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Belyayev L, Stock EM, Hattler B, Bakaeen FG, Kinlay S, Quin JA, Haime M, Biswas K, Zenati MA. Complete Coronary Revascularization and Outcomes in Patients Who Underwent Coronary Artery Bypass Grafting: Insights from The REGROUP Trial. Am J Cardiol 2024; 217:127-135. [PMID: 38266796 DOI: 10.1016/j.amjcard.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/19/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
There is growing evidence in support of coronary complete revascularization (CR). Nonetheless, there is no universally accepted definition of CR in patients who undergo coronary bypass grafting surgery (CABG). We sought to investigate the outcomes of CR, defined as surgical revascularization of any territory supplied by a suitable coronary artery with ≥50% stenosis. We performed a preplanned subanalysis in the Randomized Trial of Endoscopic or Open Saphenous Vein Graft Harvesting (REGROUP) clinical trial cohort. Of 1,147 patients who underwent CABG, 810 (70.6%) received CR. The primary outcome was a composite of major adverse cardiac events (MACEs), including death from any cause, nonfatal myocardial infarction, or repeat revascularization over a median 4.7 years of follow-up. MACE occurred in 175 patients (21.6%) in the CR group and 86 patients (25.5%) in the incomplete revascularization (IR) group (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.67 to 1.13, p = 0.29). A total of 97 patients (12.0%) in the CR group and 48 patients (14.2%) in the IR group died (HR 0.93, 95% CI 0.65 to 1.32, p = 0.67); nonfatal myocardial infarction occurred in 49 patients (6.0%) in the CR group and 30 patients (8.9%) in the IR group (HR 0.76, 95% CI 0.48 to 1.2, p = 0.24), and repeat revascularization occurred in 62 patients (7.7%) in the CR group and 39 patients (11.6%) in the IR group (HR 0.64; 95% CI 0.42 to 0.95, p = 0.027). In conclusion, in patients with a great burden of co-morbidities who underwent CABG in the REGROUP trial over a median follow-up period of a median 4.7 years, CR was associated with similar MACE rates but a reduced risk of repeat revascularization. Longer-term follow-up is warranted.
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Affiliation(s)
- Leonid Belyayev
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Eileen M Stock
- Cooperative Studies Program Coordinating Center, Office of Research and Development, US Department of Veterans Affairs, Perry Point, Maryland
| | - Brack Hattler
- Division of Cardiology, Eastern Colorado Veterans Affairs Healthcare System and University of Colorado, Aurora, Colorado
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott Kinlay
- Divisions of Cardiology, Veterans Affairs Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts
| | - Jacqueline A Quin
- Cardiac Surgery, Veterans Affairs Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts
| | - Miguel Haime
- Cardiac Surgery, Veterans Affairs Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts
| | - Kousick Biswas
- Cooperative Studies Program Coordinating Center, Office of Research and Development, US Department of Veterans Affairs, Perry Point, Maryland
| | - Marco A Zenati
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Cardiac Surgery, Veterans Affairs Boston Healthcare System, and Harvard Medical School, Boston, Massachusetts
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Michaud ME, Mota L, Bakhtiari M, Thomas BE, Tomeo J, Pilcher W, Contreras M, Ferran C, Bhasin S, Pradhan-Nabzdyk L, LoGerfo FW, Liang P, Bhasin MK. Integrated single-nuclei and spatial transcriptomic analysis reveals propagation of early acute vein harvest and distension injury signaling pathways following arterial implantation. bioRxiv 2024:2023.10.31.564995. [PMID: 37961724 PMCID: PMC10635041 DOI: 10.1101/2023.10.31.564995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Vein graft failure (VGF) following cardiovascular bypass surgery results in significant patient morbidity and cost to the healthcare system. Vein graft injury can occur during autogenous vein harvest