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Oliveira GMMD, Almeida MCCD, Rassi DDC, Bragança ÉOV, Moura LZ, Arrais M, Campos MDSB, Lemke VG, Avila WS, Lucena AJGD, Almeida ALCD, Brandão AA, Ferreira ADDA, Biolo A, Macedo AVS, Falcão BDAA, Polanczyk CA, Lantieri CJB, Marques-Santos C, Freire CMV, Pellegrini D, Alexandre ERG, Braga FGM, Oliveira FMFD, Cintra FD, Costa IBSDS, Silva JSN, Carreira LTF, Magalhães LBNC, Matos LDNJD, Assad MHV, Barbosa MM, Silva MGD, Rivera MAM, Izar MCDO, Costa MENC, Paiva MSMDO, Castro MLD, Uellendahl M, Oliveira Junior MTD, Souza OFD, Costa RAD, Coutinho RQ, Silva SCTFD, Martins SM, Brandão SCS, Buglia S, Barbosa TMJDU, Nascimento TAD, Vieira T, Campagnucci VP, Chagas ACP. Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023. Arq Bras Cardiol 2023; 120:e20230303. [PMID: 37556656 PMCID: PMC10382148 DOI: 10.36660/abc.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Denise Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | - Fabiana Goulart Marcondes Braga
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Lara Terra F Carreira
- Cardiologia Nuclear de Curitiba, Curitiba, PR - Brasil
- Hospital Pilar, Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Marly Uellendahl
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | - Ricardo Quental Coutinho
- Faculdade de Ciências Médicas da Universidade de Pernambuco (UPE), Recife, PE - Brasil
- Hospital Universitário Osvaldo Cruz da Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | | | - Sílvia Marinho Martins
- Pronto Socorro Cardiológico de Pernambuco da Universidade de Pernambuco (PROCAPE/UPE), Recife, PE - Brasil
| | | | - Susimeire Buglia
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Thais Vieira
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Rede D'Or, Aracaju, SE - Brasil
- Hospital Universitário da Universidade Federal de Sergipe (UFS), Aracaju, SE - Brasil
| | | | - Antonio Carlos Palandri Chagas
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Centro Universitário Faculdade de Medicina ABC, Santo André, SP - Brasil
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Tran-Nguyen N, Condemi F, Yan A, Fremes S, Triverio P, Jimenez-Juan L. Wall Shear Stress Differences Between Arterial and Venous Coronary Artery Bypass Grafts One Month After Surgery. Ann Biomed Eng 2022; 50:1882-1894. [PMID: 35881267 DOI: 10.1007/s10439-022-03007-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/02/2022] [Indexed: 12/30/2022]
Abstract
Although coronary artery bypass graft (CABG) surgery is a well-established intervention, graft failure can occur, and the underlying mechanisms remain incompletely understood. The purpose of this prospective study is to utilize computational fluid dynamics (CFD) to investigate how graft hemodynamics one month post surgery may vary among graft types, which have different long-term patency rates. Twenty-four grafts from 10 participants (64.6 ± 8.5 years, 9 men) were scanned with coronary CT angiography and 4D flow MRI one month after CABG surgery. Grafts included 10 left internal mammary arteries (LIMA), 3 radial arteries (RA), and 11 saphenous vein grafts (SVG). Image-guided CFD was used to quantify blood flow rate and wall area exposed to abnormal wall shear stress (WSS). Arterial grafts had a lower abnormal WSS area than venous grafts (17.9% vs. 70.1%; p = 0.001), and a similar trend was observed for LIMA vs. SVG (13.8% vs. 70.1%; p = 0.001). Abnormal WSS area correlated positively to lumen diameter (p < 0.001) and negatively to flow rate (p = 0.001). This CFD study is the first of its kind to prospectively reveal differences in abnormal WSS area 1 month post surgery among CABG types, suggesting that WSS may influence the differential long-term graft failure rates observed among these groups.
