1
|
Zhang SZ, Wang GX, Zhou XT. The clinical application of microincision vein harvesting of the great saphenous vein in coronary artery bypass grafting. BMC Cardiovasc Disord 2020; 20:297. [PMID: 32552856 PMCID: PMC7301538 DOI: 10.1186/s12872-020-01555-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study aimed to summarize the clinical application of microincision vein harvesting (MVH) of the great saphenous vein in coronary artery bypass grafting (CABG). METHODS From July 2014 to October 2017, 160 patients underwent coronary artery bypass grafting. Among them, 80 patients received MVH of the great saphenous vein, and 80 received open venous harvesting (OVH). The results of the sampling operation, complications during hospitalization, and the long-term patency of the great saphenous vein were compared between the two groups. RESULTS All the patients in both groups received successful operations. The difference in the length of the veins obtained and the injury of the veins was not statistically significant (P > 0.05). The difference in the long-term patency rate of the graft vessels between the two groups was not statistically significant. The in-hospital mortality rate was the same in both groups. The MVH group had noticeable advantages over the OVH group in terms of the vein collection times, the incision length, and the complications experienced when performing the leg incisions (P < 0.01). The time relating to the patients' observed early out-of-bed activity was significantly longer in the MVH group. Furthermore, the patients' hospitalization length was significantly shorter in the MVH group compared to the OVH group (P < 0.05). The MVH group had significant advantages in pain score and patient satisfaction, and this difference was also statistically significant (P < 0.05). CONCLUSIONS The MVH procedure met the requirements of CABG in vein grafting. When compared with OVH, MVH can significantly reduce leg incision complications and improve patients' overall satisfaction with their hospital experience.
Collapse
Affiliation(s)
- Shao-Zhong Zhang
- Department of thoracic-cardiovascular, Affiliated Hospital of Xuzhou Medical University, No. 58 of Hubei Street, Yongan District, Xuzhou, 221000 China
| | - Guo-Xiang Wang
- Department of thoracic-cardiovascular, Affiliated Hospital of Xuzhou Medical University, No. 58 of Hubei Street, Yongan District, Xuzhou, 221000 China
| | - Xiao-Tong Zhou
- Department of thoracic-cardiovascular, Affiliated Hospital of Xuzhou Medical University, No. 58 of Hubei Street, Yongan District, Xuzhou, 221000 China
| |
Collapse
|
2
|
Wijntjens GWM, van Uffelen EL, Echavarría-Pinto M, Casadonte L, Stegehuis VE, Murai T, Marques KMJ, Yoon MH, Tahk SJ, Casella G, Leone AM, López Palop R, Schlundt C, Rivero F, Petraco R, Fearon WF, Johnson NP, Jeremias A, Koo BK, Piek JJ, van de Hoef TP. Individual Lesion-Level Meta-Analysis Comparing Various Doses of Intracoronary Bolus Injection of Adenosine With Intravenous Administration of Adenosine for Fractional Flow Reserve Assessment. Circ Cardiovasc Interv 2019; 13:e007893. [PMID: 31870178 DOI: 10.1161/circinterventions.119.007893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intravenous infusion of adenosine is considered standard practice for fractional flow reserve (FFR) assessment but is associated with adverse side-effects and is time-consuming. Intracoronary bolus injection of adenosine is better tolerated by patients, cheaper, and less time-consuming. However, current literature remains fragmented and modestly sized regarding the equivalence of intracoronary versus intravenous adenosine. We aim to investigate the relationship between intracoronary adenosine and intravenous adenosine to determine FFR. METHODS We performed a lesion-level meta-analysis to compare intracoronary adenosine with intravenous adenosine (140 µg/kg per minute) for FFR assessment. The search was conducted in accordance to the Preferred Reporting for Systematic Reviews and Meta-Analysis statement. Lesion-level data were obtained by contacting the respective authors or by digitization of scatterplots using custom-made software. Intracoronary adenosine dose was defined as; low: <40 µg, intermediate: 40 to 99 µg, and high: ≥100 µg. RESULTS We collected 1972 FFR measurements (1413 lesions) comparing intracoronary with intravenous adenosine from 16 studies. There was a strong correlation (correlation coefficient =0.915; P<0.001) between intracoronary-FFR and intravenous-FFR. Mean FFR was 0.81±0.11 for intracoronary adenosine and 0.81±0.11 for intravenous adenosine (P<0.001). We documented a nonclinically relevant mean difference of 0.006 (limits of agreement: -0.066 to 0.078) between the methods. When stratified by the intracoronary adenosine dose, mean differences between intracoronary and intravenous-FFR amounted to 0.004, 0.011, or 0.000 FFR units for low-dose, intermediate-dose, and high-dose intracoronary adenosine, respectively. CONCLUSIONS The present study documents clinically irrelevant differences in FFR values obtained with intracoronary versus intravenous adenosine. Intracoronary adenosine hence confers a practical and patient-friendly alternative for intravenous adenosine for FFR assessment.
Collapse
Affiliation(s)
- Gilbert W M Wijntjens
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| | - Ellen L van Uffelen
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| | - Mauro Echavarría-Pinto
- Hospital General ISSSTE - Facultad de Medicina, Universidad Autónoma de Querétaro, México (M.E.-P.)
| | - Lorena Casadonte
- Department of Biomedical Engineering and Physics (L.C.), Amsterdam-Universitair Medische Centra, locatie-AMC, the Netherlands
| | - Valérie E Stegehuis
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| | - Tadashi Murai
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| | - Koen M J Marques
- Department of Cardiology, Amsterdam-Universitair Medische Centra, locatie VUmc, Amsterdam, the Netherlands (K.M.J.M.)
| | - Myeong-Ho Yoon
- Department of Cardiology, Ajou University, Suwon, Republic of Korea (M.-H.Y., S.-J.T.)
