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Jiang JL, Huang QJ, Chen MH. Efficacy and safety of drug-coated balloon for de novo lesions of large coronary arteries: Systematic review and meta-analysis of randomized controlled trials. Heliyon 2024; 10:e25264. [PMID: 38333846 PMCID: PMC10850513 DOI: 10.1016/j.heliyon.2024.e25264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/22/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
Background Drug-coated balloon (DCB) is a novel approach to avoiding stent-related complications and has proven effective for the treatment of in-stent restenosis (ISR) and small vessels. However, its role in the treatment of de novo lesions in large vessels is less settled. Aims To estimate the efficacy and safety of drug-coated balloon versus stent in the treatment of de novo lesions in large coronary arteries. Methods We searched the literature until April 2023. We judged the safety of DCB based on major adverse cardiovascular events (MACEs), cardiac death, all-cause mortality, non-fatal myocardial infarction, target lesion revascularization (TLR), and bleeding event; and efficacy according to late lumen loss (LLL), minimum lumen diameter (MLD). We conducted subgroup analyses according to stent type and whether urgent PCI was required. Results A total of 10 RCTs were included. Overall, LLL (mean difference (MD) = -0.19, 95 % confidence interval (CI): -0.32 to -0.06, P = 0.003) was lower in the DCB group than in the Stent arm. This effect was consistent in subgroup analysis regardless of stent type and disease type. In terms of safety indicators, there were no significant differences between DCB and stent. The subgroup analyses found that safety indicators showed no significant differences between DCB and drug-eluting stent (DES), but TLR was lower in the DCB than in the bare metal stent (BMS). Moreover, in ST-elevation myocardial infarction (STEMI), safety indicators and LLL showed no significant differences between DCB and DES, but MLD in the DCB was smaller. While in patients with excluded STEMI, MACE and TLR was lower in the DCB compared with the overall stent. Conclusions DCB could be a promising alternative for treating de novo lesions in large coronary arteries with satisfactory efficacy and low risk, superior to BMS and not inferior to DES, with a trend toward lower late lumen loss.
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Affiliation(s)
- Jin-Li Jiang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
| | - Qiao-Juan Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
| | - Meng-Hua Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
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Abromaitiene V, Greisen J, Kimose HH, Karaliunaite Z, Jakobsen CJ. Comparison of free arterial and saphenous vein grafting in outcomes after coronary bypass surgery. SCAND CARDIOVASC J 2022; 56:42-47. [PMID: 35393904 DOI: 10.1080/14017431.2022.2060525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. The goal of this study was to examine whether the use of free arterial grafts could reduce the need for repeated revascularization and all-cause mortality in patients undergoing coronary artery grafting. Design. The cohort study included 17,354 consecutive adults with isolated coronary artery grafting from 2000 to 2016 in three cardiac surgery centers. Data were obtained from the Western Denmark Heart Registry. Propensity matching with 24 factors was used to establish comparable groups of patients receiving either vein grafts (n = 1019) or free arterial grafts (n = 1019) for outcome analysis. Results. The need for repeated revascularization and all-cause mortality was similar in both graft groups at 10 years of follow-up. Creatine-Kinase MB Isoenzyme >100 μg/L increased the risk of repeated revascularization rate after 1, 5 and 10 years. Conclusions. Long-term outcomes in revascularization and survival are comparable after free arterial or saphenous vein grafting.
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Affiliation(s)
- Vijoleta Abromaitiene
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Greisen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Henrik Kimose
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Zidryne Karaliunaite
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Carl-Johan Jakobsen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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3
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Goeddel LA, Colao J, Choi CW, Stulak JM, Ramakrishna H. Comparison of Outcomes Following Coronary Artery Bypass Grafting With Arterial Versus Venous Conduits. J Cardiothorac Vasc Anesth 2021; 36:599-607. [PMID: 33674202 DOI: 10.1053/j.jvca.2021.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Lee A Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph Colao
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chun W Choi
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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The radial artery: An important component of multiarterial coronary surgery and considerations for its optimal harvest. JTCVS Tech 2020; 5:46-55. [PMID: 34318106 PMCID: PMC8300031 DOI: 10.1016/j.xjtc.2020.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/20/2020] [Indexed: 01/23/2023] Open
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Obed D, Fleissner F, Martens A, Cebotari S, Haverich A, Warnecke G, Ismail I. Total Arterial Revascularization with Radial Artery and Internal Thoracic Artery T-Grafts Is Associated with Superior Long-Term Survival in Patients Undergoing Coronary Artery Bypass Grafting. Ann Thorac Cardiovasc Surg 2020; 26:30-39. [PMID: 31956169 PMCID: PMC7046926 DOI: 10.5761/atcs.oa.19-00226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIMS Compelling evidence encourages the use of the radial artery (RA) as the second arterial graft in coronary artery bypass grafting (CABG). However, its long-term benefits remain disputed. We sought to evaluate long-term outcome and survival by comparing patients receiving RAs with those receiving venous grafts to a single internal thoracic artery (ITA). METHODS We analyzed 345 patients undergoing primary multivessel CABG and conducted a 13-year long follow-up. In all, 187 patients received the RA and the left ITA as T-graft; 158 patients received saphenous veins complementing a single ITA. We performed propensity-score matching on 81 pairs to balance treatment selection and confounders. RESULTS Patients receiving RAs were younger and less likely to be female or to have pulmonary hypertension, impaired renal function, or left main coronary disease.At 30 days, they showed significantly lower unadjusted mortality and renal impairment. Unadjusted long-term survival was superior in the RA group, even after propensity-score matching. We found that RA use protected from late mortality. CONCLUSIONS Using the RA and the left ITA as T-graft is associated with a significant long-term survival benefit in patients undergoing CABG. It may display a promising alternative to conventional use of a single ITA supplemented by saphenous veins.