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Affiliation(s)
- Nhien Tran-Nguyen
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
| | | | - Andrew Yan
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen Fremes
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Piero Triverio
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
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3
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Beerkens FJ, Claessen BE, Mahan M, Gaudino MFL, Tam DY, Henriques JPS, Mehran R, Dangas GD. Contemporary coronary artery bypass graft surgery and subsequent percutaneous revascularization. Nat Rev Cardiol 2022; 19:195-208. [PMID: 34611327 DOI: 10.1038/s41569-021-00612-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/09/2022]
Abstract
Patients who have undergone coronary artery bypass graft (CABG) surgery are susceptible to bypass graft failure and progression of native coronary artery disease. Although the saphenous vein graft (SVG) was traditionally the most-used conduit, arterial grafts (including the left and right internal thoracic arteries and the radial artery) have improved patency rates. However, the need for secondary revascularization remains common, and percutaneous coronary intervention (PCI) has become the most common modality of secondary revascularization after CABG surgery. Procedural characteristics and clinical outcomes differ considerably from those associated with PCI in patients without previous CABG surgery, owing to altered coronary anatomy and differences in conduit pathophysiology. In particular, SVG PCI carries an increased risk of complications, and operators are shifting their focus towards embolic protection strategies and complex native-vessel interventions, increasingly using SVGs as conduits to facilitate native-vessel PCI rather than pursuing SVG PCI. In this Review, we discuss the differences in conduit pathophysiology, changes in CABG surgery techniques, and the latest evidence in terms of PCI in patients with previous CABG surgery, with a particular emphasis on safety and long-term efficacy. We explore the subject of contemporary CABG surgery and subsequent percutaneous revascularization in this complex patient population.
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Affiliation(s)
- Frans J Beerkens
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bimmer E Claessen
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marielle Mahan
- Department of Ophthalmology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Derrick Y Tam
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - José P S Henriques
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Roxana Mehran
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George D Dangas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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4
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Hou X, Zhang K, Liu T, Li Y, Zhao Y, Song B, Huang Z, Zheng J, Dong R. No-Touch Sequential Saphenous Venous Harvesting Technique in Off-Pump Bypass Surgery: A Retrospective Study. Front Cardiovasc Med 2022; 8:804739. [PMID: 35141293 PMCID: PMC8818706 DOI: 10.3389/fcvm.2021.804739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background In the mid-1990s, the Swedish expert team proposed saphenous vein graft (SVG) harvesting with pedicle tissue. The short-term and long-term patency rates of the great saphenous vein obtained by the no-touch (NT) were higher than those obtained by the conventional (CON). In the past, NT harvesting was mainly used in on-pump coronary artery bypass grafting (CABG), and vein grafts were mostly single vein grafts. In this study, we retrospectively analyzed the safety and effectiveness of sequential vein grafts using NT harvesting in off-pump CABG. Methods From 2017 to 2019, a total of 505 patients were included in the study. There were 150 patients in the NT group and 355 patients in the CON group. After applying propensity score matching (1:1 matching), 148 patients were included in each group. Baseline data, graft patency, post-operative complications, leg wound complications and 1-year major adverse cardiac and cerebrovascular events (MACCEs) were compared between the two groups. Results There was no significant difference in the patency rate of sequential venous grafts between the two groups 1 year after the operation either before [NT: 7.1% (10/141) vs. CON: 11.5% (38/331), p = 0.149) or after matching (NT: 7.1% (10/140) vs. CON: 7.3% (9/124), p = 0.971]. There was no significant difference in the composite clinical endpoint between the two groups either before [NT: 3 (2.3%) vs. CON: 9 (2.8%), p = 1.000] or after matching [NT: 3 (2.3%) vs. CON: 3 (2.5%), p = 1.000]. There were differences in leg wound complications between the two groups both before [NT: 9 (6.9%) vs. CON: 6 (1.9%), p = 0.007] and after matching [NT: 9 (6.9%) vs. CON: 2 (1.7%), p = 0.043]. Conclusions The application of the NT harvesting in off-pump CABG with sequential vein grafts is safe and effective. NT method has disadvantages in leg wound.
