1
|
Jamil H, Ranganathan S, Fissha AB, Vinck EE, Vervoort D. Low-Cost Innovations in Global Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241252441. [PMID: 38828943 DOI: 10.1177/15569845241252441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, costing the lives of 18 million people annually, with up to one-third being attributable to cardiac surgical conditions. Approximately 6 billion people do not have access to safe, timely, and affordable cardiac surgery, predominantly affecting populations living in low-middle income countries. Cardiac surgical care is costly, resulting in few centers in variable-resource contexts operating continuously or with the resources observed in higher-resource environments. As a result, innovations may be formally developed or informally adopted to bypass resource constraints and ensure care delivery. Innovations have been observed across the cardiac surgical care continuum and across settings, potentially benefiting both high-income countries, where growing health care costs are becoming unsustainable, and low- and middle-income countries, where competing health agendas may limit investments into cardiac surgery. This narrative review attempts to address the costs associated with cardiac surgery, placing an emphasis on frugal innovations in the perioperative and postoperative care spectrum.
Collapse
Affiliation(s)
- Hera Jamil
- Life Sciences, Department of Biological Sciences, University of Toronto Scarborough, ON, Canada
| | | | - Aemon B Fissha
- College of Health Sciences, School of Medicine, Addis Ababa University, Ethiopia
| | - Eric E Vinck
- Division of Cardiac Surgery, Pontifical Bolivarian University, Medellín, Colombia
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| |
Collapse
|
2
|
Wyler von Ballmoos MC, Kaneko T, Iribarne A, Kim KM, Arghami A, Fiedler A, Habib R, Parsons N, Elhalabi Z, Krohn C, Bowdish ME. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2023 Update on Procedure Data and Research. Ann Thorac Surg 2024; 117:260-270. [PMID: 38040323 DOI: 10.1016/j.athoracsur.2023.11.016] [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] [Received: 09/24/2023] [Revised: 11/09/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database is one of the largest and most comprehensive contemporary clinical databases in use. It now contains >9 million procedures from 1010 participants and 3651 active surgeons. Using audited data collection, it has provided the foundation for multiple risk models, performance metrics, health policy decisions, and a trove of research studies to improve the care of patients in need of cardiac surgical procedures. This annual report provides an update on the current status of the database and summarizes the development of new risk models and the STS Online Risk Calculator. Further, it provides insights into current practice patterns, such as the change in the demographics among patients undergoing aortic valve replacement, the use of minimally invasive techniques for valve and bypass surgery, or the adoption of surgical ablation and left atrial appendage ligation among patients with atrial fibrillation. Lastly, an overview of the research conducted using the STS Adult Cardiac Surgery Database and future directions for the database are provided.
Collapse
Affiliation(s)
- Moritz C Wyler von Ballmoos
- Department of Cardiovascular Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Alexander Iribarne
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, New York
| | - Karen M Kim
- Institute for Cardiovascular Health, UT Health Austin, Austin, Texas
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Amy Fiedler
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Robert Habib
- The Society of Thoracic Surgeons, Chicago, Illinois
| | | | | | - Carole Krohn
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| |
Collapse
|
3
|
Ntinopoulos V, Haeussler A, Odavic D, Papadopoulos N, Rings L, Dushaj S, Rodriguez Cetina Biefer H, Dzemali O. Conversion from off-pump to on-pump coronary artery bypass grafting: impact of surgeon and anaesthetist experience. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad205. [PMID: 38123498 PMCID: PMC10751234 DOI: 10.1093/icvts/ivad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Intraoperative conversion from off-pump to on-pump coronary artery bypass grafting (CABG) is associated with increased postoperative morbidity and mortality. The aim of this study is to assess the impact of surgeon and anaesthetist experience on the conversion rate. METHODS We performed a retrospective analysis of the data of all patients who underwent planned off-pump CABG in a single centre in 2007-2021, some of whom were non-electively converted to on-pump. Surgeon and anaesthetist experience were assessed by the number of off-pump bypass procedures per year. Multivariable logistic regression analysis was used to assess the impact of surgeon and anaesthetist experience on conversion rate. RESULTS A total of 2742 patients met the inclusion criteria. Ninety-four (3.4%) patients underwent non-elective conversion to on-pump surgery. Converted patients had significantly higher mortality [11 (11.7%) vs 35 (1.3%), P < 0.0001] in comparison to non-converted patients. Anaesthetist experience was found to be a risk factor for conversion (P = 0.011). Surgeon experience did not significantly affect conversion rate (P = 0.51). Other risk factors for conversion were female gender [odds ratio 2.65 (95% confidence interval 1.65-4.26), P = 0.0001] and left ventricular ejection fraction ≤35% [odds ratio 1.91 (95% confidence interval 1.05-3.49), P = 0.040]. CONCLUSIONS Conversion from off-pump to on-pump CABG is associated with worse postoperative outcomes. Limited experience of anaesthetists in off-pump bypass surgery is associated with a higher conversion rate.
Collapse
Affiliation(s)
- Vasileios Ntinopoulos
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Achim Haeussler
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Laura Rings
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Stak Dushaj
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
4
|
Zhu L, Li D, Zhang X, Wan S, Liu Y, Zhang H, Luo J, Luo Y, An P, Jiang W. Comparative efficacy on outcomes of C-CABG, OPCAB, and ONBEAT in coronary heart disease: a systematic review and network meta-analysis of randomized controlled trials. Int J Surg 2023; 109:4263-4272. [PMID: 37720926 PMCID: PMC10720830 DOI: 10.1097/js9.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/12/2023] [Indexed: 09/19/2023]
Abstract
IMPORTANCE Coronary artery bypass grafting (CABG) remains the gold standard for the treatment of multivessel and left main coronary heart disease. However, the current evidence about the optimal surgical revascularization strategy is inconsistent and is not sufficient to allow for definite conclusions. Thus, this topic needs to be extensively discussed. OBJECTIVE The aim of this present study was to compare the clinical outcomes of off-pump CABG (OPCAB), conventional on-pump CABG (C-CABG), and on-pump beating heart (ONBEAT) CABG via an updated systematic review and network meta-analysis of randomized controlled trials. DATA SOURCES PubMed, Web of Science, and the Cochrane Central Registry were searched for relevant randomized controlled trials that were published in English before 1 December 2021. STUDY SELECTION Published trials that included patients who received OPCAB, C-CABG, and ONBEAT CABG were selected. DATA EXTRACTION AND SYNTHESIS Two authors independently screened the search results, assessed the full texts to identify eligible studies and the risk of bias of the included studies, and extracted data. All processes followed the Preferred Reporting Items for Systematic Review and Meta-analysis of Individual Participant Data. MAIN OUTCOMES AND MEASURES The primary outcome was postoperative mortality in patients who underwent C-CABG, OPCAB, or ONBEAT CABG. The secondary outcomes were postoperative myocardial infarction, stroke, and renal impairment in the three groups. The time point for analysis of outcomes was all time periods during the postoperative follow-up. RESULTS A total of 39 385 patients (83 496.2 person-years) in 65 studies who fulfilled the prespecified criteria were included. In the network meta-analysis, OPCAB was associated with an increase of 12% in the risk of all-cause mortality when compared with C-CABG [odds ratio (OR): 1.12; 95% CI: 1.04-1.21], a reduction of 49% in the risk of myocardial infarction when compared with ONBEAT (OR: 0.51; 95% CI: 0.26-0.99), a reduction of 16% in the risk of stroke when compared with C-CABG (OR: 0.84; 95% CI: 0.72-0.99) and a similar risk of renal impairment when compared with C-CABG and ONBEAT. CONCLUSIONS AND RELEVANCE OPCAB was associated with higher all-cause mortality but lower postoperative stroke compared with C-CABG. OPCAB was associated with a lower postoperative myocardial infarction than that of ONBEAT. Early mortality was comparable among OPCAB, ONBEAT, and C-CABG.
Collapse
Affiliation(s)
- Lin Zhu
- Department of Nutrition and Health, Beijing Advanced Innovation Center for Food, Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food, Quality, China Agricultural University
| | - Dongjie Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital
- Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University
- Beijing Lab for Cardiovascular Precision Medicine
- Key Laboratory of Medical Engineering for Cardiovascular Disease, Beijing, People’s Republic of China
| | - Xu Zhang
- Department of Nutrition and Health, Beijing Advanced Innovation Center for Food, Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food, Quality, China Agricultural University
| | - Sitong Wan
- Department of Nutrition and Health, Beijing Advanced Innovation Center for Food, Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food, Quality, China Agricultural University
| | - Yuyong Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital
- Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University
- Beijing Lab for Cardiovascular Precision Medicine
- Key Laboratory of Medical Engineering for Cardiovascular Disease, Beijing, People’s Republic of China
| | - HongJia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital
- Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University
- Beijing Lab for Cardiovascular Precision Medicine
- Key Laboratory of Medical Engineering for Cardiovascular Disease, Beijing, People’s Republic of China
| | - Junjie Luo
- Department of Nutrition and Health, Beijing Advanced Innovation Center for Food, Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food, Quality, China Agricultural University
| | - Yongting Luo
- Department of Nutrition and Health, Beijing Advanced Innovation Center for Food, Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food, Quality, China Agricultural University
| | - Peng An
- Department of Nutrition and Health, Beijing Advanced Innovation Center for Food, Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food, Quality, China Agricultural University
| | - Wenjian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital
- Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University
- Beijing Lab for Cardiovascular Precision Medicine
- Key Laboratory of Medical Engineering for Cardiovascular Disease, Beijing, People’s Republic of China
| |
Collapse
|
5
|
Surve TA, Kazim MA, Sughra M, Mirza AMW, Murugan SK, Shebani KAM, Karishma F, Trada IJ, Mansour M, Asif K, Kaur L, Kamal A, Unachukwu N, Naveed A. Revascularization Modalities in Acute Coronary Syndrome: A Review of the Current State of Evidence. Cureus 2023; 15:e47207. [PMID: 38021880 PMCID: PMC10653013 DOI: 10.7759/cureus.47207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Acute coronary syndrome (ACS) stands as a leading global cause of mortality, underscoring the importance of effective prevention, early diagnosis, and timely intervention. While medications offer benefits to many patients, revascularization procedures such as coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and emerging hybrid approaches remain pivotal for ACS management. This review delves into the 2018 ESC/EACTS guidelines alongside an analysis of existing literature to shed light on the spectrum of revascularization methods. While both CABG and PCI demonstrate promising outcomes, the optimal choice between the two hinges on a comprehensive assessment of individual patient factors, anatomical complexity guided by advanced imaging, comorbidities, and age. The determination of whether to pursue culprit or total revascularization, as well as immediate or staged revascularization, is contingent upon various factors, including age, disease complexity, and clinical outcomes. This evidence-based decision-making process is orchestrated by a multidisciplinary heart team grounded in ongoing clinical evaluation. The primary objective of this review is to provide valuable insights into revascularization strategies and scrutinize the congruence of current guidelines with recent advancements in the field.
