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Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg JM, Van Belle E, Van Craenenbroeck EM, Vidal-Perez R, Winther S. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024; 45:3415-3537. [PMID: 39210710 DOI: 10.1093/eurheartj/ehae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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El-Andari R, Bozso SJ, Fialka NM, Kang JJH, Hassanabad AF, Nagendran J. Alternative Approaches to Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention, How Do They Compare?: A Systematic Review and Meta-Analysis. Cardiol Rev 2024; 32:392-401. [PMID: 36688825 DOI: 10.1097/crd.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Coronary artery disease (CAD) is a leading cause of mortality worldwide. Severe symptomatic CAD is treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Alternative CABG (ACABG) approaches including thoracotomy, off-pump, total endoscopic, and robotic-assisted CABG are increasing in prevalence to address the increased early risk of CABG. This systematic review and meta-analysis aims to review the contemporary literature comparing outcomes after ACABG and PCI. Pubmed, Medline, and Embase were systematically searched by 2 authors for articles comparing the outcomes after ACABG and PCI. A total of 1154 articles were screened, and 11 were included in this review. The RevMan 5.4 software was used to perform a meta-analysis of the pooled data. Individual studies found rates of long-term survival, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction (MI), and repeat revascularization either favored ACABG or did not differ significantly. Pooled estimates of the compiled data identified rates of MACCE, MI, and repeat revascularization favored ACABG. The results of this review demonstrated the favorable rates of long-term mortality, MACCE, MI, and repeat revascularization for ACABG in addition to similar short-term mortality and stroke when compared with PCI. Advancement of both CABG and PCI continues to improve patient outcomes. With the increasing prevalence of ACABG, similar studies will need to be undertaken with further direct comparisons between ACABG and PCI. Finally, hybrid revascularization should continue to be explored for its combined benefits of long-term outcomes, short-term safety, and ability to achieve complete revascularization.
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Affiliation(s)
- Ryaan El-Andari
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Sabin J Bozso
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Nicholas M Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jimmy J H Kang
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Jeevan Nagendran
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Torre T, Pozzoli A, Valgimigli M, Leo LA, Toto F, Muretti M, Birova S, Ferrari E, Pedrazzini G, Demertzis S. Minimally Invasive Isolated and Hybrid Surgical Revascularization for Multivessel Coronary Disease: A Single-Center Long-Term Follow-Up. J Pers Med 2024; 14:528. [PMID: 38793110 PMCID: PMC11122097 DOI: 10.3390/jpm14050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Some evidence suggests that surgical minimally invasive (MIDCAB) and hybrid coronary revascularization (HCR) are safe and potentially effective at short-term follow-up. Data on long-term outcomes are more limited and inconclusive. METHODS Between February 2013 and December 2023, a total of 1997 patients underwent surgical coronary artery revascularization at our institution, of whom, 92 (4.7%) received left anterior mini-thoracotomy access (MIDCAB), either isolated (N = 78) or in combination with percutaneous coronary intervention (N = 14, HCR group). RESULTS After a median follow-up of 75 months (range 3.1: 149 months), cardiac mortality was 0% while overall mortality was 3%, with one in-hospital mortality and two additional late deaths. Conversion to sternotomy happened in two patients (2.1%), and surgical re-explorations occurred in five patients (4.6%), of whom three for bleeding and two for graft failure. All patients received left internal mammary (LIMA) to left anterior descending artery (LAD) grafting (100%). In the HCR group, 10 patients (72%) showed percutaneous revascularization (PCI) after MIDCAB, showing PCI on a mean of 1.6 ± 0.6 vessels and implanting 2.1 ± 0.9 drug-eluting stents. CONCLUSIONS MIDCAB, in isolation or in association with hybrid coronary revascularization, is associated with encouraging short- and long-term results in selected patients discussed within a dedicated heart-team.
