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Sadeghi R. Coronary Artery Bypass Grafting in advance aged patients. ARYA ATHEROSCLEROSIS 2023; 19:37-45. [PMID: 38881996 PMCID: PMC11179009 DOI: 10.48305/arya.2023.41535.2884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/20/2023] [Indexed: 06/18/2024]
Abstract
INTRODUCTION This study aimed to assess the impact of coronary artery bypass grafting (CABG) on outcomes in elderly patients compared to younger patients. METHOD An observational case-control study was conducted involving 535 patients, divided into two groups: older adults (≥75 years) and younger adults (<75 years). All patients underwent CABG following a similar protocol. The primary endpoints focused on early post-procedure outcomes, including in-hospital mortality and the duration of ICU or hospital stay. Patients were followed up for six months, and secondary study endpoints included long-term mortality, left ventricular ejection fraction, re-hospitalization rates, and repeated revascularization. RESULTS 535 patients who underwent CABG were enrolled in this study. The smoking habit was significantly higher among younger adults (38.2% vs. 12.5%, P=0.001). Hypertension was more prevalent among older adults than younger adults (75% vs. 60%, P=0.044). LDL cholesterol serum levels were higher among younger adult patients (94.9±32.5 vs. 80.9±32.9, P=0.028). In-hospital death was not significantly different between younger and older adults (2.8% vs. 5.0%, P=0.34). Mortality in the six-month follow-up was non-significantly higher in the elderly (2.1% vs. 8.1%, P=0.06).A significant proportion of patients in both groups (46.9% in younger patients vs. 40% in older ones, P=0.40) received dual antiplatelet therapy (DAPT) prior to CABG due to a recent myocardial infarction and receipt of a new stent, but without increased major bleeding in both groups. CONCLUSION CABG should be considered a viable treatment option for elderly patients with acceptable operative risk in current clinical practice.
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Affiliation(s)
- Roxana Sadeghi
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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2
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Küçük U, Duygu A, Kırılmaz B. Effect of Treatment Regimen on Long-Term Mortality of Geriatric Patients Diagnosed With Stable Coronary Artery Disease. Cureus 2021; 13:e13618. [PMID: 33816017 PMCID: PMC8011467 DOI: 10.7759/cureus.13618] [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] [Accepted: 02/28/2021] [Indexed: 11/05/2022] Open
Abstract
Background Increased life expectancy across the world has resulted in an increase in the proportion of the elderly population who are lost to heart diseases. Advanced age and comorbidities are believed to change the response to treatments. In this study, we aimed to investigate the effects of surgical and medical treatments on the mortality of stable coronary diseases. Methods A total of 150 geriatric patients who underwent coronary angiography (CAG) were followed up in our cardiology clinic. Patients who decided to undergo coronary artery bypass graft (CABG) surgery after CAG and were willing to undergo the operation were assigned to group 1, whereas those who were unwilling to undergo the operation were not eligible for percutaneous coronary intervention and were followed up medically, and were assigned to group 2. Keeping the primary goal as mortality rates, both the groups were compared using medical records for three years after the treatment. Results After three years, the overall mortality rate included six patients (16%) in the CABG group versus 63 patients (55%) in the medical therapy group (p < 0.001). The CABG therapy was found to be significantly and independently associated with first- and third-year mortality (risk ratio: 0.064, 95% confidence interval: 0.009-0.467, p = 0.007; risk ratio: 0.305, 95% confidence interval: 0.151-0.615, p < 0.001, respectively). Kaplan-Meier analysis for first- and third-year all-cause mortality rates led to significant results and curves between the groups. Conclusion Our study revealed that compared to CABG surgery in the treatment of coronary artery disease in geriatric patients, medical treatment is associated with poor outcomes in terms of mortality in long-term follow-up.