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Affiliation(s)
- Doha Obed
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Felix Fleissner
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Issam Ismail
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Royse AG, Brennan AP, Pawanis Z, Canty D, Royse CF. Patency When Grafted to Coronary Stenosis More Than 50% in LIMA-RA-Y Grafts. Heart Lung Circ 2019; 29:1101-1107. [PMID: 31837922 DOI: 10.1016/j.hlc.2019.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/30/2019] [Accepted: 09/13/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent coronary surgery practice is to graft arterial conduits to more severely stenosed coronary targets than in the past. We aimed to investigate postoperative arterial graft patency with native coronary stenosis at the time of surgery, using the left internal mammary artery and radial artery (RA) as a composite Y graft (LIMA-RA-Y). In the study timeframe, it was routine clinical practice to graft coronary arteries with >50% stenosis. METHODS Of 464 patients previously reported 1996-1999, 346 who underwent LIMA-RA-Y at the Royal Melbourne Hospital, 76 had postoperative angiograms at the same institution. Each anastomosis was considered separately. For arterial grafts a "string sign" was analysed as being occluded. Predictor of patency was performed with a generalised linear mixed model (GLMM). RESULTS Seventy-six (76) patients had postoperative angiograms at 5.8±5.4 years (range 0.23-19.4; interquartile range 1.7-10.0) years postoperative; with age at operation 62.5±10.7 years and 3.4±0.8 grafts per patient, 82% were male. Of 256 anastomoses, 230 were to coronary targets >50% stenosis. Overall patency was 84.0% (214/256). For coronary stenosis >50%, patency was 88% (201/230) and varied by coronary territory left anterior descending (LAD) 94% (87/93), circumflex 90% (71/79) and right coronary artery (RCA) 74% (43/58). Interaction for coronary territory was significant (p=0.022). Higher preoperative coronary stenosis predicted higher patency; with odds ratio for improved patency of 1.83 (95% CI 1.51, 2.22), p<0.001 for each 10% increase in stenosis. CONCLUSIONS Late patency of composite arterial grafts is acceptable when grafted to coronary arteries of greater than 50% stenosis.
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Affiliation(s)
- Alistair G Royse
- The University of Melbourne, Department of Surgery, Melbourne, Vic, Australia.
| | - Anthony P Brennan
- St Vincent's Hospital, Melbourne, Australia, and Department of Surgery, University of Melbourne, Melbourne, Vic, Australia
| | - Zulfayandi Pawanis
- Universitas Airlangga Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - David Canty
- The University of Melbourne, Department of Surgery, Melbourne, Vic, Australia
| | - Colin F Royse
- The University of Melbourne, Department of Surgery, Melbourne, Vic, Australia
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Ji Q, Song K, Shen J, Wang Y, Yang Y, Ding W, Xia L, Wang C. Long-Term Patency Rate of Radial Artery Conduits in Chinese Patients Undergoing Off-Pump Coronary Artery Bypass Grafting. Int Heart J 2019; 60:1276-1283. [PMID: 31735768 DOI: 10.1536/ihj.18-305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Consensus has yet to emerge among experts as to whether the radial artery (RA) conduit was superior to the saphenous vein (SV) graft for coronary artery bypass grafting (CABG) in terms of long-term patency. This study aimed to evaluate long-term patency of the RA conduit compared to the SV conduit for off-pump CABG, and to screen the independent predictors of long-term RA graft failure.Patients < 80 years of age with graftable triple-vessel disease undergoing non-emergent, primary, isolated off-pump CABG, using both the RA and the SV conduits, were reviewed. Graft patency, all-cause mortality and repeat revascularization were followed-up. The independent predictors of long-term RA graft failure were identified.A total of 296 out of 320 eligible patients (42 females, 61.3 ± 9.9 years old) received follow-up with an observed period of 93.4 ± 16.5 months. All-cause mortality was 14.5%, and repeat revascularization was conducted on 6 RA grafts and 9 SV grafts. Superior patency of the RA grafts compared to the SV grafts was observed (84.4% versus 78.5%, P = 0.035). Independent predictors of long-term RA graft failure included proximal stenosis of target right coronaries < 90% (OR = 2.35, 95%CI 1.41-5.82) and diabetes mellitus (OR = 1.66, 95%CI 1.17-4.26).The RA graft had a superior long-term patency than the SV graft. Long-term patency of the RA graft may be poor in diabetics or in the case of proximal stenosis of target right coronary <90%. (Trial registration: ChiCTR-OCH-1200212).