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Affiliation(s)
- Tiziano Torre
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Marco Valgimigli
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Laura Anna Leo
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
| | - Francesca Toto
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Mirko Muretti
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Sara Birova
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Enrico Ferrari
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Faculty of Medicine, University of Zurich (UZH), 8032 Zurich, Switzerland
| | - Giovanni Pedrazzini
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Stefanos Demertzis
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Faculty of Medicine, University of Bern, 3010 Bern, Switzerland
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Alozie A, Öner A, Löser B, Dohmen PM. Minimally invasive direct coronary artery bypass and percutaneous coronary intervention followed by transcatheter aortic valve implantation: A promising concept in high-risk octogenarians. Ann Card Anaesth 2023; 26:143-148. [PMID: 37706377 PMCID: PMC10284489 DOI: 10.4103/aca.aca_165_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/20/2022] [Accepted: 05/06/2022] [Indexed: 09/15/2023] Open
Abstract
Objectives In this article, we present our initial clinical experience with staged minimally invasive direct coronary bypass (MIDCAB), percutaneous coronary intervention (PCI), and transcatheter aortic valve implantation (TAVI) in high-risk octogenarians (Hybrid). Background The use of percutaneous techniques for managing structural heart diseases, especially in elderly high-risk patients, has revolutionized the treatment of structural heart diseases. These procedures are present predominantly being offered as isolated interventions. The feasibility, clinical benefit, and outcomes of combining these techniques with MIDCAB have not been sufficiently explored and have subsequently been underreported in the contemporary literature. Methods Four consecutive octogenarians with severe aortic stenosis (AS) and complex coronary artery disease (CAD) that were at high risk for conventional surgery with extracorporeal circulation (ECC) were discussed in our Multidisciplinary Heart Team (MDH). Our MDH consisted of an interventional cardiologist, cardiac surgeon, and cardiac anesthesiologist. A hybrid approach with the alternative strategy comprising of MIDCAB, PCI, and TAVI in a staged fashion was agreed on. All 4 patients had both PCI/stenting and MIDCAB prior to deployment of the TAVI-prosthesis. Results From January 2019 to December 2020, 4 consecutive patients aged between 83 and 85 (3 male/1 female) years were scheduled for MIDCAB/PCI followed by percutaneous treatment of severe symptomatic AS. Intraoperatively, one patient was converted to full sternotomy, and surgery was performed by off-pump coronary artery bypass grafting. The overall procedural success rate was 100% in all 4 patients with resolution of their initial presenting cardiopulmonary symptoms. There were no severe complications associated with all hybrid procedures. There was no 30-day mortality in all patients. All patients were discharged home with a median hospital stay ranging between 9 and 25 days. All patients have since then been followed-up regularly. There was one noncardiac-related mortality at 6-months postsurgery. All other patients were well at 1-year follow-up with improved New York Heart Association Class II. Conclusions In a selected group of elderly, high prohibitive risk patients with CAD and severe symptomatic AS, a staged approach with MIDCAB and PCI followed by TAVI can be safely performed with excellent outcomes. We advocate a MDH-based preliminary evaluation of this patient cohort in selecting suitable patients and appropriate timing of each stage of the hybrid procedure.
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Affiliation(s)
- Anthony Alozie
- Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, Germany
| | - Alper Öner
- Department of Cardiology, Heart Centre Rostock, University of Rostock, Germany
| | - Benjamin Löser
- Department of Anesthesiology and Intensive Care Medicine, University of Rostock, Germany
| | - Pascal M. Dohmen
- Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, Germany
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State Bloemfontein, South Africa
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Gianoli M, de Jong AR, Jacob KA, Namba HF, van der Kaaij NP, van der Harst P, J.L Suyker W. Minimally invasive surgery or stenting for left anterior descending artery disease - meta-analysis. IJC HEART & VASCULATURE 2022; 40:101046. [PMID: 35573649 PMCID: PMC9098394 DOI: 10.1016/j.ijcha.2022.101046] [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: 03/18/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022]
Abstract
Minimally invasive direct coronary artery bypass (MIDCAB) surgery and percutaneous coronary intervention (PCI) are both well-established minimally invasive revascularization strategies in patients with proximal left anterior descending (LAD) lesions. We aimed to evaluate the 20-years' experience by performing a systematic review and meta-analysis comparing MIDCAB versus PCI in adults with proximal LAD disease. We searched MEDLINE, EMBASE and Cochrane on October 1st, 2021 for articles published in the year 2000 or later. The primary outcome was all-cause mortality. Secondary outcomes included cardiac mortality, repeat target vessel revascularization (rTVR), myocardial infarction (MI), and cerebrovascular accident (CVA). Outcomes were analysed at short-term, mid-term, and long-term follow-up. Random effects meta-analyses were performed. Events were compared using risk ratios (RR) with 95% confidence intervals (CI). Our search yielded 17 studies pooling 3847 patients. At short-term follow-up, cardiac mortality was higher with MIDCAB than with PCI (RR 7.30, 95% CI: 1.38 to 38.61). At long-term follow-up, MIDCAB showed a decrease in all-cause mortality (RR 0.66, 95% CI: 0.46 to 0.93). MIDCAB showed a decrease in rTVR at mid-term follow-up (RR 0.16, 95% CI: 0.11 to 0.23) and at long-term follow-up (RR 0.25, 95% CI: 0.17 to 0.38). MI and CVA comparisons were not significant. In conclusion, in patients with proximal LAD lesions, MIDCAB showed a higher short-term mortality in the RCTs, but the cohort studies suggested a lower all-cause mortality at long-term follow-up. We confirm a decreased rTVR at mid-term follow-up in the RCTs and long-term follow-up in the cohort studies.
