. We found that the overall 18-year survival rate was 20%. Cumulative incidences of any repeat revascularization (percutaneous coronary intervention or CABG, yet most often percutaneous coronary intervention) were 2%, 7%, 13%, and 16% at 1, 5, 10, and 18 years after surgery, respectively. The rates of repeat CABG procedures were quite low for all time points (0.1%, 0.6%, 1.3%, and 1.7%, respectively). Female sex, disease severity represented by a history of percutaneous coronary intervention, preoperative dialysis, and partial revascularization were strongly associated with a higher revascularization rate, whereas advanced age, left main disease, and smoking were associated with a lower rate. There was approximately a 2-fold variation in repeat revascularization rates across centers at 1 year (interquartile range 1.7–3.6%) and 5 years (interquartile range 6.7–12.0%).
Conclusions—
Repeat revascularization is performed infrequently among older patients who undergo CABG; however, these rates vary substantially by patient subgroups and among providers.
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Affiliation(s)
- Emil L. Fosbøl
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
| | - Yue Zhao
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
| | - David M. Shahian
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
| | - Frederick L. Grover
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
| | - Fred H. Edwards
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
| | - Eric D. Peterson
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
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Saxena A, Dinh D, Dimitriou J, Reid C, Smith J, Shardey G, Newcomb A. Preoperative atrial fibrillation is an independent risk factor for mid-term mortality after concomitant aortic valve replacement and coronary artery bypass graft surgery. Interact Cardiovasc Thorac Surg 2013; 16:488-94. [PMID: 23287590 DOI: 10.1093/icvts/ivs538] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Preoperative atrial fibrillation (PAF) has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery. Few studies, however, have evaluated the impact of PAF on early and mid-term outcomes after concomitant aortic valve replacement and coronary aortic bypass graft (AVR-CABG) surgery. METHODS Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program was retrospectively analysed. Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded. Demographic and operative data were compared between patients undergoing concomitant AVR-CABG who presented with PAF and those who did not using chi-square and t-tests. The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression, respectively. RESULTS Concomitant AVR-CABG surgery was performed in 2563 patients; 322 (12.6%) presented with PAF. PAF patients were generally older (mean age 76 vs 74 years; P < 0.001) and presented more often with comorbidities including congestive heart failure, chronic pulmonary disease and cerebrovascular disease (all P < 0.05). PAF was associated with 30-day mortality on univariate analysis (P = 0.019) but not multivariate analysis (P = 0.53). The incidence of early complications was not significantly higher in the PAF group. PAF was independently associated with reduced mid-term survival (HR, 1.58; 95% CI, 1.14-2.19; P = 0.006). CONCLUSIONS PAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery. Patients with PAF undergoing AVR-CABG should be considered for a concomitant surgical ablation procedure.
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Affiliation(s)
- Akshat Saxena
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
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Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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BIERBACH BENJAMIN, SCHEEWE JENS, DERFUSS THOMAS, KRUG ALFONS, SCHRAMM RENÉ, DAHM MANFRED, KUROCZYNSKI WLODZIMIERZ, KEMPSKI OLIVER, HORSTICK GEORG. Continuous Regional Myocardial Blood Flow Measurement: Validation of a Near-Infrared Laser Doppler Device in a Porcine Model. Microcirculation 2012; 19:485-93. [DOI: 10.1111/j.1549-8719.2012.00173.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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