Collapse
Affiliation(s)
- Tahoora A Surve
- Internal Medicine, K. J. Somaiya Medical College, Mumbai, IND
| | | | - Mehak Sughra
- Internal Medicine, Gujranwala Teaching Hospital, Gujranwala, PAK
| | | | - Siva Kumar Murugan
- Internal Medicine, Meenakshi Medical College and Research Institute, Chennai, IND
| | | | - Fnu Karishma
- Internal Medicine, Ghulam Muhammad Mahar Medical College, Khairpur, PAK
| | | | - Mohammad Mansour
- General Medicine, University of Debrecen, Debrecen, HUN
- General Medicine, Jordan University Hospital, Amman, JOR
| | - Kainat Asif
- Medicine and Surgery, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, PAK
| | - Loveneet Kaur
- Medicine and Surgery, Government Medical College, Patiala, IND
| | - Amer Kamal
- Medicine, School of Medicine, The University of Jordan, Amman, JOR
| | | | | |
Collapse
|
6
|
Chan J, Dimagli A, Dong T, Fudulu DP, Sinha S, Angelini GD. Trend and early clinical outcomes of off-pump coronary artery bypass grafting in the UK. Eur J Cardiothorac Surg 2023; 64:ezad272. [PMID: 37522886 PMCID: PMC10876163 DOI: 10.1093/ejcts/ezad272] [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: 03/23/2023] [Revised: 06/21/2023] [Accepted: 07/29/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES The popularity of off-pump coronary artery bypass grafting (CABG) varies across the world, ranging from 20% in Europe and the USA to 56% in Asia. We present the trend and early clinical outcomes in off pump in the UK. METHODS All patients who underwent elective or urgent isolated CABG from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. The trend in operating surgeons and units volume and training in off pump were analysed. Early clinical outcomes between off- and on-pump CABG were compared using propensity score matching. RESULTS A total of 351 422 patients were included. The overall off-pump rate during the study period was 15.17%, it peaked in 2008 (19.8%), followed by a steady decreased to 2018 (7.63%). Its adoption varied across centres and surgeons, ranging from <1% to 48.36% and <1% to 85.5%, respectively, of total cases performed. After propensity score matching for the period 1996-2019, off pump, when compared to on pump, was associated with a lower in-hospital/30-day mortality (1.2% vs 1.5%, P < 0.001), return to theatre (3.7% vs 4.5%, P < 0.001), cerebrovascular accident (transient ischaemic attack: 0.3% vs 0.6%, stroke: 0.3% vs 0.6%, P < 0.001) and deep sternal wound infection (0.8% vs 1.2%, P ≤ 0.001). In a sub-analysis from the introduction of EuroScore II (2012-2019), there were no differences in-hospital/30-day mortality (1.0% vs 1.0%, P = 0.71). However, on pump, had a higher return to theatre (4.2% vs 2.7%, P < 0.001), cerebrovascular accident (transient ischaemic attack: 0.4% vs 0.2%, stroke: 0.5% vs 0.3%, P = 0.003) and deep sternal wound infection (1.0% vs 0.6%, P = 0.004). CONCLUSIONS Our data show a decreasing trend in the use of off pump in the UK since 2008. This is likely to be multifactorial and raises the question of whether it should be a specialized revascularization technique.
Collapse
Affiliation(s)
- Jeremy Chan
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Tim Dong
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | |
Collapse
|
7
|
Kageyama S, Serruys PW, Ninomiya K, O’Leary N, Masuda S, Kotoku N, Colombo A, van Geuns RJ, Milojevic M, Mack MJ, Soo A, Garg S, Onuma Y, Davierwala PM. Impact of on-pump and off-pump coronary artery bypass grafting on 10-year mortality versus percutaneous coronary intervention. Eur J Cardiothorac Surg 2023; 64:ezad240. [PMID: 37348857 PMCID: PMC10693439 DOI: 10.1093/ejcts/ezad240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES The very long-term mortality of off-pump and on-pump coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in a randomized complex coronary artery disease population is unknown. This study aims to investigate the impact of on-pump and off-pump CABG versus PCI on 10-year all-cause mortality. METHODS The SYNTAX trial randomized 1800 patients with three-vessel and/or left main coronary artery disease to PCI or CABG and assessed their survival at 10 years. In this sub-study, the hazard of mortality over 10 years was compared according to the technique of revascularization: on-pump CABG (n = 725), off-pump CABG (n = 128) and PCI (n = 903). RESULTS There was substantial inter-site variation in the use of off-pump CABG despite baseline characteristics being largely homogeneous among the 3 groups. The crude rate of mortality was significantly lower following on-pump CABG versus PCI [25.6% vs 28.4%, hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.65-0.96], while it was comparable between off-pump CABG and PCI (28.5% vs 28.4%, HR 0.98, 95% CI 0.69-1.40). After adjusting for the 9 variables included in the SYNTAX score II 2020, 10-year mortality remained significantly lower with on-pump CABG than PCI (HR 0.75 against PCI, P = 0.009). CONCLUSIONS In the SYNTAXES trial, 10-year mortality adjusted for major confounders was significantly lower following on-pump CABG compared to PCI. There was no evidence for unadjusted difference between off-pump CABG and PCI, although the unadjusted estimated HR had a wide CI. Site heterogeneity in the technique used in bypass surgery has had measurable effects on treatment performance.
Collapse
Affiliation(s)
- Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Kai Ninomiya
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Neil O’Leary
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Nozomi Kotoku
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Humanitas Clinical and Research Centre IRCCS, Milan, Italy
| | - Robert-Jan van Geuns
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Alan Soo
- Department of Cardiothoracic Surgery, University Hospital Galway, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Piroze M Davierwala
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| |
Collapse
|
8
|
Forouzannia SM, Forouzannia SK, Yarahmadi P, Alirezaei M, Shafiee A, Anari NY, Masoudkabir F, Dehghani Z, Pashang M. Early and mid-term outcomes of off-pump versus on-pump coronary artery bypass surgery in patients with triple-vessel coronary artery disease: a randomized controlled trial. J Cardiothorac Surg 2023; 18:140. [PMID: 37046338 PMCID: PMC10099835 DOI: 10.1186/s13019-023-02258-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND AND AIM OF THE STUDY Several studies have compared early and late outcomes of on-pump coronary artery bypass grafting (CABG) and off-pump CABG. However, there is still an ongoing debate on this matter, especially in patients with triple-vessel coronary artery disease (3VD). METHODS We randomly assigned 274 consecutive patients with 3VD to two equal groups to undergo on-pump CABG or off-pump CABG. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, acute coronary syndrome, stroke or transient ischemic attack, and the need for repeat revascularization. The secondary outcomes were postoperative infection, ventilation time, ICU admission duration, hospital stay length, and renal failure after surgery. RESULTS The median follow-up duration was 31.2 months (range 24.6-35.2 months). The mean age of patients was 61.4 ± 9.3 years (range: 38-86), and 207 (78.7%) were men. There were 15 (11.2%) and 9 (7.0%) MACCE occurrences in on-pump and off-pump groups, respectively (P value = 0.23). MACCE components including all-cause death, non-fatal MI, CVA, and revascularization did not significantly differ between on-pump and off-pump groups. We observed no difference in the occurrence of MACCE between off-pump and on-pump groups in multivariable regression analysis (HR = 0.57; 95% CI 0.24-1.32; P value = 0.192). There were no statistical differences in postoperative outcomes between the off-pump and on-pump CABG groups. CONCLUSIONS Off-pump CABG is an equal option to on-pump CABG for 3VD patients with similar rates of MACCE and postoperative complications incidence when surgery is performed in the same setting by an expert surgeon in both methods. (IRCT20190120042428N1).
Collapse
Affiliation(s)
- Seyed Mohammad Forouzannia
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar St, Tehran, 1411713138, Iran
| | - Seyed Khalil Forouzannia
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar St, Tehran, 1411713138, Iran.
| | - Pourya Yarahmadi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar St, Tehran, 1411713138, Iran
| | - Mohammad Alirezaei
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar St, Tehran, 1411713138, Iran
| | - Akbar Shafiee
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Yazdian Anari
- Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Dehghani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Cormican DS, Khalif A, McHugh S, Dalia AA, Drennen Z, Nuñez-Gil IJ, Ramakrishna H. Analysis of the Updated ACC/AHA Coronary Revascularization Guidelines With Implications for Cardiovascular Anesthesiologists and Intensivists. J Cardiothorac Vasc Anesth 2023; 37:135-148. [PMID: 36347728 DOI: 10.1053/j.jvca.2022.09.088] [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] [Received: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel S Cormican
- Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA
| | - Adnan Khalif
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA
| | - Stephen McHugh
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Adam A Dalia
- Division of Cardiac Anesthesiology, Department of Critical Care, Anesthesia, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Zachary Drennen
- Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA
| | - Ivan J Nuñez-Gil
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
10
|
Lorusso R, Bari G, Di Mauro M, Mariani S. The 'eternal' dilemma of OPCABG versus ONCABG continues: superior, equal, inferior or just different? J Cardiovasc Med (Hagerstown) 2022; 23:559-560. [PMID: 35906985 DOI: 10.2459/jcm.0000000000001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre.,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Gabor Bari
- Department of Cardiac Surgery, University of Szeged, Szeged, Hungary
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre.,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Silvia Mariani
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre.,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| |
Collapse
|
11
|
Li XW, Cui Z, Xiao JY, Gao MD, Zhang M, Zhang WJ, Tian FS, Song Y, Liu YW, Yao ZH, Ma J, Liu Y, Gao J. A five-parameter score for predicting saphenous vein graft degenerative and/or occlusive disease in recurring ischemic symptoms after one year post coronary artery bypass grafting. Perfusion 2022; 38:843-852. [PMID: 35583035 DOI: 10.1177/02676591221090588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The recurrence rate of ischemic symptoms after coronary artery bypass grafting (CABG) is increasing in recent years. How to prevent and treat saphenous vein graft disease (SVGD [symptomatic ⩾50% stenosis in at least one Saphenous vein graft]) has been a clinical challenge to date. Different pathogenesis may exist in SVGD of different periods. There are currently few available scores for estimating the risk of SVGD after one year post CABG. OBJECTIVE We sought to develop and validate a simple predictive clinical risk score for SVGD with recurring ischemia after one year post CABG. METHODS AND RESULTS This was a cross-sectional study and the results were validated using bootstrap resampling on a separate cohort. A nomogram and risk scoring system were developed based on retrospective data from a training cohort of 606 consecutive patients with recurring ischemia >1 year after CABG. Logistic regression model was used to find the predictive factors and to build a nomogram. To assess the generalization, models were validated using bootstrap resampling and an external cross-sectional study of 187 consecutive patients in four other hospitals. In multivariable analysis of the primary cohort, native lesion vessel number, SVG age, recurring ischemia type, very low-density lipoprotein level, and left ventricular end-diastolic diameter were independent predictors. A summary risk score was derived from nomogram, with a cut-off value of 15. In internal and external validation, the C-index was 0.86 and 0.82, indicating good discrimination. The calibration curve for probability of SVGD showed optimal agreement between actual observations and risk score prediction. CONCLUSION A simple-to-use risk scoring system based on five easily variables was developed and validated to predict the risk of SVGD among patients who recurring ischemia after one year post CABG. This score may be useful for providing patients with individualized estimates of SVGD risk.
