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Iacona GM, Bakhos JJ, Houghtaling PL, Tipton AE, Ramsingh R, Smedira NG, Gillinov M, McCurry KR, Soltesz EG, Roselli EE, Tong MZ, Unai SG, Elgharably HJ, Koprivanac MJ, Svensson LG, Blackstone EH, Bakaeen FG. Multiarterial grafting in redo coronary artery bypass grafting: Type of arterial conduit and patient sex determine benefit. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00927-9. [PMID: 39426712 DOI: 10.1016/j.jtcvs.2024.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 09/27/2024] [Accepted: 10/04/2024] [Indexed: 10/21/2024]
Abstract
OBJECTIVE To evaluate whether multiarterial grafting provides an incremental benefit above single arterial grafting in isolated redo coronary artery bypass grafting (CABG). METHODS From January 1980 to July 2020, 6559 adults underwent a total of 6693 isolated CABG reoperations. Patients undergoing multiarterial grafting were propensity score-matched with those undergoing single arterial grafting with or without additional vein grafts, yielding 2005 well-matched pairs. Endpoints were in-hospital postoperative complications, hospital mortality, and long-term mortality. The median follow-up was 10 years, with 25% of patients followed for >17 years. Multivariable multiphase hazard models and nonparametric random survival forest models for survival were used to identify patients for whom multiarterial grafting was most beneficial. RESULTS Among propensity score-matched patients, postoperative complications in multiarterial versus single arterial grafting included any reoperation (50 [2.5%] vs 65 [3.2%]); renal failure (73 [3.6%] vs 55 [2.7%]), stroke (44 [2.2%] vs 38 [1.9%]), and deep sternal infection (36 [1.8%] vs 25 [1.2%]). In-hospital mortality was 1.7% (n = 35) in multiarterial grafting versus 2.8% (n = 56) in single arterial grafting (P = .03). Comparing multiarterial to single arterial grafting, overall survival was 95% versus 94% at 1 year, 92% versus 88% at 3 years, 87% versus 82% at 5 years, 49% versus 42% at 15 years, and 31% versus 25% at 20 years. Better survival after multiarterial grafting was confined to males with 2 patent internal thoracic artery grafts (P < .0001). CONCLUSIONS Redo CABG with multiarterial grafting can be performed with lower in-hospital mortality and similar major morbidity to single arterial grafting. It is associated with better long-term survival, particularly in males when 2 internal thoracic artery grafts are used.
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Affiliation(s)
- Gabriele M Iacona
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jules J Bakhos
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Penny L Houghtaling
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Aaron E Tipton
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Richard Ramsingh
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicholas G Smedira
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth R McCurry
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward G Soltesz
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Z Tong
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shinya G Unai
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Haytham J Elgharably
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marijan J Koprivanac
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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Ghandakly EC, Iacona GM, Bakaeen FG. Coronary Artery Surgery: Past, Present, and Future. Rambam Maimonides Med J 2024; 15:RMMJ.10515. [PMID: 38261345 PMCID: PMC10807854 DOI: 10.5041/rmmj.10515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Coronary artery bypass grafting (CABG) is the most commonly performed and studied major cardiac operation worldwide. An understanding of the evolution of CABG, including the early days of cardiac surgery, the first bypass operation, continuous improvements in techniques, and streamlining of the operation, is important to inform current trends and future innovations. This article will examine how CABG evolved (from techniques to conduits), describe current trends in the field, and explore what lies on the horizon for the future of CABG.
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Affiliation(s)
- Elizabeth C Ghandakly
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gabriele M Iacona
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Faisal G Bakaeen
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Ruel M. Designing the coronary artery bypass surgery operation of the future. Curr Opin Cardiol 2023; 38:490-495. [PMID: 37751390 DOI: 10.1097/hco.0000000000001083] [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: 09/28/2023]
Abstract
PURPOSE OF REVIEW This article discusses current shortcomings in coronary artery bypass surgery and ways to overcome them. RECENT FINDINGS Minimally invasive coronary bypass surgery, robotic coronary bypass, and hybrid approaches aim to avoid sternotomy, employ arterial grafts, and minimize the use of cardiopulmonary bypass. Other considerations such as bypass graft validation, the optimization of guideline-directed medical therapy, and the development of coronary surgery specialists are also crucial to further the benefits of coronary artery bypass grafting on future patients. SUMMARY Coronary artery bypass grafting must become less invasive, be better validated, and be carried out with an even higher emphasis on quality, including graft validation and preoperative/postoperative optimization, if it is to remain the best treatment for advanced, severe coronary artery disease.
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Affiliation(s)
- Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Kusu-Orkar TE, Masharani K, Harky A, Muir AD. Redo Coronary Artery Bypass Grafting in the era of Advanced PCI. Braz J Cardiovasc Surg 2022; 37:546-553. [PMID: 35976207 PMCID: PMC9423790 DOI: 10.21470/1678-9741-2019-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/03/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To review the evidence behind the role and relevance of redo coronary artery bypass grafting (CABG) in the current practice of percutaneous coronary intervention (PCI). METHODS A comprehensive electronic literature search was performed to identify articles that discuss the practice of PCI and redo CABG in patients that require coronary revascularization. All relevant studies are summarized in narrative manner to reflect current indications and preference. RESULTS The advancement in utilization of PCI has reduced the rate of redo CABG in patients with previous CABG that requires revascularization of an already treated coronary disease or a new onset of coronary artery stenosis. Redo CABG is associated with satisfactory perioperative outcomes but higher mortality at immediate postoperative period when compared to PCI. CONCLUSION Redo CABG patients are less likely to develop comorbidities associated with revascularisation, but the operative mortality is higher and long-term survival rates are similar in comparison to PCI. There is a need for further research into the role of redo CABG in the current advanced practice of PCI.
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Affiliation(s)
- Ter-Er Kusu-Orkar
- School of Medicine, University of Liverpool, Liverpool, United
Kingdom
| | - Kellan Masharani
- School of Medicine, University of Liverpool, Liverpool, United
Kingdom
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
| | - Andrew D Muir
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
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