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Affiliation(s)
- Qiang Ji
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Kai Song
- Shanghai Institute of Cardiovascular Disease
| | - JinQiang Shen
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - YuLin Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Ye Yang
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - WenJun Ding
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - LiMin Xia
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
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8
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Dreifaldt M, Mannion JD, Geijer H, Lidén M, Bodin L, Souza D. The no-touch saphenous vein is an excellent alternative conduit to the radial artery 8 years after coronary artery bypass grafting: A randomized trial. J Thorac Cardiovasc Surg 2019; 161:624-630. [PMID: 31831193 DOI: 10.1016/j.jtcvs.2019.09.177] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/26/2019] [Accepted: 09/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2004, a prospective randomized trial demonstrated that after 3 years, saphenous veins (SVs) harvested with a no touch (NT) technique had a greater patency than radial grafts for coronary bypass surgery. Here we report the 8-year follow-up data of this trial. METHODS The trial included 108 patients undergoing coronary artery bypass grafting (CABG). Each patient was assigned to receive 1 NT SV and 1 radial artery (RA) graft to either the left or right coronary territory to complement the left internal thoracic artery (LITA). Sequential grafting was common, so overall graft patency as well as the patency of each anastomosis were assessed. RESULTS Angiography was performed in 84 patients (78%) at mean of 97 months postoperatively. Graft patency were high and similar for both NT and RA: 86% for NT versus 79% for RA (P = .22). The patency of coronary anastomoses was significantly higher with the NT SV grafts (91% vs 81%; P = .046). The NT grafts also had excellent patency in coronary arteries with <90% stenosis (93% patency) and in coronary arteries of small diameter (87% patency) or with mild calcification (88% patency). Patency for the LITA was 92%. CONCLUSIONS NT SV grafts have excellent patency similar to that of RA grafts after 8 years. In addition, NT SV grafts can be used in situations that are not ideal for RA grafts.
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Affiliation(s)
- Mats Dreifaldt
- Faculty of Medicine and Health, Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, Örebro University, Örebro, Sweden
| | - John D Mannion
- Department of Surgery, Bayhealth Medical Center, Dover, Del
| | - Håkan Geijer
- Faculty of Medicine and Health, Department of Radiology, Örebro University, Örebro, Sweden
| | - Mats Lidén
- Faculty of Medicine and Health, Department of Radiology, Örebro University, Örebro, Sweden
| | - Lennart Bodin
- Unit of Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Domingos Souza
- Faculty of Medicine and Health, Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, Örebro University, Örebro, Sweden.
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A Prospective Randomized Study of Endoscopic Versus Conventional Harvesting of the Radial Artery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 12:231-238. [PMID: 28763350 DOI: 10.1097/imi.0000000000000386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of the study were to determine whether endoscopic harvesting of the radial artery (RA) reduces morbidity due to pain, infection, and disability with improvement in satisfaction and cosmesis compared to the conventional technique and (2) to compare the 6-month angiographic patency of the RA harvested conventionally and endoscopically. METHODS In a prospective randomized study, 119 patients undergoing coronary artery bypass grafting using the RA were randomized to have RA harvested either conventionally (n = 59) or endoscopically (n = 60). RESULTS Radial artery harvest time (open wound time) was significantly reduced in the endoscopic group (36.5 ± 9.4 vs 57.7 ± 9.4 minutes, P < 0.001). Only one patient developed wound infection (1.6%) in the endoscopic group compared with six patients (10.2%), P = 0.061, in the conventional group. Although this was not statistically significant, clinically this was relevant in terms of reduction in postoperative morbidity. Postoperative pain in the arm incision was significantly lower in the endoscopic group at postoperative day 2 (P < 0.001) and at discharge (P < 0.001) and similar to the conventional open group at 6 weeks' follow-up (P = 0.103). Overall patient satisfaction and cosmesis were significantly better in the endoscopic group at postoperative day 2 (P < 0.001), at discharge (P < 0.001), and at 6 weeks' follow-up (P < 0.001). There was no difference in the arm disability postoperatively (P = 0.505) between the two groups. Six-month angiographic assessment of 23 patients (12 endoscopic and 11 open) revealed no difference in the patency rate (10/12 in endoscopic and 9/11 in open group). CONCLUSIONS Endoscopic RA harvesting reduced the incidence of postoperative wound infection and wound pain and improved patient satisfaction and cosmesis compared with conventional harvesting technique. There was no difference in the 6-month angiographic patency of the RA harvested conventionally and endoscopically.
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Abstract
Purpose of Review Several advances have been made in recent years to improve outcome for patients with coronary artery disease. One of the most debated topics regarding surgical treatment with coronary artery bypass grafting (CABG) is graft selection. This review aims to present the current status and scientific evidence for bilateral internal thoracic artery (BITA) grafting. Recent Findings Observational studies and pooled analyses suggest that BITA grafting is associated with improved survival. Early results from a large randomized controlled trial report safety and efficacy of the method. The improved survival might be amplified in select groups, but with an increase in sternal wound-related complications. The benefit of BITA grafts seems to remain to an approximate age of 69 years at surgery. Summary CABG with BITA grafts is likely associated with improved long-term survival at a cost of an increase in sternal wound infections. Ten-year results from the Arterial Revascularization Trial are expected in 2018, providing the best evidence regarding the method yet. Early results show it is a safe method in most patient categories considerable for CABG.
