1
|
Kirov H, Caldonazo T, Mukharyamov M, Toshmatov S, Fischer J, Schneider U, Siemeni T, Doenst T. Cardiac Surgery 2023 Reviewed. Thorac Cardiovasc Surg 2024. [PMID: 38740368 DOI: 10.1055/s-0044-1786758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term "cardiac surgery AND 2023." We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making.
Collapse
Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Murat Mukharyamov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Sultonbek Toshmatov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiac Surgery, Saarland University Medical Center, Homburg Saar, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| |
Collapse
|
2
|
Sakurai Y, Yokoyama Y, Fukuhara S, Takagi H, Kuno T. Complete transcatheter versus surgical approach to aortic stenosis with coronary artery disease: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2024; 167:1305-1313.e9. [PMID: 36150940 DOI: 10.1016/j.jtcvs.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/24/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE This meta-analysis aimed to evaluate outcomes of transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG). METHODS The MEDLINE, EMBASE, and Cochrane Library databases were searched through November 2021 to identify studies comparing TAVR + PCI and SAVR + CABG for severe aortic stenosis with concurrent coronary artery disease. Outcomes of interest were all-cause mortality, repeat coronary intervention, rehospitalization, myocardial infarction, and stroke during follow-up, and 30-day periprocedural outcomes. RESULTS Two randomized controlled trials and 6 observational studies including a total of 104,220 patients (TAVR + PCI, n = 5004; SAVR + CABG, n = 99,216) were included. The weighted mean follow-up period was 30.2 months. TAVR + PCI was associated with greater all-cause mortality and coronary reintervention during follow-up period (hazard ratio, 1.35; 95% confidence interval [CI], 1.11-1.65; P = .003, hazard ratio, 4.14; 95% CI, 1.74-9.86; P = .001, respectively), 30-day permanent pacemaker implantation rate (odds ratio [OR], 3.79; 95% CI, 1.61-8.95; P = .002), and periprocedural vascular complications (OR, 6.97; 95% CI, 1.85-26.30; P = .004). In contrast, TAVR + PCI was associated with a lower rate of 30-day acute kidney injury (OR, 0.32; 95% CI, 0.20-0.50; P = .0001). Rehospitalization, myocardial infarction, stroke during follow-up, and other periprocedural outcomes including 30-day mortality were similar in both groups. CONCLUSIONS In patients with severe aortic stenosis and coronary artery disease, TAVR + PCI was associated with greater all-cause mortality at follow-up compared with SAVR + CABG. Heart Team approach to assess TAVR candidacy remains imperative.
Collapse
Affiliation(s)
- Yosuke Sakurai
- Department of Surgery, Marshall University Joan Edwards School of Medicine, WVa
| | - Yujiro Yokoyama
- Department of Surgery, St Luke's University Health Network, Pa
| | - Shinichi Fukuhara
- Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor, Mich
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
| |
Collapse
|
3
|
Bruno F, Marengo G, De Filippo O, Wanha W, Leonardi S, Raposeiras Roubin S, Fabris E, Popovic M, Giannino G, Truffa A, Huczek Z, Gaibazzi N, Ielasi A, Cortese B, Borin A, Núñez‐Gil IJ, Melis D, Ugo F, Bianco M, Barbieri L, Marchini F, Desperak P, Montalto C, Melendo‐Viu M, Elia E, Mancone M, Buono A, Ferrandez‐Escarabajal M, Morici N, Scaglione M, Tuttolomondo D, Sardella G, Gasior M, Mazurek M, Gallone G, Pagliaro B, Lopiano C, Campo G, Wojakowski W, Abu‐Assi E, Sinagra G, De Ferrari GM, D'Ascenzo F. Impact of Complete Revascularization on Development of Heart Failure in Patients With Acute Coronary Syndrome and Multivessel Disease: A Subanalysis of the CORALYS Registry. J Am Heart Assoc 2023; 12:e028475. [PMID: 37489724 PMCID: PMC10492970 DOI: 10.1161/jaha.122.028475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/02/2023] [Indexed: 07/26/2023]
Abstract
Background The impact of complete revascularization (CR) on the development of heart failure (HF) in patients with acute coronary syndrome and multivessel coronary artery disease undergoing percutaneous coronary intervention remains to be elucidated. Methods and Results Consecutive patients with acute coronary syndrome with multivessel coronary artery disease from the CORALYS (Incidence and Predictors of Heart Failure After Acute Coronary Syndrome) registry were included. Incidence of first hospitalization for HF or cardiovascular death was the primary end point. Patients were stratified according to completeness of coronary revascularization. Of 14 699 patients in the CORALYS registry, 5054 presented with multivessel disease. One thousand four hundred seventy-three (29.2%) underwent CR, while 3581 (70.8%) did not. Over 5 years follow-up, CR was associated with a reduced incidence of the primary end point (adjusted hazard ratio [HR], 0.66 [95% CI, 0.51-0.85]), first HF hospitalization (adjusted HR, 0.67 [95% CI, 0.49-0.90]) along with all-cause death and cardiovascular death alone (adjusted HR, 0.74 [95% CI, 0.56-0.97] and HR, 0.56 [95% CI, 0.38-0.84], respectively). The results were consistent in the propensity-score matching population and in inverse probability treatment weighting analysis. The benefit of CR was consistent across acute coronary syndrome presentations (HR, 0.59 [95% CI, 0.39-0.89] for ST-segment elevation myocardial infarction and HR, 0.71 [95% CI, 0.50-0.99] for non-ST-elevation acute coronary syndrome) and in patients with left ventricular ejection fraction >40% (HR, 0.52 [95% CI, 0.37-0.72]), while no benefit was observed in patients with left ventricular ejection fraction ≤40% (HR, 0.77 [95% CI, 0.37-1.10], P for interaction 0.04). Conclusions CR after acute coronary syndrome reduced the risk of first hospitalization for HF and cardiovascular death, as well as first HF hospitalization, and cardiovascular and overall death both in patients with ST-segment elevation myocardial infarction and non-ST-elevation acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04895176.