and preparation, as well as after implantation into the arterial system, leading to the development of intimal hyperplasia, vein graft stenosis, and, ultimately, bypass graft failure. While previous studies have identified maladaptive pathways that occur shortly after implantation, the specific signaling pathways that occur during vein graft preparation are not well defined and may result in a cumulative impact on VGF. We, therefore, aimed to elucidate the response of the vein conduit wall during harvest and following implantation, probing the key maladaptive pathways driving graft failure with the overarching goal of identifying therapeutic targets for biologic intervention to minimize these natural responses to surgical vein graft injury. Methods Employing a novel approach to investigating vascular pathologies, we harnessed both single-nuclei RNA-sequencing (snRNA-seq) and spatial transcriptomics (ST) analyses to profile the genomic effects of vein grafts after harvest and distension, then compared these findings to vein grafts obtained 24 hours after carotid-cartoid vein bypass implantation in a canine model (n=4). Results Spatial transcriptomic analysis of canine cephalic vein after initial conduit harvest and distention revealed significant enrichment of pathways (P < 0.05) involved in the activation of endothelial cells (ECs), fibroblasts (FBs), and vascular smooth muscle cells (VSMCs), namely pathways responsible for cellular proliferation and migration and platelet activation across the intimal and medial layers, cytokine signaling within the adventitial layer, and extracellular matrix (ECM) remodeling throughout the vein wall. Subsequent snRNA-seq analysis supported these findings and further unveiled distinct EC and FB subpopulations with significant upregulation (P < 0.00001) of markers related to endothelial injury response and cellular activation of ECs, FBs, and VSMCs. Similarly, in vein grafts obtained 24 hours after arterial bypass, there was an increase in myeloid cell, protomyofibroblast, injury-response EC, and mesenchymal-transitioning EC subpopulations with a concomitant decrease in homeostatic ECs and fibroblasts. Among these markers were genes previously implicated in vein graft injury, including VCAN (versican), FBN1 (fibrillin-1), and VEGFC (vascular endothelial growth factor C), in addition to novel genes of interest such as GLIS3 (GLIS family zinc finger 3) and EPHA3 (ephrin-A3). These genes were further noted to be driving the expression of genes implicated in vascular remodeling and graft failure, such as IL-6, TGFBR1, SMAD4, and ADAMTS9. By integrating the ST and snRNA-seq datasets, we highlighted the spatial architecture of the vein graft following distension, wherein activated and mesenchymal-transitioning ECs, myeloid cells, and FBs were notably enriched in the intima and media of distended veins. Lastly, intercellular communication network analysis unveiled the critical roles of activated ECs, mesenchymal transitioning ECs, protomyofibroblasts, and VSMCs in upregulating signaling pathways associated with cellular proliferation (MDK, PDGF, VEGF), transdifferentiation (Notch), migration (ephrin, semaphorin), ECM remodeling (collagen, laminin, fibronectin), and inflammation (thrombospondin), following distension. Conclusions Vein conduit harvest and distension elicit a prompt genomic response facilitated by distinct cellular subpopulations heterogeneously distributed throughout the vein wall. This response was found to be further exacerbated following vein graft implantation, resulting in a cascade of maladaptive gene regulatory networks. Together, these results suggest that distension initiates the upregulation of pathological pathways that may ultimately contribute to bypass graft failure and presents potential early targets warranting investigation for targeted therapies. This work highlights the first applications of single-nuclei and spatial transcriptomic analyses to investigate venous pathologies, underscoring the utility of these methodologies and providing a foundation for future investigations.
