1
|
Shahinian JH, Lappiere H, Grau J, Glineur D. Total Arterial Revascularization: Evaluating the Length of the Radial Artery in a Composite Graft Configuration. Ann Thorac Cardiovasc Surg 2024; 30:n/a. [PMID: 37899176 PMCID: PMC10902649 DOI: 10.5761/atcs.oa.23-00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
PURPOSE Reimplanting the radial artery in the left internal thoracic artery as a composite graft allows total arterial revascularization (TAR) without aortic manipulation. The limitation of this strategy is the length of the radial artery required to reach distal right coronary artery (RCA) branches. Our analysis focuses on the feasibility of this strategy. METHODS A total of 169 patients underwent TAR using the radial artery in a composite grafting configuration. Length of the radial artery, number of sequential anastomoses, heart size, target location, length of the arm, patient height, body surface area, and flow in the composite graft were prospectively collected. RESULTS The mean length of the radial artery was 18.02 cm. Patients with a mean length of the radial artery of 15.9 cm needed an extension of the radial artery with another conduit to reach the RCA distal branches. When T-configuration is used, the length of the radial artery should be 0.53 cm per sequential anastomosis to reach the RCA distal branches. CONCLUSIONS Our study shows that an average length of 18.02 cm of radial artery is needed to reach targets on the RCA distal branches in composite grafting. In T-configuration, we need 0.53 cm more length per anastomosis to achieve TAR.
Collapse
Affiliation(s)
- Jasmin H Shahinian
- Faculty of Medicine, Institute of Surgical Pathology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | | | - Juan Grau
- The Valley Hospital, Ridgewood, NJ, USA
| | | |
Collapse
|
2
|
Gasparovic I, Artemiou P, Domonkos A, Bezak B, Gazova A, Kyselovic J, Hulman M. Multivessel Coronary Disease and Severe Atherosclerotic Aorta: Real-World Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1943. [PMID: 38003992 PMCID: PMC10672925 DOI: 10.3390/medicina59111943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Surgical revascularisation of patients with atherosclerosis of the ascending aorta remains a challenge. Different surgical strategies have been described in coronary surgical patients to offer alternative revascularisation strategies other than the conventional surgical revascularisation in patients unsuitable for it. The aim of this study is to compare the real-world outcomes between two groups of patients who underwent off-pump surgery (left internal mammary artery graft to the left anterior descending artery) or a hybrid with a percutaneous revascularisation procedure at a later stage. Materials and Methods: This is a single-centre retrospective observational study. Between the years 2010 and 2021, 91/6863 patients (1.33%) were diagnosed with severe atherosclerosis of the ascending aorta. All the patients were treated with off-pump revascularisation (91 patients), and the cardiologist would decide at a later stage whether the rest of the vessels would be treated with percutaneous revascularisation (25 patients). Results: There was no statistical difference in the various preoperative characteristics, except for coronary artery left main disease (30.30% vs. 64%; p = 0.0043). The two groups had no statistical differences in the perioperative characteristics and postoperative complications. The 1-, 5-, and 10-year mortality rates in the two groups were 6.1% vs. 0%, 59% vs. 80%, and 93.9% vs. 100%, respectively (off-pump vs. hybrid with percutaneous revascularisation procedure, p = 0.1958). Conclusions: Both strategies have high long-term comparable mortality. The off-pump surgery and the HCR procedure at a later stage may be solutions for these high-risk patients, but the target treatment should be complete HCR revascularisation during the index hospitalization.
Collapse
Affiliation(s)
- Ivo Gasparovic
- National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia; (I.G.); (A.D.); (B.B.); (M.H.)
| | - Panagiotis Artemiou
- National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia; (I.G.); (A.D.); (B.B.); (M.H.)
| | - Andrej Domonkos
- National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia; (I.G.); (A.D.); (B.B.); (M.H.)
| | - Branislav Bezak
- National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia; (I.G.); (A.D.); (B.B.); (M.H.)
| | - Andrea Gazova
- Department of Pharmacology and Clinical Pharmacology, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia;
| | - Jan Kyselovic
- 5th Department of Internal Medicine, Medical Faculty Comenius, Comenius University Bratislava, 813 72 Bratislava, Slovakia;
- Department of Pharmacology and Toxicology, University of Veterinary Medicine and Pharmacy in Kosice, 041 81 Kosice, Slovakia
| | - Michal Hulman
- National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia; (I.G.); (A.D.); (B.B.); (M.H.)