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The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality. Ann Thorac Surg 2018; 105:15-23. [DOI: 10.1016/j.athoracsur.2017.10.035] [Citation(s) in RCA: 238] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/21/2017] [Indexed: 11/22/2022]
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Shimahara Y, Fujita T, Kobayashi J, Asaumi Y, Kanzaki S, Nishimura K, Nakai M, Nakajima H. Optimal target vessel selection for composite and sequential radial artery grafting with an in situ internal thoracic artery. J Card Surg 2017; 32:613-620. [PMID: 28901634 DOI: 10.1111/jocs.13210] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We retrospectively evaluated graft patency in patients who underwent no-touch aortic arterial off-pump coronary artery bypass grafting to determine the optimal selection of target vessels for improved graft patency of composite and sequential radial artery I-grafts. METHODS The radial artery was anastomosed to the end of an in situ internal thoracic artery and was sequentially anastomosed to non-left anterior descending arteries. This composite graft was defined as an "I-graft." We evaluated 145 I-grafts with 2, 3, or 4 sequential anastomoses (437 graft segments). A graft segment with the final distal anastomosis of every I-graft was defined as the last graft segment (LGS). When a sequential anastomosis was initiated from the left coronary branch, the I-graft assumed a clockwise course (69.0%). When a sequential anastomosis was initiated from the right coronary branch, the I-graft assumed a counterclockwise course (31.0%). RESULTS On multivariable analysis, right coronary branch (P < 0.001), moderately stenotic (50-75%) target vessel (P = 0.004), and LGS with moderately stenotic target vessel (P = 0.005) were predictors of mid-term graft occlusion. In situations where the LGS was anastomosed to a severely stenotic target vessel (>75%) with a clockwise course, when the number of moderately stenotic target vessels among sequential graft segments was 0, 1, or ≥2, the mid-term graft patency rates of I-grafts were 94.0%, 86.0%, and 81.4%, respectively. CONCLUSIONS The selection of target vessels for severely stenotic lesions among sequential graft segments and the clockwise course enhance the mid-term graft patency of sequential radial I-grafts.
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Affiliation(s)
- Yusuke Shimahara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Suzu Kanzaki
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Michikazu Nakai
- Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Center, Saitama, Japan
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Schwann TA, Tatoulis J, Puskas J, Bonnell M, Taggart D, Kurlansky P, Jacobs JP, Thourani VH, O'Brien S, Wallace A, Engoren MC, Tranbaugh RF, Habib RH. Worldwide Trends in Multi-arterial Coronary Artery Bypass Grafting Surgery 2004-2014: A Tale of 2 Continents. Semin Thorac Cardiovasc Surg 2017; 29:273-280. [PMID: 29195570 DOI: 10.1053/j.semtcvs.2017.05.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 01/10/2023]
Abstract
Recent evidence shows that multi-arterial coronary artery bypass grafting (MABG) based on bilateral internal thoracic (BITA) or left internal thoracic (LITA) and radial artery (RA) improves long-term outcomes compared with single arterial coronary artery bypass grafting (SABG) (LITA + saphenous vein graft). How this evidence affected the worldwide use of MABG, if at all, is not well defined. Accordingly, we report 10-year temporal trends of MABG utilization from 2 continents. A study population of 1,683,434 non-emergent, primary, isolated LITA-based coronary artery bypass grafting (CABG) (≥2 grafts) patients was derived from the Society of Thoracic Surgeons (STS) (1,307,528 (79.5%) of 1,644,388 isolated CABG; total 1179 centers) and the Australia New Zealand Cardiothoracic (ANZ) Databases (34,213 (87%) of 39,046 isolated CABG; 24 centers) between 2004 and 2014. Patients were excluded based on the following: (1) no LITA, (2) if arterial grafts were other than RA or ITA, or (3) if grafting data were missing. The 3 MABG groups were LITA + RA, BITA, and BITA + RA, each with or without supplemental vein grafts. Grafting trends and their associated patient demographics were analyzed. SABG (89.3% STS, 51.4% ANZ) was the most common grafting strategy. MABG was most frequently accomplished by LITA + RA: (STS: 6.1%; ANZ: 42.6%), followed by BITA: (STS: 4.1%; ANZ: 4.3%), while ≥3 (BITA + RA) was rare in the STS (0.5%), but more common in ANZ (5.9%). In the STS, between 2004 and 2014, SABG rates systematically increased from 85.2% to 91.7%, BITA grafting was essentially unchanged from 3.6% to 4.3%, while RA use decreased systematically from 10.5% to 3.7%. In the ANZ, SABG rates increased from 17.3% to 51.4%, BITA grafting decreased from 6.3% to 3.6%, while RA grafting decreased from 65.8% to 39.0%. Compared with SABG patients, BITA patients were younger (STS: median age 59 vs 66, P < 0.001; ANZ: mean age 62 vs 68, P < 0.001), predominately male (STS: 84% vs 73%, P < 0.001; ANZ: 86% vs 79%, P < 0.001), less obese (body mass index >30 kg/m2) in STS (37% vs 42%, P < 0.001), more obese in ANZ (33% vs 32%, P = 0.001), and less diabetic (STS: 26% vs 43%, P < 0.001; ANZ: 25% vs 37%, P < 0.001), whereas RA patients were intermediate in age (STS: 61; ANZ: 65), in male sex (STS: 82%; ANZ: 81%), in the prevalence of diabetes (STS: 40%; ANZ: 34%), and were most obese (STS: 47%; ANZ: 34%). A decade-long analysis of STS data reveals a counterintuitive decline in the use (driven by decreasing RA use) of MABG: a potentially superior grafting strategy compared with SABG. In contra distinction, the smaller but growing ANZ data document a distinctly different CABG practice pattern, with a higher MABG utilization rate, but a similarly declining RA use. The reasons for these practice patterns and declining MABG are likely diverse and require further assessment.