Collapse
Affiliation(s)
- Xiao-Wei Li
- Tianjin Medical University, Tianjin, China.,Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Cardiovascular Institute, 499773Tianjin Chest Hospital, Tianjin, China
| | - Zhuang Cui
- Tianjin Medical University, Tianjin, China
| | - Jian-Yong Xiao
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China
| | - Ming-Dong Gao
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China
| | - Mei Zhang
- Tianjin Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Wen-Juan Zhang
- Tianjin Medical University General Hospital, Tianjin, China
| | | | - Yu Song
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Ying-Wu Liu
- Tian Jin Third Center Hospital, Tianjin, China
| | | | - Jun Ma
- Tianjin Medical University, Tianjin, China
| | - Yin Liu
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China
| | - Jing Gao
- Tianjin Medical University, Tianjin, China.,Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Cardiovascular Institute, 499773Tianjin Chest Hospital, Tianjin, China
| |
Collapse
|
12
|
Deo SV, Elgudin Y, Shroyer ALW, Altarabsheh S, Sharma V, Rubelowsky J, Cornwell L, Davierwala P, Chu D, Cmolik B. Off-Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs' Use and Outcomes. J Am Heart Assoc 2022; 11:e023514. [PMID: 35229663 PMCID: PMC9075317 DOI: 10.1161/jaha.121.023514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Coronary artery bypass can be performed off pump (OPCAB) without cardiopulmonary bypass. However, trends over time for OPCAB versus on-pump (ONCAB) use and long-term outcome has not been reported, nor has their long-term outcome been compared. Methods and Results We queried the national Veterans Affairs database (2005-2019) to identify isolated coronary artery bypass procedures. Procedures were classified as OPCAB on ONCAB using the as-treated basis. Trend analyses were performed to evaluate longitudinal changes in the preference for OPCAB. The median follow-up period was 6.6 (3.5-10) years. An inverse probability weighted Cox model was used to compare all-cause mortality between OPCAB and ONCAB. From 47 685 patients, 6759 (age 64±8 years) received OPCAB (14%). OPCAB usage declined from 16% (2005-2009) to 8% (2015-2019). Patients with triple vessel disease who received OPCAB received a lower mean number of grafts (2.8±0.8 versus 3.2±0.8; P<0.01). The ONCAB 5-, 10-, and 15-year survival rates were 82.9% (82.5-83.3), 60.4% (59.8-61.1), and 37.2% (36.1-38.4); correspondingly, OPCAB rates were 80.7% (79.7-81.7), 57.4% (56-58.7), and 34.1% (31.7-36.6) (P<0.01). OPCAB was associated with increased risk-adjusted all-cause mortality (hazard ratio, 1.15 [1.13-1.18]; P<0.01) and myocardial infarction (incident rate ratio, 1.16 [1.05-1.28]; P<0.01). Conclusions Over 15 years, OPCAB use declined considerably in Veterans Affairs medical centers. In Veterans Affairs hospitals, late all-cause mortality and myocardial infarction rates were higher in the OPCAB cohort.
Collapse
Affiliation(s)
- Salil V. Deo
- Surgical ServicesLouis Stokes Cleveland VA Medical CenterClevelandOH
- Cleveland Cardiothoracic Research GroupClevelandOH
- Department of SurgeryCase School of Medicine, Case Western Reserve UniversityClevelandOH
| | - Yakov Elgudin
- Surgical ServicesLouis Stokes Cleveland VA Medical CenterClevelandOH
- Cleveland Cardiothoracic Research GroupClevelandOH
| | - A. Laurie W. Shroyer
- Department of SurgeryHealth Sciences CenterStony Brook Renaissance School of MedicineStony BrookNew York
- Research and Development OfficeNorthport VA Medical CenterNorthportNY
| | - Salah Altarabsheh
- Department of Cardiac SurgeryQueen Alia Heart InstituteAmmanJordan
- Division of Cardiovascular SurgeryMayo ClinicRochesterMinnesota
| | - Vikas Sharma
- Surgical ServicesGeorge E Wahlen VA Medical CenterSalt Lake CityUT
- Division of Cardiothoracic SurgeryUniversity of Utah School of MedicineSalt Lake CityUT
| | - Joseph Rubelowsky
- Surgical ServicesLouis Stokes Cleveland VA Medical CenterClevelandOH
- Cleveland Cardiothoracic Research GroupClevelandOH
| | | | | | - Danny Chu
- Division of Cardiac SurgeryDepartment of Cardiothoracic SurgeryUniversity of PittsburghPA
| | - Brian Cmolik
- Surgical ServicesLouis Stokes Cleveland VA Medical CenterClevelandOH
- Cleveland Cardiothoracic Research GroupClevelandOH
| |
Collapse
|
13
|
Giannitsis E, Frey N. Isolated early peak cardiac troponin for clinical decision-making after elective cardiac surgery: useless at best. Eur Heart J 2022; 43:2404-2406. [PMID: 35175335 DOI: 10.1093/eurheartj/ehab786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Evangelos Giannitsis
- Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, Heidelberg, Germany
| |
Collapse
|
14
|
AMANO ATSUSHI. Refinement of Coronary Artery Bypass Grafting at Juntendo University Hospital. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:101-114. [PMID: 38912283 PMCID: PMC11189799 DOI: 10.14789/jmj.jmj21-0012-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/25/2021] [Indexed: 06/25/2024]
Abstract
Surgical treatment of ischemic heart disease began in 1945. After 1970, coronary artery bypass grafting (CABG) with cardiopulmonary bypass was developed along with coronary angiography. Juntendo University has been treating ischemic heart disease since 1980, and is actively performing off-pump CABG (OPCAB) since 2002. Besides the age of patients undergoing surgery, complications such as chronic hemodialysis, cerebrovascular disease, and malignancies make it challenging to reduce postoperative complications using OPCAB as graft preservation. OPCAB is technically challenging, and the CORONARY trial did not reveal its superiority over conventional CABG. Furthermore, high revascularization rates and technical differences among surgeons are important concerns. While not widely accepted in Europe and the United States, OPCAB comprises 65% of all stand-alone CABG in Japan. Japan reported a 2.5% hospital mortality rate in 2018, while the US reported 2.2% (according to the American Association of Thoracic Surgeons). In contrast, Juntendo University Hospital has maintained a 1% hospital mortality rate since 1984. To reduce the incidence of remote stroke in CABG patients, Juntendo has been using stroke-free management since 2010. Postoperative atrial fibrillation is 4-5 times more likely to recur than normal sinus rhythm after a 5-year course. In our study, 20% of patients suffered from chronic atrial fibrillation after ten years. Furthermore, left atrial appendage closure or amputation significantly reduces stroke in patients who undergo CABG and develop postoperative atrial fibrillation. Thus, OPCAB is a minimally invasive procedure with fewer complications; prevention of cardiogenic cerebral infarction can help improve remote outcomes.
Collapse
Affiliation(s)
- ATSUSHI AMANO
- Corresponding author: Atsushi Amano, Department of Cardiovascular Surgery, Juntendo University, 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan, TEL&FAX: +81-3-3813-3210 E-mail:
| |
Collapse
|
15
|
Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 535] [Impact Index Per Article: 267.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
Collapse
|
16
|
Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 159] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
17
|
Augoustides JG. Protecting the Central Nervous System During Cardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
18
|
Nair D, Sreejith N, Bhambra A, Bruce J, Mellor S, Brown LJ, Harky A. Cardiac Surgery in Patients With Blood Disorders. Heart Lung Circ 2021; 31:167-176. [PMID: 34686413 DOI: 10.1016/j.hlc.2021.09.013] [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: 06/27/2021] [Revised: 08/18/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Blood disorders that can contribute to abnormal bleeding can have a detrimental effect during cardiac surgery. Patients who are known to have such pathologies should be investigated thoroughly and cautious measures would need to be taken when cardiac surgery is needed in this cohort. The majority of current literature for cardiac surgery in patients with von Willebrand Disease and haemophilia are case reports. Nevertheless, evidence shows that optimising factor levels pre, intra and postoperatively offers outcomes similar to that of patients without these disorders. Preoperative screening followed by appropriate iron therapy reduces mortality for patients with anaemia. In this group, haemoglobin levels can be improved postoperatively through iron supplementation. The management strategy of cardiac surgery for people with blood disorders requires a multidisciplinary approach that is highly individualised for each patient. It is essential to adequately adjust preoperative, perioperative and postoperative care to the patient's blood disorder in order to achieve outcomes similar to that of patients without blood disorders.
