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Urso S, Sadaba R, Dayan V. Benefits of coronary artery bypass grafting over percutaneous coronary intervention in left main disease: the strength of the evidence. Eur Heart J 2024; 45:1684. [PMID: 38442147 DOI: 10.1093/eurheartj/ehae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Affiliation(s)
- Stefano Urso
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Barranco de la Ballena, s/n 35010, Las Palmas de Gran Canaria, Spain
| | - Rafael Sadaba
- Cardiac Surgery Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Victor Dayan
- Cardiac Surgery Department, Centro Cardiovascular Universitario, Hospital de Clinicas, Montevideo, Uruguay
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2
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Crea F. Focus on ischaemic heart disease: prevention with colchicine, role of the brain-heart axis, new therapeutic targets for ischaemia-reperfusion injury. Eur Heart J 2024; 45:1577-1581. [PMID: 38738301 DOI: 10.1093/eurheartj/ehae270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Affiliation(s)
- Filippo Crea
- Centre of Excellence of Cardiovascular Sciences, Gemelli Isola Hospital, Rome, Italy
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Kirov H, Caldonazo T, Mukharyamov M, Toshmatov S, Fischer J, Schneider U, Siemeni T, Doenst T. Cardiac Surgery 2023 Reviewed. Thorac Cardiovasc Surg 2024. [PMID: 38740368 DOI: 10.1055/s-0044-1786758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term "cardiac surgery AND 2023." We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Murat Mukharyamov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Sultonbek Toshmatov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiac Surgery, Saarland University Medical Center, Homburg Saar, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
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Mu S, Chen Y, Wang J, Guo J, Niu R, Zhang Y, Su P, Ali JM, Gao J, Wu A. The predictive and prognostic value of risk factors in patients receiving hybrid coronary revascularization with postoperative pulmonary complications. J Thorac Dis 2024; 16:2528-2538. [PMID: 38738248 PMCID: PMC11087606 DOI: 10.21037/jtd-24-422] [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] [Received: 03/13/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024]
Abstract
Background The mortality rate of coronary artery disease ranks first in developed countries, and coronary revascularization therapy is an important cornerstone of its treatment. The postoperative pulmonary complications (PPCs) in patients receiving one-stop hybrid coronary revascularization (HCR) aggravate the dysfunction of multiple organs such as the heart and lungs, therefore increasing mortality. However, the risk factors are still unclear. The objective of this study was to explore the risk factors of PPCs after HCR surgery. Methods In this study, the perioperative data of 311 patients undergoing HCR surgery were reviewed. All patients were divided into two groups according to whether the PPCs occurred. The baseline information and surgery-related indicators in preoperative laboratory examination, intraoperative fluid management, and anesthesia management were compared between the two groups. Results Advanced age [odds ratio (OR): 1.065, 95% confidence interval (CI): 1.030-1.101, P<0.001], high body mass index (BMI; OR: 1.113, 95% CI: 1.011-1.225, P=0.02), history of percutaneous coronary intervention (PCI) surgery (OR: 2.831, 95% CI: 1.388-5.775, P=0.004), one-lung volume ventilation (OR: 3.804, 95% CI: 1.923-7.526, P<0.001), inhalation of high concentration oxygen (OR: 3.666, 95% CI: 1.719-7.815, P=0.001), the application of positive end-expiratory pressure (PEEP; OR: 2.567, 95% CI: 1.338-4.926, P=0.005), and long one-lung ventilation time (OR: 1.015, 95% CI: 1.006-1.023, P=0.001) may be risk factors for postoperative PPCs in patients undergoing one-stop coronary revascularization surgery. Using the above seven factors to jointly predict the risk of PPCs in patients undergoing one-stop coronary revascularization surgery, the receiver operating characteristic (ROC) curve showed an area under the curve (AUC) =0.873, 95% CI: 0.835-0.911, sensitivity: 84.81%, and specificity: 75.82%; the predictive model was shown to be effective. Conclusions Patients undergoing HCR surgery with advanced age, high BMI, a history of PCI surgery, one-lung volume ventilation, inhalation of high concentration oxygen, use of PEEP, and prolonged single lung ventilation are more prone to PPCs.