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Affiliation(s)
- Uğur Küçük
- Cardiology, Canakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, TUR
| | - Ali Duygu
- Cardiology, Canakkale Onsekiz Mart University Faculty of Medicıne, Çanakkale, TUR
| | - Bahadır Kırılmaz
- Cardiology, Canakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, TUR
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Gomes WJ, Angelini GD. On- or Off-pump Coronary Artery Bypass Surgery. Is the Debate Settling Down? Braz J Cardiovasc Surg 2019; 34:VIII-XI. [PMID: 31454192 PMCID: PMC6713363 DOI: 10.21470/1678-9741-2019-0281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Walter J Gomes
- Universidade Federal de São Paulo Escola Paulista de Medicina Hospital São Paulo São Paulo SP Brazil Cardiovascular Surgery Discipline, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Gianni D Angelini
- University of Bristol Bristol Heart Institute Bristol Royal Infirmary Bristol United Kingdom Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
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Yuksel A, Yolgosteren A, Kan II, Cayir MC, Velioglu Y, Yalcin M, Tok M, Bicer M, Signak IS. A comparison of early clinical outcomes of off-pump and on-pump coronary artery bypass grafting surgery in elderly patients. Acta Chir Belg 2018; 118:99-104. [PMID: 28946812 DOI: 10.1080/00015458.2017.1383087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The reply of question of "which coronary artery bypass grafting (CABG) technique is superior in elderly patients, off-pump or on-pump CABG surgery?" is controversial. We aimed to compare the early clinical outcomes in elderly patients undergoing off-pump and on-pump CABG. METHODS From January 2009 to January 2015, 344 elderly patients (aged 70 or older) underwent off-pump (n = 137) or on-pump (n = 207) CABG. Patients' medical records were retrospectively reviewed, and their baseline preoperative characteristics, operative data and postoperative outcomes were analyzed, thereby a comparison of early outcomes between off-pump and on-pump patients was performed. RESULTS Mean age of patients was 74.4 ± 3.8 years. Both groups were statistically similar in terms of baseline preoperative characteristics. Number of distal bypass was significantly lower in off-pump group than in on-pump group. Postoperative length of intensive care unit and hospital stay were similar between two groups. Amounts of transfused blood products were significantly lower in off-pump CABG group. There were no significant differences in terms of postoperative complications and mortality between two groups. CONCLUSIONS Our results did not reveal a significant benefit of either surgical technique with respect to early-term clinical outcomes in elderly CABG patients. Further investigations are needed to determine whether off-pump CABG is superior than on-pump CABG in elderly patients.
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Affiliation(s)
- Ahmet Yuksel
- Department of Cardiovascular Surgery, Bursa State Hospital, Bursa, Turkey
| | - Atif Yolgosteren
- Department of Cardiovascular Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Iris Irem Kan
- Department of Cardiovascular Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | | | - Yusuf Velioglu
- Department of Cardiovascular Surgery, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Mustafa Yalcin
- Department of Cardiovascular Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Mustafa Tok
- Department of Cardiovascular Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Murat Bicer
- Department of Cardiovascular Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Isik Senkaya Signak
- Department of Cardiovascular Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
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Nicolini F, Vezzani A, Romano G, Carino D, Ricci M, Chicco MVD, Gherli T. Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly. Int Heart J 2017; 58:647-653. [PMID: 28966319 DOI: 10.1536/ihj.16-468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, the efficacy of this newer technique in the elderly is difficult to prove because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. Moreover, more widespread use of this technique is limited by the concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the decreased blood supply to the sternum and surrounding tissues.The review of the recent literature indicates that the use of bilateral internal thoracic arteries in very elderly patients should not be considered routinely. It seems reasonable to avoid it in octogenarians in the presence of well-known predictors of sternal complications such as diabetes, morbid obesity, and severe chronic lung disease.There is also still controversy about the superiority of the radial artery over the saphenous vein graft as a second or third conduit for surgical myocardial revascularization, although the majority of recent studies seem to support more liberal use of the radial artery as second arterial conduit in the elderly. Although a clinical benefit of arterial graft revascularization cannot be formally excluded for elderly patients, the increased complexity of this technique suggests that careful clinical judgment is necessary to select grafts for individual patients.
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Affiliation(s)
- Francesco Nicolini
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | | | - Giorgio Romano
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | - Davide Carino
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | - Matteo Ricci
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | | | - Tiziano Gherli
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
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Dos Santos ER, Lopes CT, Maria VLR, de Barros ALBL. Risk factors for decreased cardiac output after coronary artery bypass grafting: a prospective cohort study. Eur J Cardiovasc Nurs 2016; 16:352-359. [PMID: 27888199 DOI: 10.1177/1474515116681373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND No previous study has investigated the predictive risk factors of the nursing diagnosis of risk for decreased cardiac output after coronary artery bypass grafting (CABG). AIMS This study aimed to identify the predictive risk factors of the nursing diagnosis of risk for decreased cardiac output after CABG. METHODS This was a prospective cohort study performed at a cardiac university hospital in São Paulo, Brazil and 257 adult patients undergoing CABG were included. Potential risk factors for low cardiac output in the immediate post-operative period were investigated using the patients' medical records. Univariate analysis and logistic regression were used to identify the predictive risk factors of decreased cardiac output. The area under the receiver operating characteristic curve was calculated as a measure of accuracy. The variables that could not be analysed through logistic regression were analysed through Fisher's exact test. RESULTS One hundred and ninety-five patients had low cardiac output in the immediate post-operative period. The predictive risk factors included age ⩾60 years, decreased left ventricle ejection fraction, not using the radial artery graft, positive fluid balance and post-operative arrhythmia that differed from the pre-operative arrhythmia. This model predicted the outcome with a sensitivity of 62.9%, a specificity of 87.2% and an accuracy of 81.5%. The variables analysed through Fisher's exact test included heart failure, re-exploration and bleeding-related re-exploration. CONCLUSIONS The predictive risk factors for the nursing diagnosis of risk for decreased cardiac output after CABG were found. These results can be used to direct nurses in patient monitoring, staff training and nursing team staffing.