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Key Words
- (RA)-MIDCAB, (robotic assisted) minimally invasive direct coronary artery bypass
- BMS, bare metal stent
- CABG, coronary artery bypass grafting
- CI, confidence interval
- CVA, cerebrovascular accident
- DES, drug eluting stent
- LAD, left anterior descending
- LITA, left internal thoracic artery
- MAC(C)E, Major Adverse Cardiac (and Cerebrovascular) Events
- MI, myocardial infarction
- Meta-analysis
- Minimally invasive direct coronary artery bypass
- NNT, number needed to treat
- PCI, percutaneous coronary intervention
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- Percutaneous coronary intervention
- Proximal LAD lesion
- RCT, randomized controlled trial
- RR, risk ratio
- rTVR, repeat target vessel revascularization
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Affiliation(s)
- Monica. Gianoli
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne R. de Jong
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kirolos A. Jacob
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hanae F. Namba
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Niels P. van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem J.L Suyker
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Gupta PK, Balachander J. Predictor of in-stent restenosis in patients with drug-eluting stent (PRIDE)- a retrospective cohort study. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2021; 33:184-194. [PMID: 33622608 DOI: 10.1016/j.arteri.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND It is a fact that coronary artery disease (CAD) is more prevalent in India as compared to western countries. The major risk factors associated with the early CAD are a high prevalence of diabetes mellitus, atherogenic lipid profile, smoking habits, sedentary lifestyle, low socioeconomic condition and high prevalence of obesity. Is this true for restenosis after drug-eluting stent (DES) implantation and factors associated with it? The main objective of the study was to determine the rate of in-stent restenosis (ISR) in patients with DES and risk factors associated with it from our region. METHODS It was a single-center, retrospective cohort study in which 550 patients who underwent DES implantation were included. Patient's demographic data, coronary angiography findings, procedural characteristics and development of ISR were noted. RESULTS Out of 550 patients, 31 developed ISR with a rate of restenosis of 5.63% and target lesion revascularization (TLR) of 5.63%. On multiple Cox-regression analysis, only diabetes mellitus (DM) (p=0.008, adjusted hazard ratio (HR): 2.757, 95% confidence interval (CI): 1.296-5.863), deployment of stent in the left anterior descending (LAD) artery (p=0.031, adjusted HR: 3.342, 95% CI: 1.115-10.017) and periprocedural complication during percutaneous coronary intervention (p=0.040, adjusted HR: 2.824, 95% CI: 1.049-7.603) were found to be significantly associated with increased risk of ISR. Kaplan-Meier survival analysis of event-free survival for restenosis showed patients with DM had significantly lower event-free survival compared to patients without DM (p=0.005 by log-rank test). CONCLUSIONS In our study, the rate of restenosis after DES implantation was 5.63%. The presence of DM, the stent in the LAD territory and the periprocedural complication is strongly associated with the development of ISR.
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Affiliation(s)
- Praveen K Gupta
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
| | - Jayaram Balachander
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Liakopoulos OJ, Choi YH. Commentary: Minimally invasive coronary bypass or percutaneous coronary intervention for complex left anterior descending artery stenosis: A never-ending battle. J Thorac Cardiovasc Surg 2020; 163:1850-1851. [PMID: 32773122 DOI: 10.1016/j.jtcvs.2020.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Oliver J Liakopoulos
- Department of Cardiac Surgery, Kerckhoff Clinic, Campus Kerckhoff, University of Gießen, Bad Nauheim, Germany.
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Clinic, Campus Kerckhoff, University of Gießen, Bad Nauheim, Germany
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Ramzy D, Chikwe J. Commentary: Is robotic-assisted coronary bypass ready for prime time? J Thorac Cardiovasc Surg 2020; 163:1848-1850. [PMID: 32727688 DOI: 10.1016/j.jtcvs.2020.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Danny Ramzy
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.
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Commentary: Minimally invasive direct coronary artery bypass for isolated left anterior descending lesions: A welcomed innovation. J Thorac Cardiovasc Surg 2020; 163:1847-1848. [PMID: 32653281 DOI: 10.1016/j.jtcvs.2020.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022]
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