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Gib MC, Zanirati T, Simas P, Wender OCB, Cavazzola LT. Comparison of the internal thoracic artery flow dissected by video endoscopy or conventional technique. Acta Cir Bras 2021; 36:e360803. [PMID: 34644771 PMCID: PMC8516423 DOI: 10.1590/acb360803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose: To compare the blood flow in the internal thoracic artery when dissected
endoscopically in a conventional manner, in addition to develop a reliable
experimental training model for the surgical team. Methods: Paired experimental study. Ten pigs were operated and had both internal
thoracic arteries dissected, the right with a conventional technique and the
left by video endoscopy. The main outcomes to be studied were flow, length,
and time of dissection of each vessel. Results: Blood flow measurements were performed with mean heart rate of 100 ± 16 bpm
and mean arterial pressure of 89.7 ± 13 mm Hg. The mean blood flow of
endoscopic dissection of the internal thoracic artery was 170.2 ± 66.3
mL/min and by direct view was 180.8 ± 70.5 (p = 0.26). Thus, there was no
statistically significant difference between the flows, showing no
inferiority between the methods. Conclusions: The minimally invasive dissection of the internal thoracic artery was shown
to be not inferior to the dissection by open technique in relation to the
blood flow in the present experimental model. In addition, the model that we
replicated was shown to be adequate for the development of the learning
curve and improvement of the endoscopic abilities.
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6
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Myocardial Revascularization Surgery: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol 2021; 78:365-383. [PMID: 34294272 DOI: 10.1016/j.jacc.2021.04.099] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/20/2022]
Abstract
Coronary artery bypass grafting (CABG) was introduced in the 1960s as the first procedure for direct coronary artery revascularization and rapidly became one of the most common surgical procedures worldwide, with an overall total of more than 20 million operations performed. CABG continues to be the most common cardiac surgical procedure performed and has been one of the most carefully studied therapies. Best CABG techniques, optimal bypass conduits, and appropriate patient selection have been rigorously tested in landmark clinical trials, some of which have resolved controversy and most of which have stoked further debate and trials. The evolution of CABG cannot be properly portrayed without presenting it in the context of the parallel development of percutaneous coronary intervention. In this Historical Perspective, we a provide a broad overview of the history of coronary revascularization with a focus on the foundations, evolution, best evidence, and future directions of CABG.
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McNichols B, Spratt JR, George J, Rizzi S, Manning EW, Park K. Coronary Artery Bypass: Review of Surgical Techniques and Impact on Long-Term Revascularization Outcomes. Cardiol Ther 2021; 10:89-109. [PMID: 33515370 PMCID: PMC8126527 DOI: 10.1007/s40119-021-00211-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 12/14/2022] Open
Abstract
Coronary revascularization for multivessel disease remains a common and costly source of hospitalizations in the United States. Surgical techniques influence outcomes for coronary bypass and also affect the need for percutaneous coronary intervention in the future. As more radial access has been used for coronary angiography, consideration for use of the radial artery as a surgical conduit remains unclear. Saphenous vein grafts are commonly used for coronary bypass, however long-term patency remains suboptimal, and is also associated with a higher risk of adverse events with percutaneous coronary intervention. Thus, understanding the interplay between coronary bypass techniques and percutaneous coronary intervention has become increasingly important.
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Affiliation(s)
- Brian McNichols
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - John R Spratt
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jerin George
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Scott Rizzi
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Eddie W Manning
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
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8
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 4027] [Impact Index Per Article: 1006.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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9
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Jovin DG, Katlaps GJ, Sumption KF. Coronary artery bypass graft markers: history, usage, and effects. Gen Thorac Cardiovasc Surg 2020; 68:453-458. [DOI: 10.1007/s11748-020-01325-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/21/2020] [Indexed: 01/09/2023]
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10
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Valley TS, Iwashyna TJ, Cooke CR, Sinha SS, Ryan AM, Yeh RW, Nallamothu BK. Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study. BMJ 2019; 365:l1927. [PMID: 31164326 PMCID: PMC6547840 DOI: 10.1136/bmj.l1927] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI). DESIGN Retrospective cohort study. SETTING 1727 acute care hospitals in the United States. PARTICIPANTS Medicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015. MAIN OUTCOME MEASURE 30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI. RESULTS The analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval -11.9 to -0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (-0.9 to 3.4) percentage points). CONCLUSIONS ICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.