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Affiliation(s)
- Shanshan Mu
- Department of Anesthesiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Yingqi Chen
- Department of Anesthesiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Jiawan Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Jingjing Guo
- Department of Anesthesiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Ruitong Niu
- Department of Anesthesiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Yang Zhang
- Department of Anesthesiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Pixiong Su
- Department of Cardiac Surgery, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Jason M. Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Jie Gao
- Department of Cardiac Surgery, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
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Jalali A, Hassanzadeh A, Najafi MS, Nayebirad S, Dashtkoohi M, Karimi Z, Shafiee A. Predictors of major adverse cardiac and cerebrovascular events after percutaneous coronary intervention in older adults: a systematic review and meta-analysis. BMC Geriatr 2024; 24:337. [PMID: 38609875 PMCID: PMC11015672 DOI: 10.1186/s12877-024-04896-4] [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] [Received: 07/01/2023] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
AIM We systematically reviewed and meta-analyzed the predictors of major adverse cardiac and cerebrovascular events (MACE/MACCE) in older adults who underwent PCI. METHODS Three databases, PubMed, Embase, and Scopus, were searched for observational studies considering the out-of-hospital MACE/MACCE in adults ≥ 60 years old with coronary artery disease (acute or chronic) who underwent PCI. Studies were eligible if they had determined at least two statistically significant predictors of MACE/MACCE by multivariable analysis. We used the QUIPS tool to evaluate the risk of bias in the studies. Random-effects meta-analysis was utilized to pool the hazard ratios (HRs) of the most reported predictors. RESULTS A total of 34 studies were included in the review. Older age (HR = 1.04, 95% Confidence Interval (CI): 1.03-1.06, P-value < 0.001), diabetes (HR = 1.36, 95% CI: 1.22-1.53, P < 0.001), history of myocardial infarction (MI) (HR = 1.88, 95% CI: 1.37-2.57, P < 0.001), ST-elevation MI (STEMI) at presentation (HR = 1.72, 95% CI: 1.37-2.18, P < 0.001), reduced left ventricular ejection fraction (LVEF) (HR = 2.01, 95% CI: 1.52-2.65, P < 0.001), successful PCI (HR = 0.35, 95% CI: 0.27-0.47, P < 0.001), eGFR (HR = 0.99, 95% CI: 0.97-1.00; P-value = 0.04) and left main coronary artery (LMCA) disease (HR = 2.07, 95% CI: 1.52-2.84, P < 0.001) were identified as predictors of MACE. CONCLUSION We identified older age, diabetes, history of MI, STEMI presentation, lower LVEF, and LMCA disease increased the risk of MACE/MACCE after PCI in older adults. Meanwhile, higher eGFR and successful PCI predicted lower adverse events risk. Future studies should focus on a more robust methodology and a precise definition of MACE. REGISTRATION PROSPERO (CRD42023480332).
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Affiliation(s)
- Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, 1411713138, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hassanzadeh
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadeq Najafi
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Nayebirad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, 1411713138, Tehran, Iran
| | - Mohadese Dashtkoohi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Karimi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, 1411713138, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, 1411713138, Tehran, Iran.
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Kaski JC, Al-Lamee R, Boden WE. The year in cardiovascular medicine 2023: the top 10 papers in ischaemic heart disease. Eur Heart J 2024; 45:1201-1204. [PMID: 38442290 DOI: 10.1093/eurheartj/ehae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Rasha Al-Lamee
- Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Ducane Rd, London W12 0HS, UK
| | - William E Boden
- Boston University School of Medicine, 72 E Concord St., Boston, MA, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, USA
- Clinical Trials Network, VA New England Healthcare System, VA Boston-Jamaica Plain Campus, 150 S. Huntington Avenue, Boston, MA 02130, USA
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Gerçek M, Skuljevic T, Deutsch MA, Gummert J, Börgermann J. Off-pump coronary artery bypass grafting with clampless aortic anastomosis devices: Aortic sealing devices versus automated anastomosis punching. JTCVS Tech 2024; 24:92-104. [PMID: 38835575 PMCID: PMC11145195 DOI: 10.1016/j.xjtc.2024.01.010] [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: 11/16/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 06/06/2024] Open
Abstract
Objectives Clampless aortic anastomosis devices aim to lower stroke risk in off-pump coronary artery bypass grafting. Two main strategies for clampless anastomosis devices emerged with automated anastomosis punching and aortic sealing devices, prompting the question of perioperative outcome differences. Methods All consecutive patients undergoing elective off-pump coronary artery bypass grafting with a clampless aortic anastomosis device between September 2014 and December 2021 in 2 centers were retrospectively included. Cohorts were divided by the use of an automated anastomosis punching device or an aortic sealing device to achieve proximal anastomosis on the ascending aorta. To reach group comparability propensity score matching was performed. The primary end point was defined as a composite of all-cause mortality, stroke and rethoracotomy. Secondary end points were perioperative outcome parameters. Results A total of 3703 patients were enrolled of whom 575 and 3128 were included in the automated anastomosis punching and the aortic sealing device group, respectively. By propensity score matching a total of 1150 patients were included with 575 in each group. The primary composite endpoint showed no significant difference with 6.3% versus 5.9% events (odds ratio, 0.9; 95% confidence interval, 0.58-1.53, P = .81). All-cause mortality (P = .36), stroke (P = .81), and rethoracotomy (P = .89) also exhibit no disparity. Operation time was significantly longer in the aortic sealing device cohort with 220.0 ± 50.8 minutes and 204.6 ± 53.8 minutes (P < .01). Conclusions Clampless aortic anastomosis strategies aortic sealing device and automated anastomosis punching did not differ in perioperative outcome parameters, whereas the implementation of aortic sealing devices were associated with a prolonged operation time without inducing any inferior clinical outcome.