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Affiliation(s)
- Thomas A Schwann
- Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio; Department of Surgery, Mercy Saint Vincent Medical Center, Toledo, Ohio.
| | - James Tatoulis
- Department of Surgery, University of Melbourne, Parkville, Australia
| | - John Puskas
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark Bonnell
- Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - David Taggart
- Department of Cardiovascular Surgery, University of Oxford, Oxford, UK
| | - Paul Kurlansky
- Department of Surgery, Columbia University, New York, New York
| | - Jeffery P Jacobs
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | | | - Sean O'Brien
- Duke Clinical Research Center, Duke University, Durham, North Carolina
| | - Amelia Wallace
- Duke Clinical Research Center, Duke University, Durham, North Carolina
| | - Milo C Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Robert F Tranbaugh
- St. Vincent Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Robert H Habib
- Society of Thoracic Surgeons Research Center, Chicago, Illinois
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Schwann TA. The Surgical Treatment of Coronary Artery Occlusive Disease: Modern Treatment Strategies for an Age Old Problem. Surg Clin North Am 2017; 97:835-865. [PMID: 28728719 DOI: 10.1016/j.suc.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Coronary artery disease remains a formidable challenge to clinicians. Percutaneous interventions and surgical techniques for myocardial revascularization continue to improve. Concurrently, in light of emerging data, multiple practice guidelines have been published guiding clinicians in their therapeutic decisions. The multidisciplinary Heart Team concept needs to be embraced by all cardiovascular providers to optimize patient outcomes.
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Affiliation(s)
- Thomas A Schwann
- Department of Surgery, University of Toledo College of Medicine & Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA.
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Kiaii BB, Swinamer SA, Fox SA, Stitt L, Quantz MA, Novick RJ. A Prospective Randomized Study of Endoscopic versus Conventional Harvesting of the Radial Artery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bob B. Kiaii
- Departments of Surgery, Western University, London, ON Canada
| | | | | | - Larry Stitt
- Departments of Surgery, Western University, London, ON Canada
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Halbach J, Lowry D, Nelles M, Ayers J. Extensor pollicis longus tendon compression as the etiology of a true aneurysm of the radial artery in the anatomical snuff box. J Vasc Surg Cases Innov Tech 2016. [DOI: 10.1016/j.jvscit.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Mounsey CA, Mawhinney JA, Werner RS, Taggart DP. Does Previous Transradial Catheterization Preclude Use of the Radial Artery as a Conduit in Coronary Artery Bypass Surgery? Circulation 2016; 134:681-8. [DOI: 10.1161/circulationaha.116.022992] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The radial artery (RA) is a commonly used conduit for coronary artery bypass grafting, and recent studies have demonstrated that it provides superior long-term patency rates to the saphenous vein in most situations. In addition, the RA is also being used with increasing frequency as the access point for coronary angiography and percutaneous coronary interventions. However, there has been concern for many years that these transradial procedures may have a detrimental impact on the function of RA grafts used in coronary artery bypass grafting, and there is now comprehensive evidence that such interventions cause morphologic and functional damage to the artery in situ. Despite this, there remain remarkably few studies investigating the use of previously cannulated RAs as grafts in coronary artery bypass surgery, and there are no clear guidelines on the use of the RA in coronary artery bypass grafting after its catheterization. This article will review concisely the evidence that transradial procedures cause damage to the RA, and discuss the impact this could have on previously cannulated RAs used as coronary artery bypass grafting conduits. On the basis of the evidence assessed, we make a number of recommendations to both surgeons and cardiologists regarding use of the RA in cardiovascular procedures.