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Affiliation(s)
- Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Theodore J Iwashyna
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Colin R Cooke
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Shashank S Sinha
- Cardiac Intensive Care Unit, Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, VA, USA
- Cardiovascular Critical Care Research, Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, VA, USA
| | - Andrew M Ryan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Brahmajee K Nallamothu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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11
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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12
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Walters D, Patel M, Penny W. Saphenous Vein Graft Aneurysm: A Case-Based Review of Percutaneous Management. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1190-1195. [PMID: 30850317 DOI: 10.1016/j.carrev.2019.01.029] [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: 12/26/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 11/25/2022]
Abstract
SVG aneurysms are relatively rare clinical entities most often encountered discovered as an incidental finding in patients with prior CABG surgery. There is a substantial risk of complications including rupture and death, thus surgical or percutaneous management may be considered in particular in symptomatic patients. Here, three cases are presented highlighting various percutaneous management options and considerations, including covered stent placement, coil occlusion, and a combined approach with the use of a peripheral covered stent. Intervention within this patient population lacks large population long-term outcomes and as such should be performed carefully by experienced operators, often the guidance of a Heart Team based approach.
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Affiliation(s)
- Daniel Walters
- University of California, San Diego, United States of America.
| | - Mitul Patel
- University of California, San Diego, United States of America.
| | - William Penny
- University of California, San Diego, United States of America.
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13
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Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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14
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Squiers JJ, Mack MJ. Coronary artery bypass grafting-fifty years of quality initiatives since Favaloro. Ann Cardiothorac Surg 2018; 7:516-520. [PMID: 30094216 DOI: 10.21037/acs.2018.05.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery bypass grafting (CABG) remains one of the most commonly performed major surgical procedures worldwide and the most common procedure performed by cardiac surgeons. Rene Favaloro is widely credited with recognizing the true potential of CABG and subsequently popularizing the technique in a broad manner. Since the era of Favaloro in the late 1960s, the evolution of CABG can be understood through a series of quality initiatives that have defined which patients can benefit from the procedure and via which technique(s) they will derive the greatest benefit. Herein, we will review some of the key developments in CABG over the last 50 years with a focus on ongoing quality initiatives that will continue to refine the optimal applications and outcomes of CABG for the next 50 years.
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Affiliation(s)
- John J Squiers
- Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor Scott & White Health, TX, USA
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15
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Attia T, Koch CG, Houghtaling PL, Blackstone EH, Sabik EM, Sabik JF. Does a similar procedure result in similar survival for women and men undergoing isolated coronary artery bypass grafting? J Thorac Cardiovasc Surg 2016; 153:571-579.e9. [PMID: 28108066 DOI: 10.1016/j.jtcvs.2016.11.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/17/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To (1) identify sex-related differences in risk factors and revascularization strategies for patients undergoing coronary artery bypass grafting (CABG), (2) assess whether these differences influenced early and late survival, and (3) determine whether clinical effectiveness of the same revascularization strategy was influenced by sex. METHODS From January 1972 to January 2011, 57,943 adults-11,009 (19%) women-underwent primary isolated CABG. Separate models for long-term mortality were developed for men and women, followed by assessing sex-related differences in strength of risk factors (interaction terms). RESULTS Incomplete revascularization was more common in men than women (26% vs 22%, P < .0001), but women received fewer bilateral internal thoracic artery (ITA) grafts (4.8% vs 12%; P < .0001) and fewer arterial grafts (68% vs 70%; P < .0001). Overall, women had lower survival than men after CABG (65% and 31% at 10 and 20 years, respectively, vs 74% and 41%; P ≤ .0001), even after risk adjustment. Incomplete revascularization was associated equally (P > .9) with lower survival in both sexes. Single ITA grafting was associated with equally (P = .3) better survival in women and men. Although bilateral ITA grafting was associated with better survival than single ITA grafting, it was less effective in women-11% lower late mortality (hazard ratio, 0.89 [0.77-1.022]) versus 27% lower in men (hazard ratio, 0.73 [0.69-0.77]; P = .01). CONCLUSIONS Women on average have longer life expectancies than men but not after CABG. Every attempt should be made to use arterial grafting and complete revascularization, but for unexplained reasons, sex-related differences in effectiveness of bilateral arterial grafting were identified.