Collapse
Affiliation(s)
- Devika Nair
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Amman Bhambra
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jonathan Bruce
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sophie Mellor
- Sandwell & West Birmingham NHS Trust, Sandwell General Hospital, West Bromwich, UK
| | - Louise J Brown
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK; Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK.
| |
Collapse
|
19
|
Demal TJ, Fehr S, Mariscalco G, Reiter B, Bibiza E, Reichenspurner H, Gatti G, Onorati F, Faggian G, Salsano A, Santini F, Perrotti A, Santarpino G, Zanobini M, Saccocci M, Musumeci F, Rubino AS, De Feo M, Bancone C, Nicolini F, Dalén M, Maselli D, Bounader K, Mäkikallio T, Juvonen T, Ruggieri VG, Biancari F. Coronary Artery Bypass Grafting in Patients With High Risk of Bleeding. Heart Lung Circ 2021; 31:263-271. [PMID: 34330630 DOI: 10.1016/j.hlc.2021.06.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/31/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative bleeding after cardiac surgery is associated with increased morbidity and mortality. We tested the hypothesis that patients with a preoperatively estimated high risk of severe perioperative bleeding may have impaired early outcome after on-pump versus off-pump coronary artery bypass grafting (CABG). METHOD Data from 7,352 consecutive patients who underwent isolated CABG from January 2015 to May 2017 were included in the multicentre European Coronary Artery Bypass Grafting registry. The postoperative bleeding risk was estimated using the WILL-BLEED risk score. Of all included patients, 3,548 had an increased risk of severe perioperative bleeding (defined as a WILL-BLEED score ≥4) and were the subjects of this analysis. We compared the early outcomes between patients who underwent on-pump or off-pump CABG using a multivariate mixed model for risk-adjusted analysis. RESULTS Off-pump surgery was performed in 721 patients (20.3%). On-pump patients received more packed red blood cell units (on-pump: 1.41 [95% confidence interval {CI}, 0.99-1.86]; off-pump: 0.86 [95% CI, 0.64-1.08]; p<0.001), had a longer stay in the intensive care unit (on-pump: 4.4 [95% CI, 3.6-8.1] days; off-pump: 3.2 [95% CI, 2.0-4.4] days; p=0.049), and a higher rate of postoperative atrial fibrillation (on-pump: 46.5% [95% CI, 34.9-58.1]; off-pump: 31.3% [95% CI, 21.7-40.9]; p=0.025). Furthermore, on-pump patients showed a trend towards a higher rate of postoperative stroke (on-pump: 2.4% [95% CI, 0.9-4.1]; off-pump: 1.1 [95% CI 0.2-2.7]; p=0.094). CONCLUSION Our data suggest that in patients with an increased risk of bleeding, the use of cardiopulmonary bypass is associated with higher morbidity. These patients may benefit from off-pump surgery if complete revascularisation can be ensured.
Collapse
Affiliation(s)
- Till J Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany.
| | - Samira Fehr
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany; Medical Clinic, Israelite Hospital Hamburg, Hamburg, Germany
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Beate Reiter
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Eric Bibiza
- Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardiothoracic and Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Francesco Onorati
- Department of Cardiac Surgery, Verona University Hospital, Verona, Italy
| | - Giuseppe Faggian
- Department of Cardiac Surgery, Verona University Hospital, Verona, Italy
| | - Antonio Salsano
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Francesco Santini
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Giuseppe Santarpino
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy; Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy; Department of Cardiac Surgery, Klinikum Nu¨rnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico - Fondazione Monzino IRCCS, Milan, Italy
| | - Matteo Saccocci
- Department of Cardiac Surgery, Centro Cardiologico - Fondazione Monzino IRCCS, Milan, Italy
| | - Francesco Musumeci
- Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy
| | - Antonino S Rubino
- Cardiac Surgery Unit, Ferrarotto Hospital, University of Catania, Catania, Italy; Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marisa De Feo
- Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ciro Bancone
- Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Magnus Dalén
- Department of Molecular Medicine and Surgery, and Department of Cardiothoracic Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Daniele Maselli
- Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
| | - Karl Bounader
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Timo Mäkikallio
- Division of Cardiology, Department of Internal Medicine, University Hospital of Oulu, Oulu, Finland
| | - Tatu Juvonen
- Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Vito G Ruggieri
- Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
| | - Fausto Biancari
- Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Department of Surgery, University of Turku, Turku, Finland
| |
Collapse
|
20
|
Challenges in Patient Blood Management for Cardiac Surgery: A Narrative Review. J Clin Med 2021; 10:jcm10112454. [PMID: 34205971 PMCID: PMC8198483 DOI: 10.3390/jcm10112454] [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: 03/31/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
About 15 years ago, Patient Blood Management (PBM) emerged as a new paradigm in perioperative medicine and rapidly found support of all major medical societies and government bodies. Blood products are precious, scarce and expensive and their use is frequently associated with adverse short- and long-term outcomes. Recommendations and guidelines on the topic are published in an increasing rate. The concept aims at using an evidence-based approach to rationalize transfusion practices by optimizing the patient's red blood cell mass in the pre-, intra- and postoperative periods. However, elegant as a concept, the implementation of a PBM program on an institutional level or even in a single surgical discipline like cardiac surgery, can be easier said than done. Many barriers, such as dogmatic ideas, logistics and lack of support from the medical and administrative departments need to be overcome and each center must find solutions to their specific problems. In this paper we present a narrative overview of the challenges and updated recommendations for the implementation of a PBM program in cardiac surgery.
Collapse
|
21
|
Bonacchi M, Howe R, Micali LR, Weigel D, Parise O, Parise G, Gelsomino S. Off-Pump Coronary Artery Bypass Reduces Cardiac Death in Patients with Peripheral Arteriopathy. Thorac Cardiovasc Surg 2021; 69:614-620. [PMID: 33626589 DOI: 10.1055/s-0041-1724036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether the use of off-pump coronary artery bypass (OPCAB) may enhance early outcomes in subjects with peripheral artery disease (PAD) undergoing coronary artery bypass grafting (CABG). METHODS We employed a propensity-score (PS) method to compare early postoperative results of OPCAB and on-pump CABG patients with associated PAD. The study population consisted of 1,961 patients: 284 in the OPCAB and 1,677 in the on-pump CABG group. The inverse probability of treatment weighting was used as PS method. RESULTS The incidence of death (1.2% [95% confidence interval, CI: -0.9 to 3.3%], p = 0.262), stroke (2.2% [95% CI: -1.4 to 5.7%], p = 0.235), acute kidney disease (1.5% [95% CI: -3.8 to 6.8%], p = 0.586), limb ischemia (3.2% [95% CI: -0.6 to 7.0%], p = 0.315), and low output syndrome (1.2% [95% CI: -0.9 to 3.3%], p = 0.262) did not differ between the two groups. On the other hand, the rate of cardiac death (1.2% [95% CI: -0.1 to 2.3%], p = 0.038) was significantly higher in on-pump CABG group. CONCLUSIONS The OPCAB procedure considerably reduced the occurrence of cardiac death after coronary revascularization. This finding might suggest that the OPCAB procedure should be considered as the first option in patients with higher cardiovascular risk scores. Further research is warranted.
Collapse
Affiliation(s)
- Massimo Bonacchi
- Cardiac Surgery, University Hospital Careggi, Firenze, Toscana, Italy.,Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - Rosemary Howe
- Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - Linda Renata Micali
- Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - Daniel Weigel
- Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - Orlando Parise
- Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - Gianmarco Parise
- Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - Sandro Gelsomino
- Cardiac Surgery, University Hospital Careggi, Firenze, Toscana, Italy
| |
Collapse
|
22
|
Wahl S. Cardiac Surgery: Beyond Conventional Sternotomy With Cardiopulmonary Bypass. Crit Care Nurse 2020; 40:66-73. [PMID: 32006037 DOI: 10.4037/ccn2020258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Minimally invasive cardiac surgery options, which originated with off-pump coronary artery bypass grafting and aortic valve procedures, continue to evolve in order to address complex conditions, including those requiring mitral and tricuspid valve repair. Although these procedures are primarily indicated for high-risk patient populations, favorable patient outcomes have resulted in recommendations being expanded to include intermediate-risk groups. This article increases nursing-related knowledge of minimally invasive cardiac procedures, providing an overview of current minimally invasive cardiac surgeries and their associated risks and benefits.
Collapse
Affiliation(s)
- Sharon Wahl
- Sharon Wahl is a clinical nurse specialist at Abbott Northwestern Hospital, Minneapolis, Minnesota
| |
Collapse
|
23
|
Yavuz F, Kilic S, Kaplan M, Yıldırım A, Kucukosmanoglu M, Dogdus M. Impact of Atherogenic Indexes in Saphenous Vein Graft Stenosis. Arq Bras Cardiol 2020; 115:538-544. [PMID: 33027378 PMCID: PMC9363077 DOI: 10.36660/abc.20190683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/27/2019] [Indexed: 11/23/2022] Open
Abstract
Fundamento Os enxertos de veias safenas (EVS) são frequentemente usados em pacientes submetidos a cirurgia de revascularização do miocárdio (CRM). Objetivos Avaliar as relações entre índices aterogênicos e estenose de EVS. Métodos: No total, 534 pacientes (27,7% mulheres, com idade média de 65±8,4 anos) submetidos a CRM e angiografia coronariana eletiva foram incluídos no estudo. Pacientes com pelo menos uma estenose EVS ≥50% foram alocados ao grupo estenose EVS (+) (n=259) e pacientes sem estenose foram classificados como EVS (-) (n=275). O índice aterogênico plasmático (IAP) e o coeficiente aterogênico (CA) foram calculados a partir dos parâmetros lipídicos de rotina dos pacientes. A significância foi estabelecida no nível p<0,05. Resultados O número de pacientes com histórico de hipertensão (HT), diabetes mellitus (DM), acidente vascular cerebral e insuficiência cardíaca (IC) se mostrou significativamente maior no grupo EVS (+) do que no grupo EVS (-). O colesterol total, triglicerídeos e colesterol LDL mostraram-se significativamente mais altos e o colesterol HDL mostrou-se menor no grupo EVS (+) do que no grupo EVS (-). IAP (p<0,001) e CA (p<0,001) apresentaram-se significativamente mais altos no grupo EVS (+) do que no grupo EVS (-). A análise ROC mostra que tanto o IAP quanto o CA mostraram-se melhores que o colesterol HDL, colesterol LDL e colesterol não HDL na predição de estenose de EVS. Na análise multivariada, histórico de DM, HT, acidente vascular cerebral, IC, número de enxertos de safena, colesterol HDL, colesterol LDL, colesterol não HDL, IAP e CA foram fatores de risco independentes para estenose de EVS. Conclusão O IAP e o CA foram preditores independentes de estenose de EVS. Além disso, tanto o IAP quanto o CA têm melhor desempenho na predição de estenose de EVS do que o colesterol LDL, colesterol HDL e colesterol não HDL. (Arq Bras Cardiol. 2020; 115(3):538-544)
Collapse
Affiliation(s)
- Fethi Yavuz
- Health Sciences University, Adana Research and Training Hospital, Department of Cardiology, Adana - Turquia
| | - Salih Kilic
- Health Sciences University, Adana Research and Training Hospital, Department of Cardiology, Adana - Turquia
| | - Mehmet Kaplan
- Health Sciences University, Adana Research and Training Hospital, Department of Cardiology, Adana - Turquia
| | - Arafat Yıldırım
- Health Sciences University, Adana Research and Training Hospital, Department of Cardiology, Adana - Turquia
| | - Mehmet Kucukosmanoglu
- Health Sciences University, Adana Research and Training Hospital, Department of Cardiology, Adana - Turquia
| | - Mustafa Dogdus
- Uşak University Research and Training Hospital, Department of Cardiology, Uşak - Turquia
| |
Collapse
|
24
|
Mauldon H, Dieberg G, Smart N, King N. Effect of Age on Clinical Outcomes Following On-/Off-Pump Coronary Artery Bypass: Meta-Analysis and Meta-Regression. Braz J Cardiovasc Surg 2020; 35:797-814. [PMID: 33118746 PMCID: PMC7598957 DOI: 10.21470/1678-9741-2018-0388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective There is currently much debate about which patients would benefit more after on- or off-pump coronary artery bypass grafting (CABG). The aim of this meta-analysis and meta-regression is to investigate the effect of age on short-term clinical outcomes after these approaches. Methods To identify potential studies, systematic searches were carried out in the Excerpta Medica dataBASE (EMBASE), PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL). The search strategy included the key concepts of “cardiopulmonary bypass” AND “coronary artery bypass grafting” AND “off pump” OR “on pump”. This was followed by a meta-analysis and meta-regression investigating the effect of age on the incidences of stroke, myocardial infarction (MI), and mortality. Results Thirty-seven studies including 15,324 participants were analysed. Overall, there was a significant odds reduction for patients receiving off-pump CABG suffering a stroke (odds ratio [OR] 0.770, 95% confidence intervals [CI] 0.594, 0.998, P=0.048); however, when patients were subdivided according to different age bands, this difference disappeared. There were also no significant differences in the odds of mortality (OR 0.876, 95% CI 0.703, 1.093, P=0.241) or MI (OR 0.937, 95% CI 0.795, 1.105, P=0.439). Meta-regression analysis revealed no significant relationship between age and stroke (P=0.652), age and mortality (P=548), and age and MI (P=0.464). Conclusion Patients undergoing CABG are becoming older and may suffer from multiple comorbidities increasing their risk profile. However, with respect to short-term clinical outcomes, the patient’s age does not help in determining whether off- or on-pump is superior.