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Affiliation(s)
- Craig A. Mounsey
- From Medical Sciences Division, University of Oxford, UK (C.A.M., J.A.M.); Faculty of Medicine, University of Zurich, Switzerland (R.S.W.); and Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, UK (D.P.T.)
| | - Jamie A. Mawhinney
- From Medical Sciences Division, University of Oxford, UK (C.A.M., J.A.M.); Faculty of Medicine, University of Zurich, Switzerland (R.S.W.); and Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, UK (D.P.T.)
| | - Raphael S. Werner
- From Medical Sciences Division, University of Oxford, UK (C.A.M., J.A.M.); Faculty of Medicine, University of Zurich, Switzerland (R.S.W.); and Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, UK (D.P.T.)
| | - David P. Taggart
- From Medical Sciences Division, University of Oxford, UK (C.A.M., J.A.M.); Faculty of Medicine, University of Zurich, Switzerland (R.S.W.); and Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, UK (D.P.T.)
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18
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He GW, Taggart DP. Spasm in Arterial Grafts in Coronary Artery Bypass Grafting Surgery. Ann Thorac Surg 2016; 101:1222-9. [DOI: 10.1016/j.athoracsur.2015.09.071] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/21/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
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Long-term patency of endoscopically harvested radial arteries: from a randomized controlled trial. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:77-84. [PMID: 25807170 DOI: 10.1097/imi.0000000000000133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE From 2005 to 2007, 119 patients were enrolled in a prospective randomized controlled trial comparing open and endoscopically harvested radial arteries for coronary artery bypass grafting. The objective of the current study was to compare graft patency between intervention groups at more than 5 years from the initial trial. We hypothesized that endoscopically harvested radial arteries would show equivalent patency to those conventionally harvested. METHODS At 5 years or greater from their operation, all consenting patients underwent a single-day anatomic and functional cardiac assessment with coronary computed tomography angiography and sestamibi myocardial perfusion scanning. Medical Outcomes Study 36-Item Short-Form Health Surveys and Seattle Angina Questionnaires were completed to assess the overall quality of life. All patients had received calcium channel blocker therapy for at least 6 months postoperatively. RESULTS The mean (SD) duration of follow-up was 79.2 (8.6) months for all patients. One death occurred within 30 days of coronary artery bypass grafting in each treatment group, and eight additional noncardiac deaths occurred during the study time frame. Of 119 patients, 66 consented to follow-up. Thirty-two had open radial artery harvest, and 34 had endoscopic radial artery harvest. At more than 5 years, there were 28 patent conventionally harvested radial arteries (87.5%) and 31 patent endoscopically harvested radial arteries (91.2%) (P = 0.705). Measured quality of life was comparable between groups. CONCLUSIONS Endoscopic radial artery harvest is safe and effective when compared with open radial artery harvest, with excellent graft patency demonstrated at more than 5 years. Patency results are noninferior in endoscopic radial artery harvest.
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Pevni D, Mohr R, Paz Y, Kramer A, Ben-Gal Y, Nesher N, Medalion B. Long-term outcome of revascularization with composite T-grafts: Is bilateral mammary grafting better than single mammary and radial artery grafting? J Thorac Cardiovasc Surg 2015; 151:1311-9. [PMID: 26794927 DOI: 10.1016/j.jtcvs.2015.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 11/20/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Bilateral internal mammary artery (BIMA) grafting is associated with improved survival. However, many surgeons are reluctant to use this technique, owing to the potentially increased risk of sternal infection. The composite T-graft with radial artery (RA) attached end-to-side to the left internal mammary artery (IMA) provides complete arterial revascularization without increased risk of sternal infection. The purpose of this study is to compare outcomes of these 2 strategies. METHODS Patients who underwent BIMA grafting using the composite T-graft technique, between 1996 and 2010 (n = 1329), were compared with 389 patients who underwent composite grafting with a single IMA + RA during the same time period. RESULTS Patients undergoing single IMA grafting were older, more often women, and more likely to have diabetes, peripheral vascular disease, and COPD, and to need an emergency operation. Congestive heart failure, left main disease, and recent myocardial infarction were more prevalent with bilateral grafting. Propensity-score matching was used to account for differences between groups in preoperative patient characteristics. The 268 matched pairs had similar characteristics. The median follow-up time was 14.19 (95% confidence interval 13.43-14.95) years. Operative mortality and Kaplan-Meier 10-year survival of the 2 matched groups were similar (3.4% vs 3.7%, and 61.6% vs 64%, for the groups treated with BIMA and single IMA, respectively). Cox-adjusted survival was similar (P = .514). Age, chronic renal failure, and performance of <3 bypass grafts were independent predictors of decreased survival. CONCLUSIONS This study suggests that long-term outcomes of arterial revascularization with a composite T-graft constructed using left IMA and RA are not inferior to outcomes after BIMA grafting.