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Affiliation(s)
- Marina E. Michaud
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA 30322, USA
| | - Lucas Mota
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Mojtaba Bakhtiari
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA 30322, USA
| | - Beena E. Thomas
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA 30322, USA
| | - John Tomeo
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - William Pilcher
- Department of Biomedical Engineering, Emory University, Atlanta, GA 30322, USA
| | - Mauricio Contreras
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Christiane Ferran
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Center for Vascular Biology Research and the Division of Nephrology Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Swati Bhasin
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA 30322, USA
- Aflac Cancer and Blood Disorders Center, Children Healthcare of Atlanta, Atlanta, GA
| | - Leena Pradhan-Nabzdyk
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Frank W. LoGerfo
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Patric Liang
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Manoj K. Bhasin
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA 30322, USA
- Aflac Cancer and Blood Disorders Center, Children Healthcare of Atlanta, Atlanta, GA
- Department of Biomedical Engineering, Emory University, Atlanta, GA 30322, USA
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Du H, Gu X, Zhang Z, Dong Z, Ran X, Zhou L. Effect of right internal mammary artery versus radial artery as a second graft vessel in coronary artery bypass grafting on postoperative wound infection in patients: A meta-analysis. Int Wound J 2024; 21:e14592. [PMID: 38424286 PMCID: PMC10904365 DOI: 10.1111/iwj.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 03/02/2024] Open
Abstract
Few studies have shown that radial artery (RA), which is used as a secondary arterial graft, offers superior results compared with right internal thoracic artery (RIMA) in coronary artery bypass grafting (CABG). In a meta-analysis of observational studies starting in 2023, we looked at the effect of re-operation on postoperative infection and haemorrhage in CABG with RA vs. RIMA. The electronic database up to October 2023 was examined in the course of the research. Analysis was carried out on the clinical trials of postoperative wound infections and haemorrhage re-surgery. Among 912 trials associated with CABG, we selected 8 trials to be included in the final data analysis. The main results were secondary wound infection and re-operation after surgery. The odds ratios (OR) and confidence intervals (CIs) were computed on the basis of a randomized or fixed-effect model of wound infection and re-operation. Seven trials showed a significant reduction in the risk of wound infection in RA treated as a secondary artery transplant compared with RIMA (OR, 1.60; 95% CI, 1.03, 2.47 p = 0.04); Four trials showed that RIMA was not significantly different from RA in the rate of re-operation for postoperative bleeding (OR, 1.31; 95% CI, 0.60, 2.88 p = 0.50). In CABG, RA is used as a secondary arterial conduit graft to lower the risk of wound infection in CABG patients.
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Affiliation(s)
- Hong Du
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Xiaowei Gu
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Zhiyuan Zhang
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Zichao Dong
- Department of Cardio SurgeryWuHan Asia Cardiac Disease HospitalWuhanChina
| | - Xiaofei Ran
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Li Zhou
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
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Nardi P, Pisano C, Bassano C, Bertoldo F, Buioni D, Labriola V, Salvati AC, Scognamiglio M, Altieri C, Ruvolo G. The role of the female gender on mid-term outcome after coronary artery bypass grafting: a retrospective study. J Thorac Dis 2024; 16:862-874. [PMID: 38505022 PMCID: PMC10944725 DOI: 10.21037/jtd-23-932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/03/2023] [Indexed: 03/21/2024]
Abstract
Background Data on female gender differences on clinical prognosis after coronary artery bypass grafting (CABG) are still controversial. We evaluated retrospectively the impact of women patients in comparison with men undergoing CABG on mid-term outcome. Methods Between December 2014 and March 2022, 1,044 consecutive patients (162 females, 15.5%, 882 males, 84.5%) underwent isolated CABG. The mean follow-up was 40±27 (median 38) months. Logistic and Cox model analysis regressions were used to assess the risk of female gender and other variables, Kaplan-Meier estimates to assess survival rates. Results Women did not have a significant higher operative mortality than men (3.09% vs. 1.93%; P=0.37). There was no difference in the use of left internal mammary artery (97.5% vs. 94.9%; P=0.85). Independent predictors of early mortality were emergency CABG (P<0.0001), percutaneous coronary intervention (PCI) within 30 days (P=0.0026), and higher EuroSCORE II (P=0.0155). At 7.5 years, actuarial survival was 87%±3.6% for female gender vs. 88%±1.9% in male gender (P=0.41), freedom from cardiac death 97%±1.8% vs. 96.6%±1.0% (P=0.6), freedom from major adverse cardiac events (MACE) 87%±6.2% vs. 89.7%±2.5% (P=0.96). Independent predictor of all-causes death and cardiac death was the advanced age (74 years in dead patients vs. 67 years in survivors) (P<0.0001). Female gender was not a predictor of either operative mortality (P=0.34) or worse mid-term outcome (P=0.41). Conclusions Women undergoing CABG with the same surgical techniques currently adopted for men, do not appear to be associated with worse early prognosis. Freedom from late all-causes mortality, cardiac death and adverse cardiac events are comparable and equally satisfactory, highlighting the positive protective effect of CABG over time also in women.