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University, Suwon, Republic of Korea (M.-H.Y., S.-J.T.)
| | - Gianni Casella
- Department of Cardiology, Ospedale Maggiore, Bologna, Italy (G.C.)
| | - Antonio M Leone
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (A.M.L.)
| | - Ramón López Palop
- Department of Cardiology, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Spain (R.L.-P.)
| | | | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain (F.R.)
| | | | - William F Fearon
- Department of Cardiology, Stanford University School of Medicine, Stanford Cardiovascular Institute (W.F.F.)
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston (N.P.J.)
| | - Allen Jeremias
- St Francis Hospital, Roslyn, Cardiovascular Research Foundation, New York, NY (A.J.)
| | - Bon-Kwon Koo
- Seoul National University College of Medicine, Republic of Korea (B.-K.K.)
| | - Jan J Piek
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| | - Tim P van de Hoef
- Heart Center (G.W.M.W., E.L.v.U., V.E.S., T.M., J.J.P., T.P.v.d.H.), locatie-AMC, the Netherlands
| |
Collapse
|
3
|
Casadonte L, Piek JJ, VanBavel E, Spaan JAE, Siebes M. Discordance between pressure drift after wire pullback and intracoronary distal pressure offset affects stenosis physiology appraisal. Int J Cardiol 2018; 277:29-34. [PMID: 30173920 DOI: 10.1016/j.ijcard.2018.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Drift is a well-known issue affecting intracoronary pressure measurements. A small pressure offset at the end of the procedure is generally considered acceptable, while repeat assessment is advised for drift exceeding ±2 mmHg. This practice implies that drift assessed after wire pullback equals that at the time of stenosis appraisal, but this assumption has not been systematically investigated. Our aim was to compare intra-and post-procedural pressure sensor drift and assess benefits of correction for intra-procedural drift and its effect on diagnostic classification. METHODS In 70 patients we compared intra- and post-procedural pressure drift for 120 hemodynamic tracings obtained at baseline and throughout the hyperemic response to intracoronary adenosine. Intra-procedural drift was derived from the intercept of the stenosis pressure gradient-velocity relationship. Diagnostic reclassification after correction for intra-procedural drift was assessed for the mean distal-to-aortic pressure ratio at baseline (Pd/Pa) and hyperemia (fractional flow reserve, FFR), and corresponding stenosis resistances. RESULTS Post- and intra-procedural drift exceeding the tolerated threshold was observed in 73% and 64% of the hemodynamic tracings, respectively. Discordance in terms of acceptable drift level was present for 42% of the tracings, with avoidable repeat physiological assessment in 25% and unacceptable intra-procedural drift unrecognized at final drift check in 17% of the tracings. Correction for intra-procedural drift caused higher reclassification rates for baseline than hyperemic functional indices. CONCLUSIONS Post-procedural pressure drift frequently does not match drift during physiological assessment. Tracing-specific correction for intra-procedural drift can potentially lower the risk of inadvertent diagnostic misclassification and prevent unnecessary repeats.
Collapse
Affiliation(s)
- Lorena Casadonte
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Ed VanBavel
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jos A E Spaan
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Maria Siebes
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, the Netherlands.
| |
Collapse
|
4
|
Lindsey ML, Gray GA, Wood SK, Curran-Everett D. Statistical considerations in reporting cardiovascular research. Am J Physiol Heart Circ Physiol 2018; 315:H303-H313. [PMID: 30028200 PMCID: PMC6139626 DOI: 10.1152/ajpheart.00309.2018] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The problem of inadequate statistical reporting is long standing and widespread in the biomedical literature, including in cardiovascular physiology. Although guidelines for reporting statistics have been available in clinical medicine for some time, there are currently no guidelines specific to cardiovascular physiology. To assess the need for guidelines, we determined the type and frequency of statistical tests and procedures currently used in the American Journal of Physiology-Heart and Circulatory Physiology. A PubMed search for articles published in the American Journal of Physiology-Heart and Circulatory Physiology between January 1, 2017, and October 6, 2017, provided a final sample of 146 articles evaluated for methods used and 38 articles for indepth analysis. The t-test and ANOVA accounted for 71% (212 of 300 articles) of the statistical tests performed. Of six categories of post hoc tests, Bonferroni and Tukey tests were used in 63% (62 of 98 articles). There was an overall lack in details provided by authors publishing in the American Journal of Physiology-Heart and Circulatory Physiology, and we compiled a list of recommended minimum reporting guidelines to aid authors in preparing manuscripts. Following these guidelines could substantially improve the quality of statistical reports and enhance data rigor and reproducibility.
Collapse
Affiliation(s)
- Merry L Lindsey
- Mississippi Center for Heart Research, Department of Physiology and Biophysics, University of Mississippi Medical Center , Jackson, Mississippi.,Research Service, G. V. (Sonny) Montgomery Veterans Affairs Medical Center , Jackson, Mississippi
| | - Gillian A Gray
- British Heart Foundation/University Centre for Cardiovascular Science, Edinburgh Medical School, University of Edinburgh , Edinburgh , United Kingdom
| | - Susan K Wood
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine , Columbia, South Carolina
| | - Douglas Curran-Everett
- Division of Biostatistics and Bioinformatics, National Jewish Health , Denver, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado
| |
Collapse
|