| |
Collapse
|
3
|
Chegini A, Alaei M, Jahangiryan A, Zadsar M. Blood Products Utilization Status in Off-Pump Cardiac Surgery Patients. Int J Hematol Oncol Stem Cell Res 2023; 17:200-209. [PMID: 37817967 PMCID: PMC10560645 DOI: 10.18502/ijhoscr.v17i3.13310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/01/2022] [Indexed: 10/12/2023] Open
Abstract
Background: Transfusion support has an essential role in coronary artery bypass graft (CABG). The time-honored gold standard for CABG is the on-pump procedure (ONCAB); however, off-pump coronary artery bypass (OPCAB) is also a safe, cost-benefit procedure with fewer blood transfusion requirements. This study was performed to evaluate transfusion patterns in OPCAB due to the diversity of transfusion practices. Materials and Methods: This retrospective study was performed to determine the transfusion rate and triggers in OPCAB patients. Medical files of all patients undergoing OPCAB surgery at Sanandaj Tohid Hospital in 2014 were reviewed. Patients' demographics data, preoperative laboratory tests (PT, aPTT, Hb, Hct, Platelet count), underlying medical conditions, and their possible relation to further transfusions and the ward department in which the transfusion had taken place were extracted. SPSS 16 Chicago software, T-student Test, One Way Anova, and χ2 exam were applied for data analysis. P values ≤0.05was considered significant. Results: Among 91 elective OPCAB patients: 28(30.8%) women and 63(69.2%) men with mean age of 64.80±9.02 years, 63(69.23%) received a blood product. Mean utilization of PRBC, FFP, Platelet, and Cryoprecipitate were 2.17±2.044, 2.46±2.86, 2.86±3.80 and 0.40±2.10 units, respectively. ICU revealed the highest consumption rate for all products. Female sex (p<0.001), Hypertension (P=0.002), and low hemoglobin(P=0.004) were noted as predictive factors for transfusion. Conclusion: This study concluded that the transfusion rate in OPCAB is still very high in Iran (regarding a study in a countryside hospital) and that the highest utilization rate is seen in the ICU.
Collapse
Affiliation(s)
- Azita Chegini
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Mastaneh Alaei
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Afsaneh Jahangiryan
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Maryam Zadsar
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| |
Collapse
|
4
|
Gaudino M, Andreotti F, Kimura T. Current concepts in coronary artery revascularisation. Lancet 2023; 401:1611-1628. [PMID: 37121245 DOI: 10.1016/s0140-6736(23)00459-2] [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] [Received: 11/22/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 05/02/2023]
Abstract
Coronary artery revascularisation can be performed surgically or percutaneously. Surgery is associated with higher procedural risk and longer recovery than percutaneous interventions, but with long-term reduction of recurrent cardiac events. For many patients with obstructive coronary artery disease in need of revascularisation, surgical or percutaneous intervention is indicated on the basis of clinical and anatomical reasons or personal preferences. Medical therapy is a crucial accompaniment to coronary revascularisation, and data suggest that, in some subsets of patients, medical therapy alone might achieve similar results to coronary revascularisation. Most revascularisation data are based on prevalently White, non-elderly, male populations in high-income countries; robust data in women, older adults, and racial and other minorities, and from low-income and middle-income countries, are urgently needed.