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Affiliation(s)
- Paolo Nardi
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Calogera Pisano
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Carlo Bassano
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Fabio Bertoldo
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Dario Buioni
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Vincenzo Labriola
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | | | | | - Claudia Altieri
- Unit of Cardiology of the Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Giovanni Ruvolo
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
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González-Lorenzo Ó, Franco Pelaez JA, Kallmeyer A, Nieto L, Esteban L, Pello A, Aceña Á, Aldamiz G, Tuñón J. Non-coronary atherosclerosis: a marker of poor prognosis in patients undergoing coronary artery bypass surgery. Front Cardiovasc Med 2024; 11:1305162. [PMID: 38464841 PMCID: PMC10921089 DOI: 10.3389/fcvm.2024.1305162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/02/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction The presence of non-coronary atherosclerosis (NCA) in patients with coronary artery disease is associated with a poor prognosis. We have studied whether NCA is also a predictor of poorer outcomes in patients undergoing coronary artery bypass grafting (CABG). Materials and methods This is an observational study involving 567 consecutive patients who underwent CABG. Variables and prognosis were analysed based on the presence or absence of NCA, defined as previous stroke, transient ischaemic attack (TIA), or peripheral artery disease (PAD) [lower extremity artery disease (LEAD), carotid disease, previous lower limb vascular surgery, or abdominal aortic aneurysm (AAA)]. The primary outcome was a combination of TIA/stroke, acute myocardial infarction, new revascularization procedure, or death. The secondary outcome added the need for LEAD revascularization or AAA surgery. Results One-hundred thirty-eight patients (24%) had NCA. Among them, traditional cardiovascular risk factors and older age were more frequently present. At multivariate analysis, NCA [hazard ratio (HR) = 1.84, 95% confidence interval (CI) 1.27-2.69], age (HR = 1.35, 95% CI 1.09-1.67, p = 0.004), and diabetes mellitus (HR = 1.50, 95% CI 1.05-2.15, p = 0.025), were positively associated with the development of the primary outcome, while estimated glomerular filtration rate (HR = 0.86, 95% CI 0.80-0.93, p = 0.001) and use of left internal mammary artery (HR = 0.36, 95% CI 0.15-0.82, p = 0.035), were inversely associated with this outcome. NCA was also an independent predictor of the secondary outcome. Mortality was also higher in NCA patients (27.5% vs. 9%, p < 0.001). Conclusions Among patients undergoing CABG, the presence of NCA doubled the risk of developing cardiovascular events, and it was associated with higher mortality.
