1
|
Momin A, Ranjan R, Chandrasekaran V. Is complete myocardial revascularisation with total arterial coronary artery bypass graft a dream or reality? Health Sci Rep 2023; 6:e1532. [PMID: 37636291 PMCID: PMC10447915 DOI: 10.1002/hsr2.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Aziz Momin
- Department of Cardiac SurgerySt George's University Hospitals NHS Foundation TrustLondonUK
| | - Redoy Ranjan
- Department of Cardiac SurgerySt George's University Hospitals NHS Foundation TrustLondonUK
- Department of Cardiac SurgeryBangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
| | | |
Collapse
|
2
|
Urbanowicz T, Olasińska-Wiśniewska A, Michalak M, Perek B, Al-Imam A, Rodzki M, Witkowska A, Straburzyńska-Migaj E, Bociański M, Misterski M, Lesiak M, Jemielity M. Pre-operative systemic inflammatory response index influences long-term survival rate in off-pump surgical revascularization. PLoS One 2022; 17:e0276138. [PMID: 36520919 PMCID: PMC9754600 DOI: 10.1371/journal.pone.0276138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022] Open
Abstract
Coronary artery bypass revascularization is still the optimal treatment for complex coronary artery disease with good long-term results. The relation between inflammatory activation in the post-operative period and the long-term prognosis was already postulated. The possible predictive role of preoperative inflammatory indexes after the off-pump coronary artery bypass grafting technique on long term survival was the aim of the study. Study population included 171 patients with a median age of 64 years (59-64) operated on using off-pump technique between January and December 2014. Patients enrolled in the current study were followed-up for 8 years. We conducted a multivariable analysis of pre-operative and post-operative inflammatory markers based on analysis of the whole blood count. The overall survival rate was 80% for the total follow-up period, while 34 deaths were reported (30-days mortality rate of 1%). In the multivariable analysis, a pre-operative value of systemic inflammatory response index (SIRI) >1.27 (HR = 6.16, 95% CI 2.17-17.48, p = 0.012) revealed a prognostic value for long-term mortality assessment after off-pump surgery. Preoperative inflammatory activation evaluated by systemic inflammatory reaction index (SIRI) possess a prognostic value for patients with complex coronary artery disease. The SIRI value above 1.27 indicates a worse late prognosis after off-pump coronary artery bypass (AUC = 0.682, p<0.001).
Collapse
Affiliation(s)
- Tomasz Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
- * E-mail:
| | - Anna Olasińska-Wiśniewska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartłomiej Perek
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Ahmed Al-Imam
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
- Department of Anatomy and Cellular Biology, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Michał Rodzki
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Witkowska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Michał Bociański
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Misterski
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Lesiak
- 1 Cardiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
3
|
Spadaccio C, Nenna A, Candura D, Rose D, Moscarelli M, Al-Attar N, Sutherland F. Total arterial coronary artery bypass grafting in patients with preoperative anemia. J Card Surg 2022; 37:1528-1536. [PMID: 35324020 DOI: 10.1111/jocs.16425] [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: 01/29/2022] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Blood transfusions after coronary artery bypass grafting (CABG) has been associated to adverse outcomes, especially in anemic patients. However, little is known about the influence of the modality of revascularization. Total arterial revascularization (TAR) was shown to reduce postoperative transfusion when compared to saphenous vein-based (SV)-CABG (LIMA plus one/more SV grafts). We, therefore, aimed to investigate the impact of TAR-CABG versus SV-CABG on blood products use and perioperative outcomes in patients with preoperative anemia, normally at higher risk for postoperative transfusions. METHODS From a cohort of 936 patients with mild preoperative anemia undergoing primary elective on-pump CABG, 166 matched pairs of patients undergoing either TAR- or SV-CABG were obtained. Anemia was defined as hemoglobin level <13 g/dl for men and <12 g/dl for women. The primary endpoint was the evaluation of red packed cells (RPC) use over the entire hospital stay. RESULTS TAR patients showed significantly reduced RPC usage compared with SV (mean difference 0.45 units). TAR patients had a reduced intubation time (mean difference 7.6 h) and were discharged 1.24 days earlier than SV patients. Pneumonia and acute kidney injury were doubled among SV patients. Adjusted regression showed that TAR technique is a predictor of reduced RPC unit use regardless of age and EuroSCORE II (odds ratio: 0.63, p < .01). CONCLUSION Patients with preoperative anemia might benefit from TAR regardless of age or calculated operative risk. TAR-CABG was associated to reduced postoperative use of blood products and postoperative length of stay in comparison with SV-CABG in this subset of patients.