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Affiliation(s)
- Eduarda Ribeiro Dos Santos
- 1 Paulista Nursing School, Federal University of São Paulo (EPE-UNIFESP), Brazil.,2 Faculdade Israelita de Ciências da Saúde Albert Einstein, Brazil
| | - Camila Takao Lopes
- 1 Paulista Nursing School, Federal University of São Paulo (EPE-UNIFESP), Brazil
| | - Vera Lucia Regina Maria
- 1 Paulista Nursing School, Federal University of São Paulo (EPE-UNIFESP), Brazil.,3 Universidade São Camilo, Brazil
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Pemberthy-López C, Caraballo-Cordovez C, Gallo-Echeverri S, Jaramillo-Gómez N, Velásquez-Mejía C, Cardona-Vélez J, Contreras-Martínez H. Tratamiento del adulto mayor con síndrome coronario agudo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Koerich C, Lanzoni GMDM, Erdmann AL. Factors associated with mortality in patients undergoing coronary artery bypass grafting. Rev Lat Am Enfermagem 2016; 24:e2748. [PMID: 27508918 PMCID: PMC4990045 DOI: 10.1590/1518-8345.0708.2748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 09/20/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE to investigate the factors associated with mortality in patients undergoing coronary artery bypass grafting in a cardiovascular referral hospital in Santa Catarina. METHOD quantitative, exploratory, descriptive and retrospective study. The medical records of 1447 patients, from 2005 to 2013, were analyzed for statistically related variables, these being: profile, hospitalization diagnosis, risk factors for coronary artery disease, complications recorded during the hospitalization, length of hospitalization and cause of death. RESULTS the mortality rate was 5.3% during the study period. Death was more common in females and those of black skin color, with a mean age of 65 years. Acute myocardial infarction was the most common hospitalization diagnosis. The majority of the complications recorded during hospitalization were characterized by changes in the cardiovascular system, with longer hospitalization periods being directly related to death from septic shock. CONCLUSION the data provide subsidies for nursing work with preventive measures and early detection of complications associated with coronary artery bypass grafting. This reinforces the importance of using the data as quality indicators, aiming to guarantee care guided by reliable information to guide managers in planning patient care and high complexity health services.
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Affiliation(s)
- Cintia Koerich
- Doctoral Student, Centro de Ciências da Saúde, Universidade Federal de
Santa Catarina, Florianópolis, SC, Brazil. RN, Hospital Infantil Joana de Gusmão,
Secretaria do Estado da Saúde de Santa Catarina, São José, SC, Brazil
| | | | - Alacoque Lorenzini Erdmann
- PhD, Full Professor, Centro de Ciências da Saúde, Universidade Federal
de Santa Catarina, Florianópolis, SC, Brazil
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Kai H, Kimura T, Fukuda K, Fukumoto Y, Kakuma T, Furukawa Y. Impact of Low Diastolic Blood Pressure on Risk of Cardiovascular Death in Elderly Patients With Coronary Artery Disease After Revascularization – The CREDO-Kyoto Registry Cohort-1 –. Circ J 2016; 80:1232-41. [DOI: 10.1253/circj.cj-15-1151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hisashi Kai
- Department of Cardiology, Kurume University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kenji Fukuda
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine
- Department of Cerebrovascular Medicine, St. Mary’s Hospital
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine
| | | | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital
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Coronary artery bypass grafting in octogenarians: only when percutaneous coronary intervention is not feasible? Curr Opin Cardiol 2015; 30:636-42. [PMID: 26352246 DOI: 10.1097/hco.0000000000000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review recent literature reporting the results of coronary revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients older than 80 years. RECENT FINDINGS The review of recent studies on octogenarians demonstrates a surgical CABG advantage in the case of patients with increasing baseline coronary risk, such as severe multivessel disease, chronic total occlusions, and left ventricular dysfunction. PCI seems to be more appropriate for less severe degree and distribution of coronary lesions, and for subgroups of patients with higher surgical risk, such as acute coronary syndromes, reoperations, malignancy, dementia, poor mobility, frailty, and serious comorbidities contraindicating extracorporeal circulation. SUMMARY It is not the case that CABG is indicated only when there are contraindications to PCI. CABG confers more benefit than PCI in patients with increasing baseline cardiac risk, in the absence of serious systemic diseases that can reasonably reduce their life expectancy.CABG and PCI, with proper selection, should be considered complementary rather than competitive procedures in the therapy of octogenarians affected by coronary artery disease.