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Affiliation(s)
- Tamer Attia
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Colleen G Koch
- Department of Cardiothoracic Anesthesia, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Penny L Houghtaling
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ellen Mayer Sabik
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph F Sabik
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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Gansera B. Postoperative Ergebnisse nach A.-thoracica-interna-Bypass. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-016-0098-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McNeely C, Markwell S, Vassileva C. Trends in Patient Characteristics and Outcomes of Coronary Artery Bypass Grafting in the 2000 to 2012 Medicare Population. Ann Thorac Surg 2016; 102:132-8. [DOI: 10.1016/j.athoracsur.2016.01.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/14/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
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Affiliation(s)
- John H Alexander
- From the Duke Clinical Research Institute and the Division of Cardiology, Department of Medicine (J.H.A.), and the Division of Cardiothoracic Surgery, Department of Surgery (P.K.S.), Duke Health, Durham, NC
| | - Peter K Smith
- From the Duke Clinical Research Institute and the Division of Cardiology, Department of Medicine (J.H.A.), and the Division of Cardiothoracic Surgery, Department of Surgery (P.K.S.), Duke Health, Durham, NC
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19
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Harskamp RE, Alexander JH, Ferguson TB, Hager R, Mack MJ, Englum B, Wojdyla D, Schulte PJ, Kouchoukos NT, de Winter RJ, Gibson CM, Peterson ED, Harrington RA, Smith PK, Lopes RD. Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes: Insights From the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV Trial. Circulation 2015; 133:131-8. [PMID: 26647082 DOI: 10.1161/circulationaha.115.015549] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The internal mammary artery (IMA) is the preferred conduit for bypassing the left anterior descending (LAD) artery in patients undergoing coronary artery bypass grafting. Systematic evaluation of the frequency and predictors of IMA failure and long-term outcomes is lacking. METHODS AND RESULTS The Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial participants who underwent IMA-LAD revascularization and had 12- to 18-month angiographic follow-up (n=1539) were included. Logistic regression with fast false selection rate methods was used to identify characteristics associated with IMA failure (≥75% stenosis). The relationship between IMA failure and long-term outcomes, including death, myocardial infarction, and repeat revascularization, was assessed with Cox regression. IMA failure occurred in 132 participants (8.6%). Predictors of IMA graft failure were LAD stenosis <75% (odds ratio, 1.76; 95% confidence interval, 1.19-2.59), additional bypass graft to diagonal branch (odds ratio, 1.92; 95% confidence interval, 1.33-2.76), and not having diabetes mellitus (odds ratio, 1.82; 95% confidence interval, 1.20-2.78). LAD stenosis and additional diagonal graft remained predictive of IMA failure in an alternative model that included angiographic failure or death before angiography as the outcome. IMA failure was associated with a significantly higher incidence of subsequent acute (<14 days of angiography) clinical events, mostly as a result of a higher rate of repeat revascularization. CONCLUSIONS IMA failure was common and associated with higher rates of repeat revascularization, and patients with intermediate LAD stenosis or with an additional bypass graft to the diagonal branch had increased risk for IMA failure. These findings raise concerns about competitive flow and the benefit of coronary artery bypass grafting in intermediate LAD stenosis without functional evidence of ischemia. CLINICAL TRIAL REGISTRATION URL: http:/www.clinicaltrials.gov. Unique identifier: NCT00042081.
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Affiliation(s)
- Ralf E Harskamp
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - John H Alexander
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - T Bruce Ferguson
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Rebecca Hager
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Michael J Mack
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Brian Englum
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Daniel Wojdyla
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Phillip J Schulte
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Nicholas T Kouchoukos
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Robbert J de Winter
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - C Michael Gibson
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Eric D Peterson
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Robert A Harrington
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Peter K Smith
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.)
| | - Renato D Lopes
- From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.E.H., J.H.A., B.E., D.W., P.J.S., E.D.P., P.K.S., R.D.L.); Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands (R.E.H., R.J.d.W.); East Carolina University, Greenville, NC (T.B.F.); North Carolina State University, Raleigh (R.H.); Cardiopulmonary Research Science and Technology Institute, Dallas, TX (M.J.M.); Missouri Baptist Medical Center, St Louis (N.T.K.); PERFUSE Angiographic Laboratory, Boston, MA (C.M.G.); and Department of Medicine, Stanford University, Stanford, CA (R.A.H.).