Collapse
Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
| | - Felicita Andreotti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| |
Collapse
|
5
|
Hybrid Coronary Revascularization: Best of 2 Worlds in the Environment Where Revascularization Is in Reverse. JACC Cardiovasc Interv 2023; 16:61-63. [PMID: 36599588 DOI: 10.1016/j.jcin.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 01/03/2023]
|
6
|
Bhattacharya S, Bandyopadhyay A, Pahari S, Das S, Dey AK. Outcomes of urgent coronary artery bypass grafting in patients who have recently recovered from COVID-19 infection, with a median follow-up period of twelve months: our experience. Egypt Heart J 2022; 74:66. [PMID: 36076106 PMCID: PMC9458307 DOI: 10.1186/s43044-022-00304-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background The Coronavirus disease 2019 (COVID-19) was declared a worldwide pandemic in 2020 by the World Health Organization (WHO). Certain individuals are at higher risk, (age > 65 years, pre-existing lung or heart conditions, diabetes and obesity) especially those requiring cardiac surgery, including Coronary Artery Bypass Grafting (CABG). Here we present a case series of 11 patients, operated between April 2020 and April 2022, all of whom had recently recovered from COVID-19, who presented with unstable angina, and therefore required urgent Coronary Artery Bypass Grafting (CABG). Similar cases reported in the past, have had a high morbidity and mortality rate. Case presentation The study included 11 males, and their age varied between 53 and 68 years (median of 65 years). They were either partially or fully vaccinated. All of them had a history of recent mild COVID-19 infection. The European system for cardiac operative risk evaluation, EuroSCORE II in-hospital mortality risk at admission, varied between 1.48% and 5.12%. Six out of 11 patients (54.55%) had a recent Acute Coronary Syndrome (ACS) which is associated with a higher risk and poor prognosis. All of them underwent urgent CABG (10 of them, 90.91% cases, using the off-pump technique and one patient had to be converted to the on-pump beating heart surgery technique during surgery). Ten of the 11 patients were operated using the off-pump technique, and there was one death (9.09%). All surviving patients made an uneventful recovery and have been followed up with a median follow-up period of 12 months. Conclusions Previous studies on a similar group of patients have resulted in high morbidity and mortality. A conscious effort was made to perform all surgeries off-pump, thereby eliminating the inflammatory effects and other hazards of cardiopulmonary bypass in this case series, with only one out of 11 (9.09%) being converted to the on-pump beating heart technique due to the hemodynamic instability faced during surgery. Our findings show a mortality rate of 9.09%, with the surviving patients doing well at a median follow-up period of 12 months, suggesting that it is a safe procedure in this patient subset.
Collapse
|
7
|
Zhang S, Huang S, Tiemuerniyazi X, Song Y, Feng W. A Meta-Analysis of Early, Mid-term and Long-Term Mortality of On-Pump vs. Off-Pump in Redo Coronary Artery Bypass Surgery. Front Cardiovasc Med 2022; 9:869987. [PMID: 35548406 PMCID: PMC9081922 DOI: 10.3389/fcvm.2022.869987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/31/2022] [Indexed: 12/15/2022] Open
Abstract
We aimed to compare the early, mid-term, and long-term mortality between on-pump vs. off-pump redo coronary artery bypass grafting (CABG). We conducted a systematic search for studies comparing clinical outcomes of patients who underwent on-pump vs. off-pump redo CABG. We pooled the relevant studies quantitatively to compare the early (perioperative period, whether in hospital or within 30 days after discharge), mid-term (≥1 year and <5 years), and long-term (≥5 year) mortality of on-pump vs. off-pump redo CABG. A random-effect model was applied when there was high heterogeneity (I2 > 50%) between studies. Otherwise, a fixed-effect model was utilized. After systematic literature searching, 22 studies incorporating 5,197 individuals (3,215 in the on-pump group and 1,982 in the off-pump group) were identified. A pooled analysis demonstrated that compared with off-pump redo CABG, on-pump redo CABG was associated with higher early mortality (OR 2.11, 95%CI: 1.54–2.89, P < 0.00001). However, no significant difference was noted in mid-term mortality (OR 1.12, 95%CI: 0.57–2.22, P = 0.74) and long-term mortality (OR 1.12, 95%CI: 0.41–3.02, P = 0.83) between the two groups. In addition, the complete revascularization rate was higher in the on-pump group than the off-pump group (OR 2.61, 95%CI: 1.22–5.60, P = 0.01). In conclusion, the off-pump technique is a safe and efficient alternative to the on-pump technique, with early survival advantage and similar long-term mortality to the on-pump technique in the setting of redo CABG, especially in high-risk patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021244721.