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Kowalewski M, Pawliszak W, Malvindi PG, Bokszanski MP, Perlinski D, Raffa GM, Kowalkowska ME, Zaborowska K, Navarese EP, Kolodziejczak M, Kowalewski J, Tarelli G, Taggart DP, Anisimowicz L. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis. J Thorac Cardiovasc Surg 2015; 151:60-77.e1-58. [PMID: 26433633 DOI: 10.1016/j.jtcvs.2015.08.042] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/27/2015] [Accepted: 08/12/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the benefits and risks of off-pump coronary artery bypass (OPCAB) versus coronary artery bypass grafting (CABG) through a meta-analysis of randomized controlled trials (RCTs), and to investigate the relationship between outcomes and patient risk profile. METHODS PubMed, Embase, the Cumulative Index of Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library, and major conference proceedings databases were searched for RCTs comparing OPCAB and CABG and reporting short-term (≤ 30 days) outcomes. Endpoints assessed were all-cause mortality, myocardial infarction (MI), and cerebral stroke. RESULTS The meta-analysis included 100 studies, with a total of 19,192 subjects. There was no difference between the 2 techniques with respect to all-cause mortality and MI (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.71-1.09; P = .25; I(2) = 0% and OR, 0.90; 95% CI, 0.77-1.05; P = .19; I(2) = 0%, respectively). OPCAB was associated with a significant 28% reduction in the odds of cerebral stroke (OR, 0.72; 95% CI, 0.56-0.92; P = .009; I(2) = 0%). A significant relationship between patient risk profile and benefits from OPCAB was found in terms of all-cause mortality (P < .01), MI (P < .01), and cerebral stroke (P < .01). CONCLUSIONS OPCAB is associated with a significant reduction in the odds of cerebral stroke compared with conventional CABG. In addition, benefits of OPCAB in terms of death, MI, and cerebral stroke are significantly related to patient risk profile, suggesting that OPCAB should be strongly considered in high-risk patients.
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Affiliation(s)
- Mariusz Kowalewski
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland; Faculty of Health Sciences, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Düsseldorf, Germany.
| | - Wojciech Pawliszak
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Pietro Giorgio Malvindi
- University Hospital Southampton NHS Foundation Trust, Wessex Cardiothoracic Centre, Southampton, United Kingdom
| | - Marek Pawel Bokszanski
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Damian Perlinski
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Magdalena Ewa Kowalkowska
- Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Düsseldorf, Germany; Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Collegium Medicum, Bydgoszcz, Poland
| | - Katarzyna Zaborowska
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Eliano Pio Navarese
- Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Düsseldorf, Germany; Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michalina Kolodziejczak
- Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Düsseldorf, Germany; Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Janusz Kowalewski
- Lung Cancer and Thoracic Surgery Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Giuseppe Tarelli
- Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - David Paul Taggart
- Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Lech Anisimowicz
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
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Deschka H, Müller D, Dell'Aquila A, Matthäus M, Erler S, Wimmer-Greinecker G. Non-elective cardiac surgery in octogenarians: Do these patients benefit in terms of clinical outcomes and quality of life? Geriatr Gerontol Int 2015; 16:416-23. [DOI: 10.1111/ggi.12484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Heinz Deschka
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery; University Hospital Münster; Münster Germany
| | - Dirk Müller
- Department of Cardiology; Heart & Vessel Center Bad Bevensen; Bad Bevensen Germany
| | - Angelo Dell'Aquila
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery; University Hospital Münster; Münster Germany
| | - Martin Matthäus
- Department of Cardiothoracic Surgery; Heart & Vessel Center Bad Bevensen; Bad Bevensen Germany
| | - Stefan Erler
- Department of Cardiothoracic Surgery; Heart & Vessel Center Bad Bevensen; Bad Bevensen Germany
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Benedetto U, Amrani M, Bahrami T, Gaer J, De Robertis F, Smith RD, Raja SG. Survival probability loss from percutaneous coronary intervention compared with coronary artery bypass grafting across age groups. J Thorac Cardiovasc Surg 2015; 149:479-84. [DOI: 10.1016/j.jtcvs.2014.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/21/2014] [Accepted: 10/04/2014] [Indexed: 11/30/2022]