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Kurlansky P. Internal thoracic artery grafting in the elderly and the challenge to conventional wisdom. J Thorac Cardiovasc Surg 2015; 150:900-1. [PMID: 26424371 DOI: 10.1016/j.jtcvs.2015.07.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Paul Kurlansky
- Department of Surgery, Columbia University, New York, NY.
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21
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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Immediate and Long-Term Results of Drug-Eluting Stents in Mammary Artery Grafts. Am J Cardiol 2015; 116:1695-9. [PMID: 26433270 DOI: 10.1016/j.amjcard.2015.08.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/25/2015] [Accepted: 08/25/2015] [Indexed: 11/22/2022]
Abstract
UNLABELLED Percutaneous intervention of a coronary graft is the treatment of choice when the graft fails. The objective is to report the long-term results of drug-eluting stents (DES) in mammary artery grafts (MAG). Patients who had been treated with DES for MAG in 27 centers were selected. The baseline and procedural clinical data were included prospectively, and the follow-up was performed with the patients, families, and medical records. Two hundred and sixty-eight patients were included: age 65.5 ± 10.1 years, diabetes 47.8%, ejection fraction 55.5 ± 14.9%. INDICATION stable angina 28.4%, unstable angina 38.1%, non-ST-elevation myocardial infarction 21.6%, ST-elevation myocardial infarction 5.3%, and heart failure 6.7%; 1.19 ± 0.59 stents/patient were implanted measuring 18.8 ± 8.8 mm in length and 2.68 ± 0.35 mm in diameter. Rapamycin was used in 78 cases (29.1%), paclitaxel in 77 (28.7%), everolimus in 70 (26.1%), zotarolimus in 34 (12.7%), and biolimus in 9 (3.4%). All cases were successful except for 1 in which the patient died 30 minutes after the procedure. There were no other inhospital events. After a follow-up of 41 months (Q25: 23.7 to Q75: 57.8), 24 patients (9%) died of heart-related causes and 20 (7.5%) of noncardiac causes. Repeat revascularization was necessary in 31 cases, and in 1 additional patient, there was total occlusion, which was not treated. These 32 patients represented 11.9% of the total. In conclusion, the implantation of DES in MAG shows very high procedural success and also low long-term event rates.
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Parasca CA, Head SJ, Mohr FW, Mack MJ, Morice MC, Holmes DR, Feldman TE, Colombo A, Dawkins KD, Serruys PW, Kappetein AP. The impact of a second arterial graft on 5-year outcomes after coronary artery bypass grafting in the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery Trial and Registry. J Thorac Cardiovasc Surg 2015; 150:597-606.e2. [PMID: 26055439 DOI: 10.1016/j.jtcvs.2015.05.010] [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: 12/04/2014] [Revised: 04/09/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite various evidence supporting the advantages of multiple arterial grafting, inconsistencies in use of the procedure have resulted in high variability in the acceptance and practice of arterial grafting. The purpose of this study was to assess the effects of an arterial versus venous second grafts on outcomes at 5-year follow-up in the coronary artery bypass grafting population from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. METHODS Patients (n = 1419) with an arterial graft to the left anterior descending artery and ≥1 other graft were included and divided according to the second graft's type: 2nd-graft-arterial group (n = 456) and 2nd-graft-venous group (n = 963). Five-year outcomes were compared between subgroups. Event rates were estimated with Kaplan-Meier analyses. Propensity-score matching was used, to control for selection bias due to nonrandom group assignment in a 1:1 manner, resulting in 432 pairs with balanced baseline characteristics. RESULTS In unmatched groups, the 2nd-graft-arterial group had significantly lower rates of death (8.9% vs 13.1%; P = .02), and composite safety endpoint of death/stroke/myocardial infarction (13.3% vs 18.7%; P = .02), compared with the 2nd-graft-venous group. The rate of major adverse cardiac or cerebrovascular events was similar between groups (22.9% vs 25.5%; P = .30), because it includes the rate of repeat revascularization (12.6% in the 2nd-graft-arterial group vs 9.6% in the 2nd-graft-venous group; P = .10). After propensity-score matching, no statistically significant differences were found between groups. CONCLUSIONS This study reveals comparable 5-year outcomes with arterial and venous conduits as second grafts after an arterial graft anastomosed to the left anterior descending artery. This study demonstrates the multi-institutional variation in patient selection and operator technique with regard to arterial revascularization, although extended follow-up beyond 5 years is required to estimate its impact on long-term outcomes. CLINICAL TRIAL NUMBER NCT00114972.