Collapse
Affiliation(s)
- Hayley Mauldon
- University of Plymouth Ringgold Standard Institution Plymouth United Kingdom of Great Britain and Northern Ireland University of Plymouth, Ringgold Standard Institution, Plymouth, United Kingdom of Great Britain and Northern Ireland
| | - Gudrun Dieberg
- University of New England Ringgold Standard Institution Armidale Australia University of New England, Ringgold Standard Institution, Armidale, Australia
| | - Neil Smart
- University of New England Ringgold Standard Institution Armidale Australia University of New England, Ringgold Standard Institution, Armidale, Australia
| | - Nicola King
- University of Plymouth Ringgold Standard Institution Plymouth United Kingdom of Great Britain and Northern Ireland University of Plymouth, Ringgold Standard Institution, Plymouth, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
25
|
Yang L, Lin S, Zhang H, Gu D, Chen S, Shi Y, Zheng Z. Long-Term Graft Patency After Off-Pump and On-Pump Coronary Artery Bypass: A CORONARY Trial Cohort. Ann Thorac Surg 2020; 110:2055-2061. [PMID: 32339504 DOI: 10.1016/j.athoracsur.2020.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/23/2020] [Accepted: 03/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Randomized controlled trials have compared the early and midterm prognosis of on-pump coronary artery bypass grafting (CABG) and off-pump CABG. However the results are controversial, and there is limited information on graft patency and long-term outcomes. METHODS Between May 2007 and October 2011, 349 patients were randomized to off-pump or on-pump CABG as part of the CORONARY trial at Fuwai Hospital. The primary outcome was coronary bypass graft patency, which was assessed at a mean of 6.7 ± 1.7 years after surgery by multidetector computed tomography. A secondary endpoint was a composite outcome of death, nonfatal myocardial infarction, repeat coronary revascularization, or stroke; mean follow-up was 6.5 ± 1.7 years. Graft patency was compared between the off-pump and on-pump CABG treatment arms in 206 patients with follow-up computed tomography. RESULTS During the follow-up period 107 patients were in the off-pump CABG group and 99 in the on-pump group. These patients underwent a total of 723 grafts, and the overall rate of graft patency did not differ significantly between the off-pump and on-pump groups (87.4% vs 88.9%, P = .527). The patency rate of the posterior descending branch was lower than average. Higher incidences of mortality, nonfatal myocardial infarction, and repeat revascularization were found in the off-pump patients; however it did not reach significance. CONCLUSIONS There were no statistical differences in graft patency rates in off-pump versus on-pump CABG patients during long-term follow-up. The on-pump CABG group appeared to have a better long-term prognosis even with no statistical differences for the limited study population.
Collapse
Affiliation(s)
- Limeng Yang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shen Lin
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Heng Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dachuan Gu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Sipeng Chen
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ye Shi
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| |
Collapse
|
26
|
Lin S, Rao C, Yang L, Yang X, Feng W, Sun H, Zheng Z. Impact of coronary total occlusion on graft failure and outcomes of coronary artery bypass grafting. J Thorac Cardiovasc Surg 2020; 163:1349-1357.e5. [PMID: 32499074 DOI: 10.1016/j.jtcvs.2020.04.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study objective was to assess the impact of chronic total occlusion on long-term graft failure and outcomes in patients who underwent coronary artery bypass grafting. METHODS We conducted an observational study involving a single-center subgroup of the CORONARY trial. At 6 to 9 years after coronary artery bypass grafting, all alive patients were invited for coronary computed tomography angiography and clinical follow-up. We assessed the association between chronic total occlusion graft and failing graft showing Fitzgibbon type B or O. Risk factors associated with chronic total occlusion graft failure were assessed. The impact of chronic total occlusion on clinical outcomes was analyzed, including death, myocardial infarction, and repeated revascularization. RESULTS A total of 349 patients undergoing coronary artery bypass grafting were enrolled between May 2007 and October 2011. Of 301 alive patients at follow-up time (median, 6.8 years; interquartile range, 6.0-8.0 years), repeat coronary computed tomography angiography was performed in 206 patients (68.4%) with 723 grafts (154 chronic total occlusion grafts and 569 nonchronic total occlusion grafts). Chronic total occlusion graft was significantly associated with an increased risk of long-term graft failure after adjustment for patient- and graft-level characteristics (adjusted odds ratio, 2.27; 95% confidence interval, 1.42-3.62; P < .001). Arterial graft, side-to-side anastomosis, higher graft flow, and antiplatelet therapy at discharge were associated with chronic total occlusion graft patency. The presence of 1 or more chronic total occlusions was not significantly associated with long-term composite of death, myocardial infarction, or repeat revascularization (adjusted hazard ratio, 0.91; 95% confidence interval, 0.54-1.51; P = .707). CONCLUSIONS Chronic total occlusion graft was associated with an increased risk of graft failure. Surgical technique and guideline-directed medical therapy should be noted to improve chronic total occlusion graft patency.
Collapse
Affiliation(s)
- Shen Lin
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chenfei Rao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Limeng Yang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xupeng Yang
- Department of Cardiovascular Surgery, Beijing Tsinghua Changgung Hospital, Beijing, People's Republic of China
| | - Wei Feng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hansong Sun
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| |
Collapse
|
27
|
Kowalewski M, Jasiński M, Staromłyński J, Zembala M, Widenka K, Brykczyński M, Skiba J, Zembala M, Bartuś K, Hirnle T, Dziembowska I, Knapik P, Tobota Z, Maruszewski B, Suwalski P. On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK). PLoS One 2020; 15:e0231950. [PMID: 32320434 PMCID: PMC7176119 DOI: 10.1371/journal.pone.0231950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background No single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive. Methods and findings Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Of initial 188,972 patients undergoing CABG, 7,913 presented with baseline AF (76.0% men, mean age 69.1±8.2) and underwent CABG without concomitant valve surgery between 2006–2019 in 37 reference centers across Poland. Mean follow-up was 4.7±3.5 years (median 4.3 IQR 1.7–7.4). Cox proportional hazards models were used for computations. Of included patients, 3,681 underwent On-Pump- (46.52%) as compared to 4,232 (53.48%) who underwent Off-Pump CABG. Patients in the latter group less frequently were candidates for complete revascularization (P<0.001). In an unadjusted comparison, On-Pump surgery was associated with significantly worse survival at 30 days: HR: 1.28; 95%CIs: (1.07–1.53); P = 0.007. Along the 13-year study period, the trend shifted in favor of On-Pump CABG: HR: 0.92; 95%CIs: (0.83–0.99); P = 0.005. After rigorous propensity matching, 636 pairs were identified. The direction and magnitude of treatment effects was sustained with HRs of 3.58; (95%CIs: 1.34–9.61); p = 0.001 and 0.74; [95%CIs: 0.56–0.98]; p = 0.036) for 30-day and late mortality respectively. Conclusions Off-Pump CABG offered 30-day survival benefit to patients undergoing CABG surgery and presenting with underlying AF. On-Pump CABG was associated with significantly improved survival at long term.