Collapse
Affiliation(s)
- Francesco Bruno
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Giorgio Marengo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Ovidio De Filippo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico San MatteoCoronary Care UnitPaviaItaly
| | | | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano IsontinaUniversity of TriesteItaly
| | - Maja Popovic
- Department of Medical SciencesUniversity of TurinItaly
| | - Giuseppe Giannino
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | | | - Zenon Huczek
- 1st Department of CardiologyMedical University of WarsawWarszawaPoland
| | | | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed InterventisticaIstituto Clinico Sant’AmbrogioMilanItaly
| | - Bernardo Cortese
- Cardiovascular Research TeamSan Carlo ClinicMilanItaly
- Fondazione Ricerca e Innovazione CardiovascolareMilanItaly
| | - Andrea Borin
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | | | - Daniele Melis
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Fabrizio Ugo
- Department of CardiologySant’Andrea HospitalVercelliItaly
| | - Matteo Bianco
- Division of CardiologySan Luigi Gonzaga University Hospital, OrbassanoTurinItaly
| | - Lucia Barbieri
- Division of CardiologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- University of MilanMilanItaly
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
| | - Piotr Desperak
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Claudio Montalto
- Fondazione IRCCS Policlinico San MatteoCoronary Care UnitPaviaItaly
| | | | - Edoardo Elia
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Massimo Mancone
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e CardiovascolariSapienza Università di RomaRomaItaly
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular DepartmentFondazione Poliambulanza Istituto OspedalieroBresciaItaly
| | | | - Nuccia Morici
- IRCCS S. Maria Nascente‐Fondazione Don Carlo Gnocchi ONLUSMilanItaly
| | | | | | - Gennaro Sardella
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e CardiovascolariSapienza Università di RomaRomaItaly
| | - Mariusz Gasior
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Maciej Mazurek
- 1st Department of CardiologyMedical University of WarsawWarszawaPoland
| | - Guglielmo Gallone
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Beniamino Pagliaro
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
- IRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Clara Lopiano
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
- IRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano IsontinaUniversity of TriesteItaly
| | - Gaetano Maria De Ferrari
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Fabrizio D'Ascenzo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | | |
Collapse
|
4
|
Popova NV, Popov VA, Revishvili AS. [Myocardial revascularization in chronic coronary artery disease. State of art]. KARDIOLOGIIA 2023; 63:3-13. [PMID: 37470728 DOI: 10.18087/cardio.2023.6.n2263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/31/2022] [Indexed: 07/21/2023]
Abstract
The review addresses debatable issues of myocardial revascularization in chronic forms of ischemic heart disease, shows major differences between percutaneous coronary intervention and coronary artery bypass grafting in terms of long-term prognosis, and the dependence of the results on the clinical profile of the disease. The review of current publications demonstrates advantages of open surgery in long-term survival and prevention of adverse outcomes in target groups of patients.
Collapse
Affiliation(s)
- N V Popova
- Vishnevsky National Medical Research Center of Surgery, Moscow
| | - V A Popov
- Vishnevsky National Medical Research Center of Surgery, Moscow; Russian Medical Academy of Postgraduate Education, Moscow
| | - A S Revishvili
- Vishnevsky National Medical Research Center of Surgery, Moscow; Russian Medical Academy of Postgraduate Education, Moscow
| |
Collapse
|
5
|
Chieffo A, Beneduce A. Percutaneous coronary interventions for ostial left main disease: the future is bright. EUROINTERVENTION 2023; 18:1393-1394. [PMID: 37092269 PMCID: PMC10111120 DOI: 10.4244/eij-e-23-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
|
6
|
Dąbrowski EJ, Kożuch M, Dobrzycki S. Left Main Coronary Artery Disease-Current Management and Future Perspectives. J Clin Med 2022; 11:jcm11195745. [PMID: 36233613 PMCID: PMC9573137 DOI: 10.3390/jcm11195745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023] Open
Abstract
Due to its anatomical features, patients with an obstruction of the left main coronary artery (LMCA) have an increased risk of death. For years, coronary artery bypass grafting (CABG) has been considered as a gold standard for revascularization. However, notable advancements in the field of percutaneous coronary intervention (PCI) led to its acknowledgement as an important treatment alternative, especially in patients with low and intermediate anatomical complexity. Although recent years brought several random clinical trials that investigated the safety and efficacy of the percutaneous approach in LMCA, there are still uncertainties regarding optimal revascularization strategies. In this paper, we provide a comprehensive review of state-of-the-art diagnostic and treatment methods of LMCA disease, focusing on percutaneous methods.