Collapse
Affiliation(s)
- Shicheng Zhang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyuan Huang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xieraili Tiemuerniyazi
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangwu Song
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
8
|
Wagner C, Hawkins RB. Commentary: Splitting hairs on the crème de la crème of all-arterial revascularization strategies. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01820-1. [DOI: 10.1016/j.jtcvs.2021.12.032] [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: 12/18/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
|
9
|
Nishi H, Yokoyama H, Yaku H, Doi K, Nishimura Y, Abe K, Tsukui H, Tabata M, Okamoto K, Park YK, Matsuda H. Efficacy of simulation training for beating heart coronary anastomosis using BEAT + YOUCAN simulator. Asian Cardiovasc Thorac Ann 2021; 30:661-668. [PMID: 34757850 DOI: 10.1177/02184923211060214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to evaluate our distributed practice program developed for training for beating heart anastomosis by employing a novel beating heart simulator. METHODS Eleven trainees watched and reviewed instructional video recordings of coronary anastomosis methods with a BEAT + YOUCAN training device, then performed coronary anastomosis procedures under a beating condition. Next, they participated in a four-hour training program developed by faculty surgeons. Ten different anastomosis components were assessed on a five-point rating scale (5, good; 3, average; 1, poor). After finishing the training program, each trainee again performed a coronary anastomosis procedure. Component scores were then compared before and after the training program. RESULTS The mean time to completion of the procedure improved from 1033 ± 424 to 795 ± 201 s (p < 0.05). Assessment scores improved from 1.88 ± 0.41 to 2.57 ± 0.30 (p < 0.05). Improvements in some technical components related to handling of instruments were noted (p < 0.05), whereas no significant improvement was seen with arteriotomy, graft orientation, suture management, or knot tying after finishing the training program. CONCLUSION Trainees who participated in our four-hour focused training program for coronary anastomosis with a novel beating heart simulator showed improved ability under the beating condition in regard to technical skills related to handling instruments.
Collapse
Affiliation(s)
- Hiroyuki Nishi
- Department of Cardiovascular Surgery, 13707National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, 12775Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kiyoshi Doi
- Department of Cardiovascular Surgery, 38225Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, 13145Wakayama Medical University, Wakayama, Japan
| | - Kohei Abe
- Department of Cardiovascular Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Hiroyuki Tsukui
- Department of Cardiothoracic Surgery, 22426Excela Health Westmoreland Hospital, Jeannette, United States
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo-Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Kazuma Okamoto
- Department of Cardiovascular Surgery, 12872Kindai University, Higashiosaka, Japan
| | - Young-Kwang Park
- Department of Cardiovascular Surgery, 12775Fukushima Medical University, Fukushima, Japan
| | - Hikaru Matsuda
- Department of Cardiovascular Surgery, Higashi-Takarazuka Satoh Hospital, Hyogo, Japan
| |
Collapse
|
10
|
Urbanowicz T, Michalak M, Gąsecka A, Perek B, Rodzki M, Bociański M, Straburzyńska-Migaj E, Jemielity M. Postoperative Neutrophil to Lymphocyte Ratio as an Overall Mortality Midterm Prognostic Factor following OPCAB Procedures. Clin Pract 2021; 11:587-597. [PMID: 34563003 PMCID: PMC8482266 DOI: 10.3390/clinpract11030074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Off-pump coronary artery bypass grafting (OPCAB) is believed to limit inflammatory reaction. Neutrophil to lymphocyte ratio (NLR) is one of the more common and easily accessible markers of inflammatory response. The aim of the study was to compare postoperative results of NLR with mid-term OPCAB results. METHODS In total, 224 patients (198 (88%) men and 26 (12%) women) with mean age 65 +/- 9 years who underwent OPCAB though median full sternotomy in our department in 2018 enrolled into the study. We scrupulously collected the postoperative mid-term results, including survival rate, clinical status and risk for major adverse events, and compared them with perioperative laboratory results. RESULTS A three-year follow-up was completed by 198 individuals (90% survival rate) with 12 (5%) showing major adverse cardiovascular (MACE) events risk. In the multivariable analysis, the laboratory parameters noticed on the 1st postoperative day were statistically significantly predictive of survival, including neutrophils (HR 1.59, 1.33-1.89 95%CI, p < 0.0001), platelets (HR 1.01, 1.01-1.01 95%CI, p = 0.0065), NLR (HR 1.47, 1.3-1.65 95%CI, p < 0.0001) and postoperative ejection fraction (HR 0.9, 0.87-0.95 95%CI, p < 0.0001). CONCLUSIONS Postoperative NLR above 4.6, as an inflammatory reaction marker, is related to mid-term mortality in OPCAB patients.
Collapse
Affiliation(s)
- Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (B.P.); (M.R.); (M.B.); (M.J.)
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Aleksandra Gąsecka
- Department of Cardiology Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (B.P.); (M.R.); (M.B.); (M.J.)
| | - Michał Rodzki
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (B.P.); (M.R.); (M.B.); (M.J.)
| | - Michał Bociański
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (B.P.); (M.R.); (M.B.); (M.J.)
| | | | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (B.P.); (M.R.); (M.B.); (M.J.)
| |
Collapse
|