Collapse
Affiliation(s)
- Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
- * E-mail:
| | - Marek Jasiński
- Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Staromłyński
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marian Zembala
- Department of Cardiac, School of Medicine with the Division of Dentistry in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
- Division of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Center for Heart Disease, Zabrze, Poland
| | - Kazimierz Widenka
- Clinical Department of Cardiac Surgery, District Hospital no. 2, University of Rzeszów, Poland
| | | | - Jacek Skiba
- Department of Cardiac Surgery, 4 Military Clinical Hospital Centre for Heart Diseases, Wroclaw, Poland
| | - Michał Zembala
- Department of Cardiac, School of Medicine with the Division of Dentistry in Zabrze, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
- Division of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Center for Heart Disease, Zabrze, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Tomasz Hirnle
- Department of Cardiosurgery, Medical University of Bialystok, Bialystok, Poland
| | - Inga Dziembowska
- Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Piotr Knapik
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Zdzisław Tobota
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
| | - Bohdan Maruszewski
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | |
Collapse
|
28
|
Meybohm P, Westphal S, Ravn HB, Ranucci M, Agarwal S, Choorapoikayil S, Spahn DR, Ahmed AB, Froessler B, Zacharowski K. Perioperative Anemia Management as Part of PBM in Cardiac Surgery – A Narrative Updated Review. J Cardiothorac Vasc Anesth 2020; 34:1060-1073. [DOI: 10.1053/j.jvca.2019.06.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/18/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022]
|
29
|
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]
|
30
|
Wang D, Liu Y, Chen Z, Yang F, Zhang Z, Wei Y. Impact of diabetes mellitus on coagulation function before and after off-pump coronary artery bypass grafting. J Thorac Dis 2020; 11:5517-5526. [PMID: 32030271 DOI: 10.21037/jtd.2019.11.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background This study aims to explore the influence of off-pump coronary artery bypass grafting (OPCABG) on coagulation function and the effects of diabetes on coagulation function during OPCABG. Methods Patients who met the inclusion and exclusion criteria were divided into two groups: diabetes mellitus (DM) and non-diabetes mellitus (NDM) groups. Thromboelastography (TEG) was tested at the following time points: T0, five days after aspirin and clopidogrel therapy, and before OPCABG; T1, returning to care unit after OPCABG; T2, 5 days after aspirin and clopidogrel therapy, and after OPCABG. Results A total of 56 patients were involved. There were no deaths, or no early postoperative thrombotic events and abnormal bleeding after OPCABG. Intra-group comparison: Compared with T0, the R and K value decreased, while the α angle and MA value increased at T1 and T2, in both groups (P<0.05). A significantly statistical difference was found in the multiple comparison at T0, T1 and T2 (P<0.05). The results are as follows: the R value decreased at T1 and increased at T2, but the value remained less than that at T0. After the OPCABG, the K value gradually decreased, while the MA value and α angle gradually increased. Comparison between groups: T1: the R values were lower in the DM group, when compared to the NDM group (t=3.611, P=0.001). The differences in the MA, K and α angle were not statistically significant. T0 and T2: there were no statistically difference in the R, MA, K, α angle and LY30 between the two groups (P>0.05). Conclusions The coagulation function of patients was at a hypercoagulable state at the early stage after OPCABG. The coagulation function was affected by diabetes at the day of OPCABG. However, there was no statistical difference after 5 days of aspirin and clopidogrel therapy following OPCABG.
Collapse
Affiliation(s)
- Dawei Wang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
| | - Yu Liu
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Ziying Chen
- Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Fei Yang
- Department of Medical Imaging, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
| | - Zhenming Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
| | - Yulei Wei
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
| |
Collapse
|
31
|
Li Z, Liu L. Patency of Individual and Sequential Coronary Artery Bypass in Patients with Ischemic Heart Disease: A Meta-analysis. Braz J Cardiovasc Surg 2019; 34:420-427. [PMID: 31165611 PMCID: PMC6713377 DOI: 10.21470/1678-9741-2018-0284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the patency of individual and sequential coronary artery bypass
in patients with ischemic heart disease. Methods We searched PubMed, Cochrane Library, Excerpta Medica Database, and
ClinicalTrials.gov databases for controlled trials. Endpoints included graft
patency, anastomosis patency, occluded rates in left anterior descending
(LAD) system and right coronary artery (RCA) system, in-hospital mortality,
and follow-up mortality. Pooled risk ratios (RRs) and standardized mean
difference (SMD) were used to assess the relative data. Results Nine cohorts, including 7100 patients and 1440 grafts under individual or
sequential coronary artery bypass. There were no significant differences
between individual and sequential coronary artery bypass in the graft
patency (RR=0.96; 95% CI=0.91-1.02; P=0.16;
I2=87%), anastomosis patency (RR=0.95; 95%
CI=0.91-1.00; P=0.05; I2=70%),
occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16;
P=0.58; I2=37%), occluded rate
in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35;
I2=95%), in-hospital mortality (RR=1.57; 95%
CI=0.92-2.69; P=0.10; I2=0%),
and follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93;
I2=0%). Conclusion No significant differences on clinical data were observed regarding
anastomosis patency, occluded rate in LAD system, occluded rate in RCA
system, in-hospital mortality, and follow-up mortality, indicating that the
patency of individual and the patency of sequential coronary artery bypass
are similar to each other.
Collapse
Affiliation(s)
- Zeshu Li
- Shandong Provincial PKUcare Luzhong Hospital Department of Thoracic and Cardiovascular Surgery Zibo Shandong People's Republic of China Department of Thoracic and Cardiovascular Surgery, Shandong Provincial PKUcare Luzhong Hospital, Zibo, Shandong, People's Republic of China.,Shandong University Shandong Provincial Qianfoshan Hospital Department of Cardiac Surgery Jinan Shandong People's Republic of China Department of Cardiac Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Luqi Liu
- Shandong University Shandong Provincial Qianfoshan Hospital Department of Cardiac Surgery Jinan Shandong People's Republic of China Department of Cardiac Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| |
Collapse
|
32
|
Benedetto U, Puskas J, Kappetein AP, Brown WM, Horkay F, Boonstra PW, Bogáts G, Noiseux N, Dressler O, Angelini GD, Stone GW, Serruys PW, Sabik JF, Taggart DP. Off-Pump Versus On-Pump Bypass Surgery for Left Main Coronary Artery Disease. J Am Coll Cardiol 2019; 74:729-740. [PMID: 31395122 DOI: 10.1016/j.jacc.2019.05.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/13/2019] [Accepted: 05/29/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Concerns remain for a greater risk of incomplete revascularization and reduced survival with off-pump coronary artery bypass grafting (CABG) surgery compared with on-pump surgery particularly in patients with left main disease and extensive underlying myocardial ischemia. OBJECTIVES This study sought to compare outcomes following off-pump versus on-pump surgery for left main disease by performing a post hoc analysis from the multicenter, randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. METHODS The EXCEL trial was designed to compare percutaneous coronary intervention with everolimus-eluting stents versus CABG in patients with left main disease. CABG was performed with or without cardiopulmonary bypass (on-pump vs. off-pump surgery) according to the discretion of the operator. The 3-year outcomes in the off-pump and on-pump groups were compared using inverse probability of treatment weighting (IPTW) for treatment effect estimation. RESULTS Among 923 CABG patients, 652 and 271 patients underwent on-pump and off-pump surgery, respectively. Despite a similar extent of disease, off-pump surgery was associated with a lower rate of revascularization of the left circumflex coronary artery (84.1% vs. 90.0%; p = 0.01) and right coronary artery (31.1% vs. 40.6%; p = 0.007). After IPTW adjustment for baseline differences, off-pump surgery was associated with a significantly increased risk of 3-year all-cause death (8.8% vs. 4.5%; hazard ratio: 1.94; 95% confidence interval: 1.10 to 3.41; p = 0.02) and a nonsignificant difference in the risk for the composite endpoint of death, myocardial infarction, or stroke (11.8% vs. 9.2%; hazard ratio: 1.28; 95% confidence interval: 0.82 to 2.00; p = 0.28). CONCLUSIONS Among patients with left main disease treated with CABG in the EXCEL trial, off-pump surgery was associated with a lower rate of revascularization of the coronary arteries supplying the inferolateral wall and an increased risk of 3-year all-cause death compared with on-pump surgery.
Collapse
Affiliation(s)
| | - John Puskas
- Mount Sinai Saint Luke's Hospital, New York, New York
| | | | | | | | | | | | | | | | | | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York. https://twitter.com/GreggWStone
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom
| | - Joseph F Sabik
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | |
Collapse
|
33
|
Register oder randomisierte Studien. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2019. [DOI: 10.1007/s00398-018-0258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
34
|
Effect of octopus tissue stabilizer on cardiac output during off-pump coronary artery bypass graft surgery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 16:69-73. [PMID: 31410093 PMCID: PMC6690156 DOI: 10.5114/kitp.2019.86358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/28/2019] [Indexed: 12/04/2022]
Abstract
Introduction Significant hemodynamic derangements can occur during off-pump coronary artery bypass graft (OPCAB) surgery resulting from the displacement of the beating heart, which may necessitate conversion to on-pump surgery. Aim We proposed to evaluate the alterations in hemodynamic parameters in patients during the course of anastomosis in OPCAB surgery using the Octopus tissue stabilizer. Material and methods In 100 consecutive patients undergoing OPCAB surgery, hemodynamic variables including cardiac output (CO), heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were recorded at baseline, during each coronary artery anastomosis at 2 min, 10 min and after release of the Octopus tissue stabilizer. Results CO decreased significantly after target stabilization and during all coronary anastomoses (5.42 ±1.1 l/min at baseline, 4.26 ±1.02 l/min at 2 min and 3.92 ±0.98 l/min at 10 min; p < 0.001), with the greatest decrease noted during obtuse marginal (OM) branch of left circumflex artery anastomosis (3.67 ±0.86 l/min at 2 min and 3.38 ±0.78 l/min at 10 min). Inotropic drugs were required to maintain mean arterial pressure (MAP) > 60 mm Hg in 43 patients, which was most frequently noted during OM anastomosis (p < 0.001). The incidence of bradycardia requiring inotropes was noted to be the highest during left anterior descending (LAD) artery anastomosis (p = 0.002). Conclusions During OPCAB surgery using the Octopus for coronary target stabilization, CO decreased the most during OM anastomosis requiring inotropes, while bradycardia was most frequent during LAD anastomosis. Careful monitoring and management of hemodynamic variables are therefore of utmost importance to avoid conversion to on-pump surgery.
Collapse
|
35
|
|
36
|
Matkovic M, Tutus V, Bilbija I, Milin Lazovic J, Savic M, Cubrilo M, Aleksic N, Atanasijevic I, Andrijasevic V, Putnik S. Long Term Outcomes of The Off-Pump and On-Pump Coronary Artery Bypass Grafting In A High-Volume Center. Sci Rep 2019; 9:8567. [PMID: 31189989 PMCID: PMC6561934 DOI: 10.1038/s41598-019-45093-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/29/2019] [Indexed: 12/25/2022] Open
Abstract
Coronary artery bypass grafting (CABG) remains the most frequent surgery in the practice of an adult cardiac surgeon and the most frequently performed cardiac surgical procedure worldwide. Despite the ongoing debates regarding the superiority or inferiority of off-pump coronary artery bypass grafting, it still comprises 15-30% of all CABG cases varying in different national registries. We performed a propensity matched study of 302 consecutive CABG patients,143 off -pump cases performed by the four experienced off-pump surgeons and the on-pump CABG cases performed by those surgeons and four other experienced coronary surgeons. The five year follow up was performed and data collected comprised of mortality, rehospitalization due to cardiac origin, repeated revascularization, myocardial infarction and cerebrovascular accident. Overall, the off-pump group of patients had a higher risk profile than the patients in the on-pump group. After matching, fewer differences were found between the groups. Propensity score matching analysis showed no difference in long-term survival as well as MACCE and repeated revascularization. The higher risk profile of the patients subjected to OPCAB and the comparable survival to lower risk CPB patients in this series indicate that in experienced hands, OPCAB is a valuable option in this important subgroup of patients.