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Affiliation(s)
- Mustafa Gerçek
- Heart Center Duisburg, Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Duisburg, Germany
| | - Tomislav Skuljevic
- Heart Center Duisburg, Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Duisburg, Germany
- Ruhr-University Bochum, Bochum, Germany
| | - Marcus-André Deutsch
- Herz- und Diabeteszentrum NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany
| | - Jan Gummert
- Herz- und Diabeteszentrum NRW, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Heart Center Duisburg, Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Duisburg, Germany
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8
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Crea F. Quality standards for artificial intelligence-based studies and clinical trials. Eur Heart J 2023; 44:4815-4818. [PMID: 38059791 DOI: 10.1093/eurheartj/ehad784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, IIS-IP, CIBER-CV, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, C/ Diego de León 62, Madrid 28006, Spain
| | - Alexander Marschall
- Department of Cardiology, IIS-IP, CIBER-CV, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, C/ Diego de León 62, Madrid 28006, Spain
| | - Fernando Rivero
- Department of Cardiology, IIS-IP, CIBER-CV, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, C/ Diego de León 62, Madrid 28006, Spain
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Lesiak M, Urbanowicz TK, Olasińska-Wiśniewska A, Michalak M, Grygier M, Filipiak KJ, Tykarski A, Jemielity M, Lesiak M. Neutrophil and lymphocyte count as predictors of the location of calcific coronary lesions in patients treated with rotational atherectomy. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2023; 19:343-350. [PMID: 38187494 PMCID: PMC10767571 DOI: 10.5114/aic.2023.133809] [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] [Received: 08/05/2023] [Accepted: 10/15/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction The role of immune system activation in development and progression of atherosclerotic plaques has been postulated. Previous studies on inflammation have focused on the severity of coronary disease, the risk of acute coronary syndrome, and the prediction of outcomes based on hematological indices obtained from whole blood count analysis. Aim To analyze simple data of the whole blood count in relation to the location of calcified atherosclerotic lesions in patients treated with coronary rotational atherectomy (RA). Material and methods Eighty-one patients (57 (70%) males, mean (SD) age of 70.4 ±8 years) who underwent RA were enrolled in the study. The study group was divided into two subgroups depending on the proximal (group 1) and non-proximal (group 2) location of the culprit lesions in coronary arteries. The angiographic results were compared with demographic and clinical data and whole blood count analysis. Results The multivariable analysis revealed the predictive value of low neutrophil (OR = 0.75, 95% CI: 0.58-0.97, p = 0.030) and lymphocyte counts (OR = 0.27, 95% CI: 0.11-0.68, p = 0.005) for the proximal location of the culprit lesions. In the ROC analysis, combined neutrophil and lymphocyte counts showed the best prediction of proximal location, with the area under the curve of 0.747 (p < 0.001), yielding a sensitivity of 79.07% and specificity of 73.68%. Conclusions The lower neutrophil and lymphocyte counts in peripheral blood count analysis may be more representative of proximal calcified coronary lesions. The relationship between neutrophil and lymphocyte blood count and calcific atherosclerotic plaque location can indicate the inflammatory background of epicardial atheroma formation and distribution.
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Affiliation(s)
- Michał Lesiak
- 1 Cardiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz K. Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Olasińska-Wiśniewska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Michal Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Grygier
- 1 Cardiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof J. Filipiak
- Institute of Clinical Science, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Lesiak
- 1 Cardiology Department, Poznan University of Medical Sciences, Poznan, Poland
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