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Affiliation(s)
- Dmitry Pevni
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
| | - Rephael Mohr
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel.
| | - Yosef Paz
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
| | - Amir Kramer
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
| | - Yanai Ben-Gal
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
| | - Nahum Nesher
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
| | - Benjamin Medalion
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
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22
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Cheng K, Rehman SM, Taggart DP. A Review of Differing Techniques of Mammary Artery Harvesting on Sternal Perfusion: Time for a Randomized Study? Ann Thorac Surg 2015; 100:1942-53. [PMID: 26410160 DOI: 10.1016/j.athoracsur.2015.06.087] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 06/05/2015] [Accepted: 06/22/2015] [Indexed: 11/30/2022]
Abstract
The use of internal mammary artery (IMA) grafts for coronary artery bypass may devascularize the sternum. We performed a literature review by searching the PubMed database for studies that assessed sternal perfusion after IMA harvesting. The majority of papers describe various techniques and compared (1) IMA harvest versus no IMA harvest, (2) single versus bilateral, and (3) skeletonized versus pedicled. Evidence is inconclusive as to whether single harvesting causes significant devascularisation and whether this is increased with bilateral harvesting. Sternal ischemia may also be a transient phenomenon. However, skeletonization may preserve perfusion more than pedicled harvesting, particularly in diabetic patients.
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Affiliation(s)
- Kevin Cheng
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Syed M Rehman
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
| | - David P Taggart
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Fleissner F, Engelke H, Rojas-Hernandez S, Ismail I, Stiefel P, Cebotari S, Haverich A, Shrestha M, Martens A. Long-term follow-up of total arterial revascularization with left internal thoracic artery and radial artery T-grafts: survival, cardiac morbidity and quality of life. Eur J Cardiothorac Surg 2015; 49:1195-200. [DOI: 10.1093/ejcts/ezv289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/16/2015] [Indexed: 12/24/2022] Open
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24
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Permeabilidad de los injertos de arteria radial mediante tomografía computarizada cardiaca de 256 cortes y su impacto pronóstico a medio plazo. Rev Esp Cardiol (Engl Ed) 2015. [DOI: 10.1016/j.recesp.2015.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Viladés Medel D, Muñoz Guijosa C, Carreras Costa F, Padró Fernández JM, Pons Lladó G, Leta Petracca R. Assessment of Radial Artery Graft Patency Through 256-slice Cardiac Computed Tomography, and the Mid-term Prognostic Impact of Graft Occlusion. ACTA ACUST UNITED AC 2015; 68:812-3. [PMID: 26169328 DOI: 10.1016/j.rec.2015.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/23/2015] [Indexed: 11/16/2022]
Affiliation(s)
- David Viladés Medel
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Francesc Carreras Costa
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Guillem Pons Lladó
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Leta Petracca
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Schwann TA, Al-Shaar L, Tranbaugh RF, Dimitrova KR, Hoffman DM, Geller CM, Engoren MC, Bonnell MR, Habib RH. Multi Versus Single Arterial Coronary Bypass Graft Surgery Across the Ejection Fraction Spectrum. Ann Thorac Surg 2015; 100:810-7; discussion 817-8. [PMID: 26116479 DOI: 10.1016/j.athoracsur.2015.02.111] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/11/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Left internal thoracic artery (LITA) and radial artery (RA) multi-arterial CABG (MABG) is generally associated with improved long-term survival compared with traditional LITA and saphenous vein single arterial CABG (SABG). We examined the hypothesis that this multi-arterial survival advantage persists irrespective of left ventricular ejection fraction (LVEF). METHODS We retrospectively analyzed the primary, non-salvage multi-graft CABG experience (n = 11,261; 64.4 ± 10.4 years, 70.4% men) from 2 institutions (1995 to 2011). Risk-adjusted 15-year survival was pairwise compared for the MABG versus SABG grafting approaches within 3 LVEF subcohorts (>0.50, n = 4,833 [44% MABG]; 0.36 to 0.50, n = 4,465 [39% MABG]; and ≤ 0.35, n = 1,963 [35% MABG]) using propensity-matched and covariate adjusted Cox regression (all patients) comparisons. RESULTS Propensity matching yielded 1,317 (LVEF > 0.50), 1,179 (LVEF, 0.36 to 0.50), and 470 (LVEF ≤ 0.35) well-matched grafting method pairs. Acute perioperative mortality was equivalent between MABG and SABG within each LVEF group, but increased with decreasing LVEF. MABG was uniformly associated with better 15-year survival compared with SABG for all LVEF categories. The associated matched-adjusted hazard ratios (95% confidence intervals) were consistent across EF groups at 0.79 (0.68 to 0.93), 0.80 (0.69 to 0.93), and 0.82 (0.66 to 1.0), respectively. Covariate adjusted HR in all patients concurred with matched results. CONCLUSIONS MABG results in significantly enhanced long-term survival compared with LITA/SVG SABG regardless of the degree of LV dysfunction. These results favor MABG as the therapy of choice in patients with LV dysfunction.
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Affiliation(s)
- Thomas A Schwann
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Laila Al-Shaar
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| | - Robert F Tranbaugh
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | | | - Darryl M Hoffman
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Charles M Geller
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Milo C Engoren
- Mercy Saint Vincent Medical Center, Toledo, Ohio; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mark R Bonnell
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Robert H Habib
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon; Department of Surgery, Mount Sinai Beth Israel Medical Center, New York, New York.