Collapse
Affiliation(s)
- Milos Matkovic
- Department for Cardiac surgery, Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia.
| | - Vladimir Tutus
- Department for Anesthesiology and Intensive care, Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia
| | - Ilija Bilbija
- Department for Cardiac surgery, Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica 15, 11000, Belgrade, Serbia
| | - Jelena Milin Lazovic
- Department for Biostatistics, Faculty of Medicine, University of Belgrade, Doktora Subotica 15, 11000, Belgrade, Serbia
| | - Marko Savic
- Department for Biostatistics, Faculty of Medicine, University of Belgrade, Doktora Subotica 15, 11000, Belgrade, Serbia
| | - Marko Cubrilo
- Department for Cardiac surgery, Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia
| | - Nemanja Aleksic
- Department for Cardiac surgery, Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia
| | - Igor Atanasijevic
- Institute for Cardiovascular diseases Dedinje, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Vuk Andrijasevic
- Department for Cardiac surgery, Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia
| | - Svetozar Putnik
- Department for Cardiac surgery, Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Doktora Subotica 15, 11000, Belgrade, Serbia
| |
Collapse
|
37
|
Wei H, Chai S, Liu C, Huang X, Gu C. Left Ventricular Aneurysm Repair: Off-pump Linear Plication versus On-pump Patch Plasty. Braz J Cardiovasc Surg 2019; 34:187-193. [PMID: 30916129 PMCID: PMC6436783 DOI: 10.21470/1678-9741-2018-0366] [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: 10/16/2018] [Accepted: 12/17/2018] [Indexed: 11/25/2022] Open
Abstract
Objective The study aimed to compare the clinical outcomes of simplified linear
plication and classic patch plasty in patients with left ventricular
aneurysm (LVA). Methods We retrospectively reviewed 282 patients undergoing LVA repair between 2006
and 2016. After propensity score matching, 45 pairs of patients receiving
LVA surgery were divided into either a patch group (on-pump endoventricular
patch plasty) or a plication group (off-pump linear plication). Then, their
early surgical outcomes and long-term survival were compared in two matched
groups. Results The heart function improvement at discharge was similar in the two matched
groups, while patients in the patch group more commonly suffered from low
cardiac output syndrome (P=0.042) with higher proportion of
intra-aortic balloon pumping assistance (P=0.034) than
patients in the plication group. Compared with patients in the patch group,
the patients in the plication group had shorter recovery times, regarding to
mechanical ventilation, intensive care unit stay, and hospital stay
(P<0.001, P<0.001, and
P=0.001, respectively). No significant difference was
found in the long-term survival (P=0.62). Conclusions Off-pump linear plication presented acceptable results in terms of early
outcomes and long-term survival. For high-risk patients, the simplified LVA
repair technique may be an option.
Collapse
Affiliation(s)
- Hua Wei
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Shoudong Chai
- Department of Cardiac Surgery, Liaocheng People's Hospital, Clinical School of Taishan Medical University, Shandong, China
| | - Changcheng Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xinsheng Huang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| |
Collapse
|
38
|
Gaudino MFL, Spadaccio C, Taggart DP. State-of-the-Art Coronary Artery Bypass Grafting: Patient Selection, Graft Selection, and Optimizing Outcomes. Interv Cardiol Clin 2019; 8:173-198. [PMID: 30832941 DOI: 10.1016/j.iccl.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite the progressive expansion of clinical indications for percutaneous coronary intervention and the increasingly high risk profile of referred patients, coronary artery bypass grafting (CABG) remains the mainstay in multivessel disease, providing good long-term outcomes with low complication rates. Multiple arterial grafting, especially if associated with anaortic techniques, might provide the best longer-term outcomes. A surgical approach individualized to the patients' clinical and anatomic characteristics, and surgeon and team experience, are key to excellent outcomes. Current evidence regarding patient selection, indications, graft selection, and potential strategies to optimize outcomes in patients treated with CABG is summarized.
Collapse
Affiliation(s)
- Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10021, USA.
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow G81 4DY, UK; University of Glasgow, Institute of Cardiovascular and Medical Sciences, 126 University Place, Glasgow G128TA, UK
| | - David P Taggart
- Department of Cardiovascular Surgery, University of Oxford, Headley Way, Oxford, Oxforshire OX39DU, UK; Department Cardiac Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, Oxfordshire OX3 9DU, UK
| |
Collapse
|
39
|
To Pump or not to pump? CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
40
|
Tena MÁ, Urso S, Martínez-Comendador JM, Bellot R, Gutiérrez EM, González JM, Sadaba R, Meca J, Ríos L, Abad C, Portela F. Cirugía coronaria sin bomba: revisión sistemática contemporánea y metaanálisis de sus resultados respecto a la cirugía con circulación extracorpórea. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
41
|
Thakur U, Nerlekar N, Muthalaly RG, Comella A, Wong NC, Cameron JD, Harper RW, Smith JA, Brown AJ. Off- vs. On-Pump Coronary Artery Bypass Grafting Long-Term Survival is Driven by Incompleteness of Revascularisation. Heart Lung Circ 2019; 29:149-155. [PMID: 30686645 DOI: 10.1016/j.hlc.2018.11.019] [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: 09/29/2018] [Accepted: 11/30/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Off-pump coronary artery bypass grafting (CABG) negates the requirement for extracorporeal circulation used with the traditional on-pump approach. However, off-pump CABG is technically more challenging and may theoretically lead to less complete revascularisation. Recent data suggests a prognostic benefit for traditional on-pump CABG, but the mechanism for this remains unclear. We hypothesised that the inferior outcomes with off-pump CABG could be driven by the need for repeat revascularisation, with this benefit only becoming clear at long-term follow-up. We therefore evaluated short, medium and long-term outcomes of patients undergoing revascularisation with on vs. off-pump CABG. METHODS Electronic databases were searched to identify suitable randomised controlled trials enrolling ≥100 patients in each arm. Clinical outcomes were extracted at 30-days, 12-months or >4years. The primary outcome was long-term all-cause death, while secondary outcomes included 30-day, 12-month and >4-year cardiac death, stroke, myocardial infarction or revascularisation. RESULTS Thirteen (13) studies comprising 13,234 patients were included. Off-pump CABG was associated with an increased risk of all-cause death (Odds Ratio [OR] 1.18, 95% confidence interval [CI] 1.02-1.32, p=0.01) and repeat bypass surgery (OR 2.57, 95%CI 1.23-5.39, p=0.01) at long-term follow-up. A significant, increased requirement for revascularisation in off-pump was seen at 12-month follow-up (OR 1.59, 95%CI 1.09-2.33, p=0.02). No differences were noted between groups at 30-days, 12-months and >4years for myocardial infarction or stroke. CONCLUSIONS Off-pump CABG is associated with significantly higher rates of all-cause mortality rate at long-term follow-up. These outcomes demonstrate a temporal relationship that may be driven by a greater requirement for repeat revascularisation at 1- and 5-year follow-up. STUDY REGISTRATION CRD42018102019 (PROSPERO).
Collapse
Affiliation(s)
- Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia; Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Vic, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia
| | - Rahul G Muthalaly
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia; Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Vic, Australia
| | - Andrea Comella
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia; Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Vic, Australia
| | - Nathan C Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia; Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Vic, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia
| | - Richard W Harper
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia; Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Vic, Australia
| | - Julian A Smith
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia; Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Vic, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia.
| |
Collapse
|
42
|
Cuminetti G, Bonadei I, Vizzardi E, Sciatti E, Lorusso R. On-Pump Coronary Artery Bypass Graft: The State of the Art. Rev Recent Clin Trials 2019; 14:106-115. [PMID: 30836924 DOI: 10.2174/1574887114666190301142114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/21/2017] [Accepted: 12/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) remains the standard of care for patients with coronary artery disease (CAD). Debate exists concerning several factors, which include percutaneous coronary intervention (PCI) vs. CABG, single vs. bilateral mammary artery grafts, radial artery vs. saphenous vein grafts, right internal mammary artery vs. radial artery grafts, endoscopic vs. open vein-graft harvesting, and on-pump vs. off- pump surgery. Moreover, challenging is the management of diabetic patients with CAD undergoing CABG. This review reports current indications, practice patterns, and outcomes of CABG. METHODS Randomized controlled trials comparing CABG to other therapeutical strategies for CAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. RESULTS Large multicenter randomized and observational studies (SYNTAX, BEST, PRECOMBAT, ASCERT) have reported excellent outcomes in CABG patients, with always fewer rates of operative mortality and major morbidity, than PCI. The 10-year follow-up of ARTS II trial showed no difference between single and bilateral mammary artery. BARI 2D, MASS II, CARDia, FREEDOM trials showed that CABG is the best choice for diabetic patients. CONCLUSION CABG still represents one of the most widespread major surgeries, with well-known benefits on symptoms and prognosis in patients with CAD. However, further studies and follow-up data are needed to validate these evidences.
Collapse
Affiliation(s)
- Giovanni Cuminetti
- Cardiology Unit, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Ivano Bonadei
- Cardiology Unit, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Edoardo Sciatti
- Cardiology Unit, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| |
Collapse
|
43
|
Gaudino M, Benedetto U, Bakaeen F, Rahouma M, Tam DY, Abouarab A, Di Franco A, Leonard J, Elmously A, Puskas JD, Angelini GD, Girardi LN, Fremes SE, Taggart DP. Off- Versus On-Pump Coronary Surgery and the Effect of Follow-Up Length and Surgeons' Experience: A Meta-Analysis. J Am Heart Assoc 2018; 7:e010034. [PMID: 30373421 PMCID: PMC6404195 DOI: 10.1161/jaha.118.010034] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/27/2018] [Indexed: 12/02/2022]
Abstract
Background The debate on the relative benefits of off-pump and on-pump coronary artery bypass surgery ( OPCABG and ONCABG ) is still open. We aimed to provide an updated and complete summary of the evidence on the differences between OPCABG and ONCABG and to explore whether the length of the follow-up and the surgeons' experience in OPCABG modify the comparative results. Methods and Results All randomized clinical trials comparing OPCABG and ONCABG were included. Primary outcome was follow-up mortality. Secondary outcomes were operative mortality, perioperative stroke, perioperative myocardial infarction, and late repeated revascularization. Subgroup analyses were performed based on the length of the follow-up and the percentage of crossover from the OPCABG group (used as a surrogate of surgeon experience with OPCABG ). One hundred four trials were included (20 627 patients, OPCABG : 10 288; ONCABG : 10 339). Weighted mean follow-up time was 3.7 years (range 1-7.5 years). OPCABG was associated with a higher risk of follow-up mortality (incidence rate ratio 1.11, 95% confidence interval 1.00-1.23, P=0.05). The difference was significant only for trials with mean follow-up of ≥3 years and for studies with a crossover rate of ≥10%. There was a trend toward lower risk of perioperative stroke and higher need for late repeated revascularization in the OPCABG arm. Conclusions OPCABG is associated with a higher incidence of incomplete revascularization, an increased need for repeated revascularization, and decreased midterm survival compared with ONCABG . Surgeon inexperience in OPCABG is associated with late mortality.