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Affiliation(s)
- Catalina A Parasca
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Friedrich W Mohr
- Department of Cardiac Surgery, Herzzentrum Universität Leipzig, Leipzig, Germany
| | - Michael J Mack
- The Heart Hospital, Baylor Health Care Systems, Plano, Tex
| | - Marie-Claude Morice
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | - David R Holmes
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minn
| | - Ted E Feldman
- Department of Cardiology, North Shore University Health System, Evanston, Ill
| | - Antonio Colombo
- Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Patrick W Serruys
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Kleszczewski T, Buzun L, Lisowska A, Modzelewska B. Potassium induced contraction of the internal thoracic artery in vitro is time related: the potential consequences in the analysis of the mechanism of the spasm after coronary artery bypass grafting and in the analysis of the results of in vitro studies. Heart Vessels 2015; 31:616-21. [PMID: 25939631 PMCID: PMC4820489 DOI: 10.1007/s00380-015-0684-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
The aim of the present study was to examine how, under in vitro conditions, the human left internal thoracic artery (LITA) reacts to contractile agonist:potassium chloride (KCL) as a function of time, as well as to examine whether a change in the LITA reactivity can correlate with the occurrence of the refractory vascular spasm (RVS). Distal segments of LITA obtained from 33 patients aged 38–73, at the time of routine coronary artery surgical revascularization (CABG). Contractile response to 80 mmol K+ was recorded under isometric conditions. In 16 (48,5 %) LITA segments, contractile reaction to K+ after experiments ranging 1–10 h were registered. No contractile response even after 10 h of incubation was observed in 17 (51.5 %) LITA segments. Between 120 and 300 min after the beginning of the experiment, the reaction was maximum and amounted up to 300 % control reaction, then decreased. First, with respect to in vitro research isolated by LITA rings, while analyzing the results of the research, one should take into consideration the possibility that during the research, the functional state of the tissues changes and in particular its sensitivity to depolarization of the cell membrane. Second, the change in the sensitivity to depolarization of the cell membrane of the smooth muscles’ LITA might be the potential mechanism causing the occurrence of the postoperative spasm after the CABG treatment.
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Affiliation(s)
- Tomasz Kleszczewski
- />Department of Biophysics, Medical University of Bialystok, ul. Mickiewicza 2A, 15-222 Białystok, Poland
| | - Leszek Buzun
- />Department of Cardiac Surgery, Medical University of Białystok, ul. M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland
- />Department of Cardiac Surgery, The Regional Specialist Hospital in Olsztyn Poland, ul. Żołnierska 18, 10-561 Olsztyn, Poland
| | - Anna Lisowska
- />Department of Cardiology, Medical University of Białystok, ul. M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland
| | - Beata Modzelewska
- />Department of Biophysics, Medical University of Bialystok, ul. Mickiewicza 2A, 15-222 Białystok, Poland
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Head SJ, Kappetein AP, Kolh P. Bilateral internal thoracic artery use: will another retrospective study ever strengthen the prospect? Eur J Cardiothorac Surg 2014; 47:709-11. [PMID: 25312528 DOI: 10.1093/ejcts/ezu332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Philippe Kolh
- Department of Cardiothoracic Surgery, University Hospital of Liège, Liège, Belgium
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3323] [Impact Index Per Article: 332.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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