Collapse
Affiliation(s)
- Cristiano Spadaccio
- Cardiothoracic Surgery Department, Golden Jubilee National Hospital, Glasgow, UK.,Cardiac Surgery Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonio Nenna
- Cardiac Surgery Department, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Dario Candura
- Cardiac Surgery Department, Leiden University Medical Centrum, Leiden, The Netherlands
| | - David Rose
- Cardiac Surgery Department, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Marco Moscarelli
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital (GVM), Cotignola, Ravenna, Italy
| | - Nawwar Al-Attar
- Cardiothoracic Surgery Department, Golden Jubilee National Hospital, Glasgow, UK
| | - Fraser Sutherland
- Cardiothoracic Surgery Department, Golden Jubilee National Hospital, Glasgow, UK
| |
Collapse
|
4
|
Rojas P, Sisniegas J, Zamudio R, Ríos J. [Revascularización quirúrgica utilizando dos arterias torácicas internas en Sudamérica]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:33-40. [PMID: 37408599 PMCID: PMC10318995 DOI: 10.47487/apcyccv.v3i1.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/31/2022] [Indexed: 07/07/2023]
Abstract
La derivación de la arteria coronaria utilizando la arteria torácica interna bilateral se ha relacionado con beneficios de supervivencia en pacientes con enfermedad arterial coronaria, pero los datos no son concluyentes. En Sudamérica, varios centros reportaron su propia experiencia con buenos resultados en supervivencia, mínimos eventos cardiovasculares postoperatorios y un bajo grado de infección mediastínica, sin embargo, el número de casos es bajo y la ausencia de publicaciones en varios países es preocupante. Revisamos las principales publicaciones sobre el injerto de arteria torácica interna bilateral en nuestra región, evaluando cuánto hemos avanzado en la cirugía coronaria.
Collapse
Affiliation(s)
- Pedro Rojas
- Cardiovascular Surgery Department, National Cardiovascular Institute, EsSalud. Lima, Perú. Cardiovascular Surgery DepartmentNational Cardiovascular Institute, EsSaludLimaPerú
| | - Josué Sisniegas
- Cardiovascular Surgery Department, National Cardiovascular Institute, EsSalud. Lima, Perú. Cardiovascular Surgery DepartmentNational Cardiovascular Institute, EsSaludLimaPerú
| | - Romel Zamudio
- Cardiovascular Surgery Department, National Cardiovascular Institute, EsSalud. Lima, Perú. Cardiovascular Surgery DepartmentNational Cardiovascular Institute, EsSaludLimaPerú
| | - Josías Ríos
- Cardiovascular Surgery Department, National Cardiovascular Institute, EsSalud. Lima, Perú. Cardiovascular Surgery DepartmentNational Cardiovascular Institute, EsSaludLimaPerú
| |
Collapse
|
5
|
Marin-Cuartas M, Sá MP, Torregrossa G, Davierwala PM. Minimally invasive coronary artery surgery: Robotic and nonrobotic minimally invasive direct coronary artery bypass techniques. JTCVS Tech 2021; 10:170-177. [PMID: 34984377 PMCID: PMC8691906 DOI: 10.1016/j.xjtc.2021.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/08/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, Pa
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pa
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, Pa
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pa
| | - Piroze M. Davierwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Van Praet KM, Kofler M, Shafti TZN, El Al AA, van Kampen A, Amabile A, Torregrossa G, Kempfert J, Falk V, Balkhy HH, Jacobs S. Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature. ACTA ACUST UNITED AC 2021; 16:e08. [PMID: 34295373 PMCID: PMC8287382 DOI: 10.15420/icr.2021.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/29/2021] [Indexed: 12/21/2022]
Abstract
Minimally invasive coronary revascularisation was originally developed in the mid 1990s as minimally invasive direct coronary artery bypass (MIDCAB) grafting is a less invasive approach compared to conventional coronary artery bypass grafting (CABG) to address targets in the left anterior descending coronary artery (LAD). Since then, MIDCAB has evolved with the adoption of a robotic platform and the possibility to perform multivessel bypass procedures. Minimally invasive coronary revascularisation surgery also allows for a combination between the benefits of CABG and percutaneous coronary interventions for non-LAD lesions – a hybrid approach. Hybrid coronary revascularisation results in fewer blood transfusions, shorter hospital stay, decreased ventilation times and patients return to work sooner when compared to conventional CABG. This article reviews the available literature, describes standard approaches and considers topics, such as limited access procedures, indications and patient selection, diagnostics and imaging, techniques, anastomotic devices, hybrid coronary revascularisation and outcome analysis.
Collapse
Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
| | - Timo Z Nazari Shafti
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Berlin Institute of Health Berlin, Germany
| | - Alaa Abd El Al
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
| | - Antonia van Kampen
- ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Leipzig Heart Center, University Clinic for Cardiac Surgery Leipzig, Germany
| | - Andrea Amabile
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Gianluca Torregrossa
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Berlin Institute of Health Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin Berlin, Germany.,Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zurich, Switzerland
| | - Husam H Balkhy
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
| |
Collapse
|