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Shavadia J, Norris CM, Graham MM, Verma S, Ali I, Bainey KR. Symptomatic graft failure and impact on clinical outcome after coronary artery bypass grafting surgery: Results from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry. Am Heart J 2015; 169:833-40. [PMID: 26027621 DOI: 10.1016/j.ahj.2015.02.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 02/24/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND In contemporary coronary artery bypass graft (CABG) surgery, the association between symptomatic graft failure (GF) and long-term clinical outcome remains unclear. We sought to identify the clinical characteristics and outcomes of GF in symptomatic patients requiring cardiac catheterization within 1 year of CABG surgery. METHODS Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease registry, 5,276 patients undergoing CABG surgery from September 2002 to August 2011 were identified. Clinical outcomes in patients with symptomatic GF were observed. Predictors of GF were analyzed at a graft level, whereas long-term survival was assessed at a patient level. A propensity score matching technique was used to adjust for baseline characteristics. RESULTS Of our CABG cohort, 5.3% (281 patients [285 arterial and 653 vein grafts]) required symptom based coronary angiography within 1 year of CABG surgery. Acute coronary syndrome was the most common presentation (64.4%). At angiography, 27.0% (77/285) of arterial and 34.5% (225/653) of vein grafts were occluded. Respectively, arterial and vein GFs were treated as follows: percutaneous coronary intervention 61.0% versus 41.8%, re-do CABG 9.1% versus 0%, and medically without intervention 29.9% versus 58.2%. A strong trend toward reduced patient survival was noted with "arterial graft failure" (arterial ± vein GF) compared to "vein graft failure only" (no arterial GF) (adjusted hazard ratio 2.2, 95% CI 0.98-5.0, P = .056). CONCLUSION Although the rate of cardiac catheterization within 1 year of CABG is infrequent, these patients exhibit high GF rates and commonly present with an acute coronary syndrome. In addition, "arterial graft failure" compared to "vein graft failure only" confers a higher risk of adverse long-term survival.
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Burns DJ, Swinamer SA, Fox SA, Romsa J, Vezina W, Akincioglu C, Warrington J, Guo LR, Chu MW, Quantz MA, Novick RJ, Kiaii B. Long-term Patency of Endoscopically Harvested Radial Arteries: From a Randomized Controlled Trial. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel J.P. Burns
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Stuart A. Swinamer
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie A. Fox
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Jonathan Romsa
- Division of Nuclear Medicine, Department of Medical Imaging, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - William Vezina
- Division of Nuclear Medicine, Department of Medical Imaging, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Cigdem Akincioglu
- Division of Nuclear Medicine, Department of Medical Imaging, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - James Warrington
- Division of Nuclear Medicine, Department of Medical Imaging, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Lin-Rui Guo
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Michael W.A. Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Mackenzie A. Quantz
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Richard J. Novick
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
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Gaudino M, Crea F, Cammertoni F, Massetti M. The radial artery: a forgotten conduit. Ann Thorac Surg 2015; 99:1479-85. [PMID: 25725926 DOI: 10.1016/j.athoracsur.2014.11.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/13/2014] [Accepted: 11/24/2014] [Indexed: 10/23/2022]
Abstract
We reviewed the published literature on the clinical and angiographic outcome of radial artery (RA) grafts and on the comparison between the RA and the other conduits used in coronary operations. The RA is a better graft than the saphenous vein and comparable to the right internal thoracic artery (RITA); moreover, the RA seems a better choice than the RITA in patients at risk of sternal or pulmonary complications. We conclude that the RA should be preferred to the saphenous vein and considered at least equivalent to the RITA as the second conduit during every elective coronary artery bypass procedure.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | | | - Massimo Massetti
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
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Technical Issues in the Use of the Radial Artery as a Coronary Artery Bypass Conduit. Ann Thorac Surg 2014; 98:2247-54. [DOI: 10.1016/j.athoracsur.2014.07.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/06/2014] [Accepted: 07/09/2014] [Indexed: 11/20/2022]
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31
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Taggart DP. Contemporary coronary artery bypass grafting. Front Med 2014; 8:395-8. [PMID: 25363396 DOI: 10.1007/s11684-014-0374-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 09/12/2014] [Indexed: 11/25/2022]
Abstract
Current evidence clearly demonstrates that coronary artery bypass grafting (CABG) remains the "gold standard" treatment for most patients with multivessel and left main stem disease. This article summarizes the relevant evidence basis demonstrating that CABG, in comparison to stenting, reduces mortality and subsequent myocardial infarction and the need for repeat revascularization. The article also describes the evidence basis to support the use of more arterial grafts during CABG and the current role of off-pump CABG.
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Affiliation(s)
- David P Taggart
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK,
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Settepani F, Cappai A, Citterio E, Melis LCM, Tarelli G. Unusable radial artery for severe atherosclerosis in a young patient. J Card Surg 2014; 30:263-4. [PMID: 24827760 DOI: 10.1111/jocs.12356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a young diabetic patient who was found to have an unusable radial artery (RA) for coronary bypass grafting because of severe and diffuse atherosclerosis. Techniques to diagnose RA conduits, which are not usable for coronary surgery, are reviewed.
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Affiliation(s)
- Fabrizio Settepani
- Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano (MI), Italy
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