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Benedetto U, Amrani M, Raja SG. Guidance for the use of bilateral internal thoracic arteries according to survival benefit across age groups. J Thorac Cardiovasc Surg 2014; 148:2706-11. [DOI: 10.1016/j.jtcvs.2014.07.088] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 06/27/2014] [Accepted: 07/13/2014] [Indexed: 10/24/2022]
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Clinical features of coronary artery ectasia in the elderly. J Geriatr Cardiol 2014; 11:185-91. [PMID: 25278965 PMCID: PMC4178508 DOI: 10.11909/j.issn.1671-5411.2014.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 06/03/2014] [Accepted: 08/21/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the incidence, imaging and clinical characteristics in elderly patients with coronary artery ectasia (CAE). METHODS A retrospective analysis was conducted on patients with CAE who underwent coronary angiography between January 2006 and December 2012. According to age, the enrolled patients were divided into two groups (elderly group, age ≥ 65 years; non-elderly group, age < 65 years). The clinical feature, imaging characteristics and the 5-year survival rate of the two groups were compared. RESULTS The prevalence of CAE in elderly patients was 0.33%. Patients in elderly group were found to have significantly higher proportion of female (30.1% vs. 10.1%, P < 0.001), three-vessel disease (60.5% vs. 45.2%, P = 0.003) and localized ectasia (55.0% vs. 40.2%, P = 0.003). In addition, body mass index (20.90 ± 2.71 kg/m(2) vs. 22.31 ± 2.98 kg/m(2), P < 0.001) and percentage of current smokers (45.0% vs. 64.6%, P < 0.001) were significantly lower in elderly group. Cumulative survival curves demonstrated reduced 5-year cumulative survival at the follow-up in the elderly group compared with the non-elderly group (88.0% vs. 96.0%, P = 0.002). But the 5-year event free survival rate failed to show a significant difference between the two groups (31.0% vs. 35.0%, P = 0.311). CONCLUSION The prevalence of CAE in elderly patients was 0.33%, which was about 1/3 of the entire numbers of CAE patients. There were significant differences between the elderly and the non-elderly patients with CAE in terms of coronary artery disease risk factors and coronary artery ectatic characteristics. CAE might be associated with increased mortality risk in the elderly.
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Koyama S, Itatani K, Yamamoto T, Miyazaki S, Kitamura T, Taketani T, Ono M, Miyaji K. Optimal bypass graft design for left anterior descending and diagonal territory in multivessel coronary disease. Interact Cardiovasc Thorac Surg 2014; 19:406-13. [PMID: 24893870 DOI: 10.1093/icvts/ivu182] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Coronary artery bypass grafting for multivessel disease requires an appropriate graft design to avoid the competition of flow between the graft and the native vessel in order to achieve a sufficient coronary flow and durable graft patency. METHODS Three-dimensional computational models of the left coronary artery were created based on the angiographic data. Three stenosis patterns of 75 and 90% combinations were created in the left anterior descending artery (LAD), the diagonal branch (Dx) and the circumflex artery (LCx). The left internal thoracic artery (LITA) was anastomosed to the LAD, and separate saphenous vein grafts (SVGs) were anastomosed to the Dx and the LCx in the 'Independent' model. The 'Sequential' model included sequential SVG anastomoses to the Dx and the LCx with a left internal thoracic artery-left anterior descending artery bypass, and Y-composite arterial grafts to LAD and Dx were created in the 'Composite' model. RESULTS The 'Independent' model had high reverse flow from the Dx to the LAD in systole, resulting in decreased LITA flow when Dx stenosis was mild. The 'Sequential' model also had reverse flow in diastole, resulting in additional LAD flow. The 'Composite' model distributed increased flow to the Dx when Dx stenosis was severe, resulting in decreased flow to the LAD. CONCLUSIONS Systematic flow evaluation is beneficial for determining the optimal bypass graft arrangement in patients with multivessel disease. Individual SVG anastomoses to the Dx and the LCx are not desirable when Dx stenosis is not severe and a Y-composite arterial graft to the LAD and the Dx is not desirable when Dx stenosis is severe.
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Affiliation(s)
- Sachi Koyama
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan Department of Hemodynamic Analysis, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tadashi Yamamoto
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Hokkaido, Japan
| | - Shohei Miyazaki
- Department of Hemodynamic Analysis, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tuyoshi Taketani
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Chiyoda, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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