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Takase S. Does the Cardiac Surgeon Accept Coronary Artery Bypass Grafting With Incomplete Revascularization for Patients With Low Ventricular Function and Complex Multivessel Coronary Disease? Circ J 2018; 83:25-26. [PMID: 30531120 DOI: 10.1253/circj.cj-18-1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinya Takase
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine
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Boldeanu I, Perreault Bishop J, Nepveu S, Stevens LM, Soulez G, Kieser TM, Lamy A, Noiseux N, Chartrand-Lefebvre C. Incidental findings in CT imaging of coronary artery bypass grafts: results from a Canadian multicenter prospective cohort. BMC Res Notes 2018; 11:72. [PMID: 29368660 PMCID: PMC5784672 DOI: 10.1186/s13104-018-3168-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/12/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To assess the prevalence and clinical significance of incidental findings identified during computed tomography imaging of coronary artery bypass grafts. Results This prospective study includes 144 patients undergoing coronary graft patency assessment using computed tomography. Incidental findings were classified as significant if they were considered to need an immediate action or treatment, short-term work-up or follow-up, or minor. A total of 211 incidental findings were present in 109 (75.7%) patients. Seventy-one incidental findings (33.6%) were cardiac and 140 (66.4%) were extracardiac. Most common cardiac incidental findings were atrial dilatation [39 patients, 48 incidental findings (67.6%)] and aortic valve calcifications (7 patients, 9.9%). Among the 140 extracardiac incidental findings, the most common were lung nodules (51 patients, 54 nodules, 38.6%), and emphysema (21 patients, 15%). Thirty-six (25.7%) extracardiac incidental findings were significant and notably, 23 (63.9%) were lung nodules. Follow-up was recommended in 37 cases, among which all patients with significant lung nodules (23 patients, 62.2%). In conclusion, most common computed tomography incidental findings in patients with coronary grafts were lung nodules and emphysema. Electronic supplementary material The online version of this article (10.1186/s13104-018-3168-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I Boldeanu
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC, H2X 0C1, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - J Perreault Bishop
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC, H2X 0C1, Canada
| | - S Nepveu
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC, H2X 0C1, Canada
| | - L-M Stevens
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Division of Cardiac Surgery, CHUM, Montreal, Canada
| | - G Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC, H2X 0C1, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - T M Kieser
- Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - A Lamy
- Division of Cardiac Surgery, McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| | - N Noiseux
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Division of Cardiac Surgery, CHUM, Montreal, Canada
| | - C Chartrand-Lefebvre
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC, H2X 0C1, Canada. .,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.
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Long-term follow-up of off-pump and on-pump coronary artery bypass grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 9:122-9; discussion 129. [PMID: 24557507 DOI: 10.1097/imi.0000000000000042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Despite increasing recognition of the benefits of off-pump coronary artery bypass grafting (CABG), concerns persist regarding its impact on long-term mortality and freedom from reintervention. In this study, we assessed the impact of off-pump CABG on long-term outcomes. METHODS From January 2002 to December 2002, a total of 307 consecutive patients who underwent isolated multivessel off-pump CABG at our institution were compared with a control group of 397 patients who underwent multivessel on-pump CABG during the same period. Perioperative data were prospectively collected and compared. In addition, univariate and risk-adjusted comparisons between the two groups were performed at 10 years. RESULTS After adjusting for clinical covariates, off-pump CABG did not emerge as a significant independent predictor of long-term mortality [hazard ratio (HR), 0.91; 95% confidence interval (CI), 0.70-1.12], readmission to hospital for cardiac cause (HR, 0.96; 95% CI, 0.78-1.10), or the need for reintervention (HR, 0.93; 95% CI, 0.87-1.05). CONCLUSIONS At long-term follow-up, off-pump CABG remains a safe and effective myocardial revascularization strategy with no adverse impact on survival or freedom from reintervention.
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Raja SG, Benedetto U, Chudasama D, Daley S, Husain M, Amrani M. Long-Term Follow-up of Off-Pump and On-Pump Coronary Artery Bypass Grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900208] [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)
- Shahzad G. Raja
- Departments of Cardiac Surgery, Harefield Hospital, London, UK
| | | | | | | | | | - Mohamed Amrani
- Departments of Cardiac Surgery, Harefield Hospital, London, UK
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Raja SG, Husain M, Popescu FL, Chudasama D, Daley S, Amrani M. Does off-pump coronary artery bypass grafting negatively impact long-term survival and freedom from reintervention? BIOMED RESEARCH INTERNATIONAL 2013; 2013:602871. [PMID: 24106710 PMCID: PMC3784151 DOI: 10.1155/2013/602871] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 08/05/2013] [Indexed: 01/08/2023]
Abstract
Recently published evidence has raised concerns about worse late mortality and increasing need for reintervention after off-pump coronary artery bypass grafting. We undertook this study to assess the impact of off-pump coronary artery bypass grafting on survival and freedom from reintervention at 10 years. From January 2002 to December 2002, 307 consecutive patients who had isolated multivessel off-pump coronary artery bypass grafting at our institution were compared to a control group of 397 patients that underwent multivessel on-pump coronary artery bypass grafting during the same period. In addition, univariate and risk-adjusted comparisons between the two groups were performed at 10 years. Kaplan-Meier survival was similar for the two cohorts. After adjusting for clinical covariates, off-pump coronary artery bypass grafting did not emerge as a significant independent predictor of long-term mortality (Hazard Ratio 0.91; 95% Confidence Interval 0.70-1.12), readmission to hospital for cardiac cause (Hazard Ratio 0.96; 95% Confidence Interval 0.78-1.10), or the need for reintervention (Hazard Ratio 0.93; 95% Confidence Interval 0.87-1.05). Off-pump coronary artery bypass grafting compared with on-pump coronary artery bypass grafting does not adversely impact survival or freedom from reintervention at a 10-year follow-up.
