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Zhu P, Qiu J, Xu H, Liu J, Zhao Q. Hybrid coronary revascularization versus total arterial revascularization for the treatment of left main coronary artery disease. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:285. [PMID: 33708912 PMCID: PMC7944322 DOI: 10.21037/atm-20-4224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Hybrid coronary revascularization (HCR) has a similar clinical outcome to coronary artery bypass grafting (CABG) in treating multivessel disease. However, the outcome of HCR in treating left main coronary artery (LM) disease is unclear. This study sought to compare the clinical outcome of HCR with total arterial revascularization (TAR) for treating LM disease. Methods Patients who underwent treatment for LM disease in our center between January 2009 and December 2019 were selected. Of these, 33 patients underwent HCR, and 70 patients underwent TAR. The primary efficacy outcome of this study was mid-term major adverse cardiac and cerebrovascular events (MACCE). The primary safety outcome was perioperative MACCE. Results The incidence of postoperative outcomes was comparable between the two groups after adjustment with inverse probability weighting (IPW) (P>0.05). The median follow-up time was 47 (interquartile range, 20 to 85) months. There was no significant difference in the incidence of all mid-term outcomes and the freedom of MACCE between the two groups after adjustment (P>0.05). The Cox proportional hazard model demonstrated that HCR was not a significant determinant for MACCE [hazard ratio (HR) =3.516, 95% confidence interval (CI): 0.835 to 14.813]. Conclusions HCR may be safe and effective for the treatment of LM disease compared with TAR.
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Affiliation(s)
- Pengxiong Zhu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiapei Qiu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Xu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lazar HL. Commentary: Total arterial revascularization: Is it for everyone? J Thorac Cardiovasc Surg 2019; 157:2237-2239. [PMID: 30709675 DOI: 10.1016/j.jtcvs.2018.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, Boston University School of Medicine, Boston, Mass.
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Tinica G, Chistol RO, Bulgaru Iliescu D, Furnica C. Long-term graft patency after coronary artery bypass grafting: Effects of surgical technique. Exp Ther Med 2019; 17:359-367. [PMID: 30651804 PMCID: PMC6307371 DOI: 10.3892/etm.2018.6929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 10/11/2018] [Indexed: 11/06/2022] Open
Abstract
The aim of the current study was to identify surgical factors associated with long-term patency of grafts used in coronary artery bypass grafting (CABG). The present study analyzed data from 127 patients who underwent CABG at our institute between 2000 and 2006 and presented for ambulatory examination and coronary computed tomography angiography evaluation of graft patency in 2016 (139.78±36.64 months post-CABG). The 127 patients received 340 grafts (2.68 grafts/patient) and 399 distal anastomoses (3.14 anastomoses/patient), 220 (55.14%) with arterial grafts and 179 (44.86%) with saphenous vein grafts. Graft patency varied according to coronary territory, proximal anastomosis type (in situ graft, composite graft, graft anastomosed to the ascending aorta), Y anastomosis angle (47.21° for patent arterial grafts vs. 56° for occluded), and distal anastomosis angle (in sequential anastomoses irrespective to graft type, 48.60° for patent side-to-side anastomosis vs. 53.97° for occluded, 65.12° for patent end-to-side anastomosis vs. 90.80° for occluded; in single end-to-side anastomosis of arterial grafts, 39.46° for patent and 44.94° for occluded). A single end-to-side anastomosis angle 60° or greater was associated with a 5.149 occlusion odds ratio (OR) (P<0.001) for arterial grafts. Venous grafts were not sensitive to single end-to-side anastomosis angle. In conclusion, a small anastomosis angle for proximal Y and distal anastomoses is associated with a higher long-term patency of the free graft. Radial artery grafts registered higher patency rates when anastomosed to the ascending aorta compared with composite grafting with the left internal thoracic artery, whereas in situ right internal thoracic artery (RITA) anastomosed to the right coronary territory is associated with a lower patency rate compared with free RITA used to revascularise the anterolateral or circumflex territory in composite grafting.