Collapse
Affiliation(s)
- Mario Gaudino
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | - Umberto Benedetto
- Bristol Heart InstituteSchool of Clinical SciencesUniversity of BristolUnited Kingdom
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular SurgeryCleveland ClinicClevelandOH
| | - Mohamed Rahouma
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | - Derrick Y. Tam
- Schulich Heart Centre Sunnybrook Health ScienceUniversity of TorontoCanada
| | - Ahmed Abouarab
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | - Antonino Di Franco
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | - Jeremy Leonard
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | - Adham Elmously
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | - John D. Puskas
- Department of Cardiovascular SurgeryIcahn School of Medicine at Mount SinaiNew York CityNY
| | - Gianni D. Angelini
- Bristol Heart InstituteSchool of Clinical SciencesUniversity of BristolUnited Kingdom
| | - Leonard N. Girardi
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | - Stephen E. Fremes
- Schulich Heart Centre Sunnybrook Health ScienceUniversity of TorontoCanada
| | - David P. Taggart
- Nuffield Department of Surgical SciencesUniversity of OxfordUnited Kingdom
| |
Collapse
|
44
|
Tsai MF, Tsay SL, Moser D, Huang TY, Tsai FC. Examining symptom trajectories that predict worse outcomes in post-CABG patients. Eur J Cardiovasc Nurs 2018; 18:204-214. [PMID: 30379108 PMCID: PMC6399732 DOI: 10.1177/1474515118809906] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Coronary artery bypass grafting is one of the most common interventional revascularisation procedures used to treat coronary artery disease worldwide. With a wide variability in postoperative cardiac symptoms, identification of symptom trajectories during the 3-month postoperative recovery period may improve clinicians' abilities to support symptom recovery. AIMS To identify distinct trajectories of cardiac symptoms seen over time in a cohort of patients during the 3-month post-coronary artery bypass grafting period, and determine clinical characteristics associated with different symptom trajectories postoperatively. METHODS A prospective trial used the cardiac symptom survey to determine patient symptoms at baseline prior to surgery, and at 1 week, 6 weeks and 3 months following coronary artery bypass grafting. A latent class growth model and multivariate logistic regression analyses were used. RESULTS Data were obtained from patients ( N=198) undergoing coronary artery bypass grafting in six medical centres of Taiwan, through patient medical records and interviews. Based on their frequency, trajectories were explored for the six most common postoperative symptoms including angina, dyspnoea, fatigue, depression, sleep problems and anxiety. We identified two to three distinct classes of trajectories for each symptom. Age, longer intensive care unit stay, fewer vessels bypassed, off-pump coronary artery bypass grafting, smoking history and lack of regular exercise were associated with worse symptom outcome trends over time. CONCLUSIONS Using this unique trajectories-based research method, we are able to achieve a better understanding of symptom recovery patterns over time among coronary artery bypass grafting patients. Recognising risk factors and potential recovery patterns prior to surgery may allow healthcare providers to deliver targeted discharge planning and individualised care after coronary artery bypass grafting.
Collapse
Affiliation(s)
- Ming-Fen Tsai
- 1 Chang Gung University of Science and Technology, College of Nursing, Taiwan
| | | | - Debra Moser
- 3 University of Kentucky, College of Nursing, USA
| | - Tsuey-Yuan Huang
- 4 Chang Gung University of Science and Technology, College of Nursing, Taiwan
| | - Feng-Chun Tsai
- 5 Chang Gung Memorial Hospital, Division of Cardiovascular Surgery, Taiwan
| |
Collapse
|
45
|
Affiliation(s)
- O P Yadava
- Department of Cardiac Surgery, National Heart Institute, 49-50 Community Centre, East of Kailash, New Delhi 110065, India.
| |
Collapse
|
46
|
Takagi H, Hari Y, Mitta S, Kawai N, Ando T. A meta-analysis of ≥5-year mortality in randomized controlled trials of off-pump versus on-pump coronary artery bypass grafting. J Card Surg 2018; 33:716-724. [DOI: 10.1111/jocs.13828] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery; Shizuoka Medical Center; Shizuoka Japan
- Department of Cardiovascular Surgery; Kitasato University School of Medicine; Sagamihara Japan
| | - Yosuke Hari
- Department of Cardiovascular Surgery; Shizuoka Medical Center; Shizuoka Japan
- Department of Cardiovascular Surgery; Kitasato University School of Medicine; Sagamihara Japan
| | - Shohei Mitta
- Department of Cardiovascular Surgery; Shizuoka Medical Center; Shizuoka Japan
| | - Norikazu Kawai
- Department of Cardiovascular Surgery; Shizuoka Medical Center; Shizuoka Japan
| | - Tomo Ando
- Department of Cardiology; Detroit Medical Center; Detroit Michigan
| | | |
Collapse
|
47
|
Gao J, Liu Y, Li YM. Review of risk factors, treatment, and prevention of saphenous vein graft disease after coronary artery bypass grafting. J Int Med Res 2018; 46:4907-4919. [PMID: 30178686 PMCID: PMC6300967 DOI: 10.1177/0300060518792445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Saphenous vein graft disease (SVGD) is a type of vascular disease that may develop after coronary artery bypass grafting (CABG). SVGD seriously affects the short-term and long-term effects of CABG and increases the incidence of major adverse cardiovascular events. It is very important to identify patients at greatest risk and carry out prevention and treatment measures to determine the risk factors for SVGD. Many factors contribute to SVGD when the vein is grafted into an arterial environment, such as surgery-related factors, smoking, diabetes mellitus, hyperlipidemia, and others. In this review, we discuss the risk factors for SVGD, current surgical and pharmacologic therapies with which to manage SVGD, and the prevention of SVGD.
Collapse
Affiliation(s)
- Jing Gao
- 1 Logistics University of Chinese People's Armed Police Forces, Dongli District, Tianjin, P. R. China.,2 Cardiovascular Institute, Tianjin Chest Hospital, Jinnan District, Tianjin, P. R. China
| | - Yin Liu
- 3 Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, P. R. China
| | - Yu-Ming Li
- 1 Logistics University of Chinese People's Armed Police Forces, Dongli District, Tianjin, P. R. China
| |
Collapse
|
48
|
Ueki C, Miyata H, Motomura N, Sakata R, Sakaguchi G, Akimoto T, Takamoto S. Off-pump technique reduces surgical mortality after elective coronary artery bypass grafting in patients with preoperative renal failure. J Thorac Cardiovasc Surg 2018; 156:976-983. [DOI: 10.1016/j.jtcvs.2018.03.145] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 01/03/2018] [Accepted: 03/02/2018] [Indexed: 01/09/2023]
|
49
|
Gaudino M, Angelini GD, Antoniades C, Bakaeen F, Benedetto U, Calafiore AM, Di Franco A, Di Mauro M, Fremes SE, Girardi LN, Glineur D, Grau J, He G, Patrono C, Puskas JD, Ruel M, Schwann TA, Tam DY, Tatoulis J, Tranbaugh R, Vallely M, Zenati MA, Mack M, Taggart DP. Off-Pump Coronary Artery Bypass Grafting: 30 Years of Debate. J Am Heart Assoc 2018; 7:e009934. [PMID: 30369328 PMCID: PMC6201399 DOI: 10.1161/jaha.118.009934] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Mario Gaudino
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | | | | | | | | | | | - Antonino Di Franco
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | | | - Stephen E. Fremes
- Schulich Heart CentreSunnybrook Health ScienceUniversity of TorontoCanada
| | - Leonard N. Girardi
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | - David Glineur
- Division of Cardiac SurgeryOttawa Heart InstituteOttawaCanada
| | - Juan Grau
- Division of Cardiac SurgeryOttawa Heart InstituteOttawaCanada
| | - Guo‐Wei He
- TEDA International Cardiovascular HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeTianjinChina
| | - Carlo Patrono
- Department of PharmacologyCatholic University School of MedicineRomeItaly
| | - John D. Puskas
- Department of Cardiovascular SurgeryIcahn School of Medicine at Mount SinaiNew York CityNY
| | - Marc Ruel
- University of Ottawa Heart InstituteOttawaCanada
| | | | - Derrick Y. Tam
- Schulich Heart CentreSunnybrook Health ScienceUniversity of TorontoCanada
| | - James Tatoulis
- Department of SurgeryUniversity of MelbourneParkvilleAustralia
| | - Robert Tranbaugh
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | | | | | | | | | | |
Collapse
|
50
|
Reynolds AC, King N. Hybrid coronary revascularization versus conventional coronary artery bypass grafting: Systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11941. [PMID: 30113498 PMCID: PMC6112891 DOI: 10.1097/md.0000000000011941] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Hybrid coronary revascularization (HCR) combining minimally invasive grafting of the left internal mammary artery to the left anterior descending artery with percutaneous coronary intervention has become a viable option for treating coronary artery disease. The aim of this meta-analysis was to compare HCR with conventional coronary artery bypass grafting (CABG) in a range of clinical outcomes and hospital costs. METHODS To identify potential studies, systematic searches were carried out in various databases. The key search terms included "hybrid revascularization" AND "coronary artery bypass grafting" OR "HCR" OR "CABG." This was followed by a meta-analysis investigating the need for blood transfusion, hospital costs, ventilation time, hospital stay, cerebrovascular accident, myocardial infarction, mortality, postoperative atrial fibrillation, renal failure, operation duration, and ICU stay. RESULTS The requirement for blood transfusion was significantly lower for HCR: odds ratio 0.38 (95% confidence intervals [CIs] 0.31-0.46, P < .00001) as was the hospital stay: mean difference (MD) -1.48 days (95% CI, -2.61 to -0.36, P = 0.01) and the ventilation time: MD -8.99 hours (95% CI, -15.85 to -2.13, P = .01). On the contrary, hospital costs were more expensive for HCR: MD $3970 (95% CI, 2570-5370, P < .00001). All other comparisons were insignificant. CONCLUSIONS In the short-term, HCR is as safe as conventional CABG and may offer certain benefits such as a lower requirement for blood transfusion and shorter hospital stays. However, HCR is more expensive than conventional CABG.
Collapse
|