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Affiliation(s)
- Shahzad G. Raja
- Department of Cardiac Surgery, Harefield Hospital, Hill End Road, Harefield, London UB9 6JH, UK
| | - Mubassher Husain
- Department of Cardiac Surgery, Harefield Hospital, Hill End Road, Harefield, London UB9 6JH, UK
| | - Florentina L. Popescu
- Department of Cardiac Surgery, Harefield Hospital, Hill End Road, Harefield, London UB9 6JH, UK
| | - Dimple Chudasama
- Department of Quality & Safety, Harefield Hospital, Hill End Road, Harefield, London UB9 6JH, UK
| | - Siobhan Daley
- Department of Quality & Safety, Harefield Hospital, Hill End Road, Harefield, London UB9 6JH, UK
| | - Mohamed Amrani
- Department of Cardiac Surgery, Harefield Hospital, Hill End Road, Harefield, London UB9 6JH, UK
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Raja SG, Akhtar S. Hypercoagulable state after off-pump coronary artery bypass grafting: evidence, mechanisms and implications. Expert Rev Cardiovasc Ther 2011; 9:599-608. [PMID: 21615323 DOI: 10.1586/erc.11.51] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
During the past decade, there has been a dramatic resurgence in the adoption of off-pump technology in coronary artery bypass surgery. This has inspired remarkable advances in the techniques of localized tissue stabilization and a greater understanding of the physiology of beating-heart mobilization and exposure. An avalanche of reports in the literature has demonstrated the early safety and efficacy of the procedure. However, despite abundant evidence validating the safety and efficacy of off-pump coronary artery bypass surgery, considerable controversy still persists regarding the long-term outcomes of this approach to myocardial revascularization. One area of concern, and even greater uncertainty, surrounds the issue of the existence of a hypercoagulable state after off-pump coronary artery bypass surgery. This article evaluates the current best evidence available from randomized controlled trials to assess the impact of off-pump coronary artery bypass surgery on coagulation, fibrinolysis and platelet activation, discusses the issue of hypercoagulability with emphasis on the mechanisms responsible for this actual or potential hypercoagulability, and explores the implications of this issue for clinical practice.
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Affiliation(s)
- Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, Harefield, London, UB9 6JH, UK.
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Mukherjee D, Rao C, Ibrahim M, Ahmed K, Ashrafian H, Protopapas A, Darzi A, Athanasiou T. Meta-Analysis of Organ Damage After Conversion From Off-Pump Coronary Artery Bypass Procedures. Ann Thorac Surg 2011; 92:755-61. [DOI: 10.1016/j.athoracsur.2011.05.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 05/07/2011] [Accepted: 05/11/2011] [Indexed: 11/27/2022]
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Hoff SJ, Ball SK, Leacche M, Solenkova N, Umakanthan R, Petracek MR, Ahmad R, Greelish JP, Walker K, Byrne JG. Results of Completion Arteriography After Minimally Invasive Off-Pump Coronary Artery Bypass. Ann Thorac Surg 2011; 91:31-6; discussion 36-7. [DOI: 10.1016/j.athoracsur.2010.09.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 09/24/2010] [Accepted: 09/27/2010] [Indexed: 11/26/2022]
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Raja SG, Amrani M. Reoperative off-pump coronary artery bypass grafting: current outcomes, concerns and controversies. Expert Rev Cardiovasc Ther 2010; 8:685-94. [PMID: 20450302 DOI: 10.1586/erc.10.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increasing numbers of patients have undergone coronary artery bypass grafting in the last four decades. As a result, the incidence of reoperative coronary artery bypass grafting is rising. Reoperative procedures pose several technical difficulties and are associated with increased operative risks, which exceed those of the initial revascularization. As the incidence of reoperative procedures is increasing so is the experience of reoperative coronary artery bypass grafting, with the resultant evolution of several alternative strategies to lower the operative risks. These strategies include alternative techniques for re-entry, strict avoidance of graft manipulation to minimize the risk of graft atheroembolism, and modification of the method of myocardial protection, depending on the status of the native coronary circulation and the patency of venous or arterial grafts. Off-pump coronary artery bypass grafting is one such technique that, through the avoidance of inherent risks of cardiopulmonary bypass, has the potential to reduce the morbidity associated with reoperative coronary artery bypass grafting. This article evaluates the current outcomes of reoperative off-pump coronary artery bypass grafting, and highlights the concerns and controversies associated with this strategy.
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Affiliation(s)
- Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, Hill End Road, Harefield, London, UB9 6JH, UK.
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Abstract
Coronary artery bypass is arguably the most extensively studied operation in surgical history. The technical advances and beneficial effects on symptoms and prognosis have been well documented over four decades. Percutaneous coronary interventions (PCIs) have also evolved through numerous modifications, and symptom relief has been substantiated; both modalities have been challenged by many randomized controlled trials. The rapid growth of PCIs has decreased coronary artery bypass volumes, and resulted in concerns about training, teaching, research, jobs and income. The most important concern, however, is the increasing 'off-label' application of PCIs with drug-eluting stents to a variety of untested coronary lesions. The randomized controlled trials studied a small fraction of those registered and excluded patients who are known to benefit from surgery and, thus, these studies were inherently biased. The results were then extrapolated to 'real-world' patients, who had been misinformed and misled about the performance and prognosis of coronary stents, as was later revealed in various registries. Hospitals should develop a collaborative revascularization strategy to provide patients and families with realistic alternatives.
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