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Affiliation(s)
- Grigore Tinica
- Department of Cardiovascular Surgery, 'Prof. Dr. George I.M. Georgescu' Cardiovascular Diseases Institute, 700503 Iasi, Romania.,Discipline of Cardiac Surgery, Department of Surgery I, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Raluca Ozana Chistol
- Department of Medical Imaging, 'Prof. Dr. George I.M. Georgescu' Cardiovascular Diseases Institute, 700503 Iasi, Romania
| | - Diana Bulgaru Iliescu
- Discipline of Forensic Medicine, Medical Department III, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Institute of Forensic Medicine, 700455 Iasi, Romania
| | - Cristina Furnica
- Institute of Forensic Medicine, 700455 Iasi, Romania.,Discipline of Anatomy, Department of Morpho-Functional Sciences I, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Luthra S, Leiva-Juárez MM, Matuszewski M, Morgan IS, Billing JS. Does a third arterial conduit to the right coronary circulation improve survival? J Thorac Cardiovasc Surg 2017; 155:855-860.e2. [PMID: 29248279 DOI: 10.1016/j.jtcvs.2017.09.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/12/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The long-term benefits of a third arterial conduit to the right circulation in triple-vessel disease remain debatable. This retrospective, single-center, propensity-matched study investigates the impact of a third arterial conduit to the right circulation on early and intermediate survival after coronary artery bypass grafting. METHODS Data were retrospectively collected from 2004 to 2014 for all surgical revascularizations for triple-vessel disease with at least 2 arterial conduits to the left circulation and a third arterial or venous conduit to the right circulation. A total of 167 pairs were propensity matched to arterial versus venous third conduit to right circulation. Hazard functions were obtained with Cox multivariate regression and Kaplan-Meier survival curves were compared between the matched cohorts. RESULTS Extracardiac arteriopathy, logistic euroSCORE, and left main stem disease were significant predictors of adverse survival. A third arterial conduit to the right circulation was not a significant predictor of improved survival in multivariate analysis (HR, 0.72; 95% CI, 0.34-1.55; P = .411). 30-day mortality was 0.6% in both groups. There was no significant difference in early or intermediate survival in the propensity-matched groups (venous vs arterial, 99.2% vs 99.2%; P = 1.000 at 1 year; 85.2% vs 88.8%; P = .248 at 5 years and 69.2% vs 88.8%; P = .297 at 7 years) CONCLUSIONS: The use of a third arterial versus a venous conduit to the right circulation does not improve early or intermediate survival up to 7 years in triple-vessel coronary artery disease in this study. Longer follow-up and larger cohorts may be needed for differences to emerge.
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Affiliation(s)
- Suvitesh Luthra
- Division of Cardiac Surgery, Derriford Hospital, Plymouth, Devon, United Kingdom.
| | | | - Maciej Matuszewski
- Department of Cardiothoracic Surgery, New Cross Hospital, Wolverhampton, West Midlands, United Kingdom
| | - Ian S Morgan
- Department of Cardiothoracic Surgery, New Cross Hospital, Wolverhampton, West Midlands, United Kingdom
| | - John S Billing
- Department of Cardiothoracic Surgery, New Cross Hospital, Wolverhampton, West Midlands, United Kingdom
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Parissis H, Parissis M, Al-Alao B. Which is the best graft for the right coronary artery? Response. Asian Cardiovasc Thorac Ann 2015; 23:885-6. [PMID: 25972293 DOI: 10.1177/0218492315586487] [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]
Affiliation(s)
- Haralabos Parissis
- Cardiothoracic Department, Royal Victoria Hospital, Belfast BT12 6BA, UK
| | - Mondrian Parissis
- Cardiothoracic Department, Royal Victoria Hospital, Belfast BT12 6BA, UK
| | - Bassel Al-Alao
- Cardiothoracic Department, Mayo Clinic, Rochester, Minnesota, USA
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Saeed G, Bobzin M, Neuzner J. Which is the best graft for the right coronary artery? Asian Cardiovasc Thorac Ann 2015; 23:884. [PMID: 25969549 DOI: 10.1177/0218492315586486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Giovanni Saeed
- Department of Cardiovascular Surgery, Klinikum Kassel GmbH, Kassel, Germany
| | - Martin Bobzin
- Department of Internal Medicine II and Cardiology, Klinikum Kassel GmbH, Kassel, Germany
| | - Jörg Neuzner
- Department of Internal Medicine II and Cardiology, Klinikum Kassel GmbH, Kassel, Germany
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Athanasiou T, Ashrafian H, Mukherjee D, Harling L, Okabayashi K. Are arterial grafts superior to vein grafts for revascularisation of the right coronary system? A systematic review. Heart 2012; 99:835-42. [DOI: 10.1136/heartjnl-2012-303225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Mukherjee D, Cheriyan J, Kourliouros A, Athanasiou T. How does the right gastroepiploic artery compare with the saphenous vein for revascularization of the right coronary artery? Interact Cardiovasc Thorac Surg 2012; 15:888-92. [PMID: 22851757 DOI: 10.1093/icvts/ivs336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was 'is the saphenous vein graft or right gastroepiploic artery a better conduit for revascularization of the right coronary artery?' One hundred and five articles were found using a designated search, of which 10 articles were found to represent the best available evidence to answer the clinical question. Of these 10 articles, two were reports of a randomized controlled trial and represented the highest level of evidence, whereas eight articles were retrospective observational studies. All were published between 2002 and 2012. Outcome measures varied considerably, but mostly included graft patency at varying periods of follow-up. The randomized evidence suggested that the saphenous vein had better early (6-month) and mid-term (3-year) graft patency than the right gastroepiploic artery when used for right coronary artery revascularization. The use of the saphenous vein was also found to be predictive of superior graft function using multivariate regression; however, a more recent propensity score analysis identified gastroepiploic-right coronary grafts to yield superior very long-term (>10 years) clinical outcomes. Overall, based on the best quality evidence and in view of technical limitations and flow characteristics of the right gastroepiploic artery, it appears that saphenous vein grafts may offer superior outcomes for revascularization of the right coronary artery in most cases, and should be preferentially used.
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Hajj-Chahine J, Jayle C, Tomasi J, Corbi P. eComment. The best graft for the right coronary artery. Interact Cardiovasc Thorac Surg 2012; 15:247. [PMID: 22802510 DOI: 10.1093/icvts/ivs248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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