Collapse
|
7
|
Comanici M, Salmasi MY, Schulte KL, Raja SG, Attia RQ. Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons? J Card Surg 2022; 37:3776-3798. [PMID: 36098376 DOI: 10.1111/jocs.16925] [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: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons. METHODS EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. Eight hundred and ninety-two results were obtained, 27 represented best evidence (2-meta-analyses, 1-RCT, and 24 retrospective cohort studies). RESULTS In all 474,160 operative outcomes were assessed for 434,535 coronary artery bypass grafting (CABG) (431,329 on-pump vs. 3206 off-pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital, and 4797 thoracic procedures. In all 398,058 cases were performed by trainees and 75,943 by consultants. One hundred fifty-nine cases were indeterminate. There were no statistically significant differences in the patients' preoperative risk scores. All studies excluded extreme high-risk patients in emergency setting, patients with poor left ventricular function, and reoperation cases that were undertaken by consultants. There were no differences in cardiopulmonary bypass and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the postoperative outcomes including perioperative myocardial infarction, resternotomy for bleeding, stroke, renal failure, intensive therapy unit length of stay, and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in-hospital or midterm mortality out to 5-years. DISCUSSION Trainees can perform cardiothoracic surgery in dedicated high-volume units with outcomes comparable to those of fully trained surgeons.
Collapse
Affiliation(s)
- Maria Comanici
- Department of Cardiac Surgery, Harefield Hospital, London, UK.,Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, Galați, Romania
| | | | | | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | - Rizwan Q Attia
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| |
Collapse
|
8
|
Doenst T, Schneider U, Can T, Caldonazo T, Diab M, Siemeni T, Färber G, Kirov H. Cardiac Surgery 2021 Reviewed. Thorac Cardiovasc Surg 2022; 70:278-288. [PMID: 35537447 DOI: 10.1055/s-0042-1744264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PubMed displayed more than 35,000 hits for the search term "cardiac surgery AND 2021." We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term "myocardial revascularization" is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.
Collapse
Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Tolga Can
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena, Germany
| |
Collapse
|
9
|
Park S, Park SJ, Park DW. Percutaneous Coronary Intervention for Left Main Coronary Artery Disease. JACC: ASIA 2022; 2:119-138. [PMID: 36339118 PMCID: PMC9627854 DOI: 10.1016/j.jacasi.2021.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
For several decades, coronary artery bypass grafting has been regarded as the standard choice of revascularization for significant left main coronary artery (LMCA) disease. However, in conjunction with remarkable advancement of device technology and adjunctive pharmacology, percutaneous coronary intervention (PCI) offers a more expeditious approach with rapid recovery and is a safe and effective alternative in appropriately selected patients with LMCA disease. Several landmark randomized clinical trials showed that PCI with drug-eluting stents for LMCA disease is a safe option with similar long-term survival rates to coronary artery bypass grafting surgery, especially in those with low and intermediate anatomic risk. Although it is expected that the updated evidence from recent randomized clinical trials will determine the next guidelines for the foreseeable future, there are still unresolved and unmet issues of LMCA revascularization and PCI strategy. This paper provides a comprehensive review on the evolution and an update on the management of LMCA disease. With advancements in PCI, clinical outcomes after left main PCI have progressively improved. Unmet needs still exist between clinical practice and the current evidence for left main PCI. Better decision making of revascularization choice and PCI optimization should be emphasized to improve outcomes of LMCA disease. Further research will provide further evidence to resolve conflicting issues on left main PCI.
Collapse
|
10
|
Lee G, Vervoort D, Sud M, Fremes SE. Commentary: Coronary artery bypass grafting versus percutaneous coronary intervention in left main disease: Plausibility does not equal evidence. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01277-0. [PMID: 34544613 DOI: 10.1016/j.jtcvs.2021.08.072] [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: 08/28/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Grace Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maneesh Sud
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
11
|
Lazar HL. Commentary: Percutaneous coronary intervention for left main lesions: Once again coronary artery bypass grafting gets the shaft. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01235-6. [PMID: 34456054 DOI: 10.1016/j.jtcvs.2021.08.037] [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: 08/15/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, Boston University School of Medicine, Boston, Mass.
| |
Collapse
|