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Affiliation(s)
| | | | - Andrea Kallmeyer
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Nieto
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Laura Esteban
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Pello
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Faculty of Medicine, Autónoma University, Madrid, Spain
| | - Gonzalo Aldamiz
- Department of Cardiac Surgery, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - José Tuñón
- Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Faculty of Medicine, Autónoma University, Madrid, Spain
- Laboratory Department of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
- CIBERCV, ISCIII, Madrid, Spain
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Thorsteinsson EG, Sveinsdottir N, Heitmann LA, Heidarsdottir SR, Rezk M, Taha A, Jeppsson A, Gudbjartsson T. [New-onset postoperative atrial fibrillation following coronary artery bypass grafting: Incidence, clinical course and short-term outcomes]. LAEKNABLADID 2024; 110:11-19. [PMID: 38126792 DOI: 10.17992/lbl.2024.01.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION The aims of this retrospective study were to investigate the incidence, clinical course and short term outcomes of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass surgery (CABG). MATERIALS AND METHODS A nation-wide study on 1622 patients who underwent CABG from 2006-2020 at Landspitali University Hospital. Clinical data were extracted from registries and 121 patients with pre-existing AF excluded, leaving 1501 patients for further analysis. Patient charts and postoperative ECGs were manually reviewed for determining details of POAF, which was defined as a postoperative episode of AF before discharge lasting at least 5 minutes. Patients with POAF (n=483) were compared to non-POAF patients (n=1018). RESULTS Altogether 483 (32.2%) patients developed POAF; the annual incidence decreasing over time (tau= -0,45, p=0.023). Most patients were diagnosed on the second day postoperatively (43.5%) and over 90% were diagnosed within 4 days. The median number of POAF episodes was 3 (IQR: 1-5), the first episode lasting 1-6 hours in half of the cases and the total POAF-duration being 12 hours median (IQR: 5-30). Over 94% of cases converted to sinus rythm before discharge, with 25 (5.3%) patients being discharged in AF. Most patients were treated with beta-blockers (98.8%), amiodarone (95%) and 14.9% with electric cardioversion. POAF-patients were older, had higher EuroSCORE II and a longer hospital stay, however, they had similar rates of early postoperative stroke and 30 day mortality. CONCLUSION The incidence of POAF remains high and was associated with prolonged hospital stay, but not significantly higher 30 day mortality or early postoperative stroke compared to patients in sinus rhythm. POAF-episodes were predominantly transient and almost 95% of patients were discharged in sinus rythm.
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Affiliation(s)
| | | | | | | | - Mary Rezk
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, Departments of Cardiothoracic Surgery Gothenburg, Sweden
| | - Amar Taha
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, Departments of Cardiothoracic Surgery Gothenburg, Sweden, Department of Cardiothoracic Surgery, Landspitali University Hospital
| | - Tomas Gudbjartsson
- Faculty of Medicine, University of Iceland, Department of Cardiothoracic Surgery, Landspitali University Hospital
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Zhang K, Fu W, Dai Q, Liu T, Zheng J, Song Y, Zhang H, Biekan J, Dong R. Prediction of left ventricular ejection fraction improvement in patients with ischemic cardiomyopathy after coronary artery bypass grafting based on cardiac magnetic resonance. Cardiovasc Diagn Ther 2023; 13:1003-1018. [PMID: 38162106 PMCID: PMC10753245 DOI: 10.21037/cdt-23-220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024]
Abstract
Background To investigate the risk factors of left ventricular ejection fraction (LVEF) improvement in patients with ischemic cardiomyopathy (ICM) after coronary artery bypass grafting (CABG), and to construct a model that predicts LVEF improvement. Methods A retrospective analysis was performed on 106 ICM patients who received CABG and underwent cardiac magnetic resonance (CMR) at Beijing Anzhen Hospital, Capital Medical University from January 2017 to June 2022. Patients were divided into two groups with improved LVEF and no improved LVEF based on the results of postoperative 6-month transthoracic echocardiography. To analyze the risk factors affecting the LVEF non-improvement after CABG and establish a prediction model. Results There was LVEF non-improvement in 30.2% (32/106) of patients. Multivariate analysis showed that the number of transmural scar segments and left ventricular end-systolic volume index (LVESVI) were independent risk factors in LVEF non-improvement after CABG [odds ratio (OR) =2.398, 95% confidence interval (CI): 1.607-3.579, P<0.001; OR =1.036, 95% CI: 1.009-1.063, P=0.008]. The model is built and internally verified. ROC showed that the area under the curve (AUC) was 0.866 (95% CI: 0.792-0.940), calibration curve showed that the probability predicted by the model matched well with the clinical results, and decision curve analysis (DCA) showed that the model had good clinical applicability. During the mean follow-up time of 1.5 years, the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the LVEF non-improvement group was higher (5.4% vs. 25.0%, P=0.009), and the NYHA grading was higher (P=0.016), when compared to the LVEF improvement group. Conclusions The prediction model based on the number of transmural scar segments and LVESVI has good diagnostic efficacy. Our findings help to identify patients with improved LVEF and thus guide the selection of clinical treatment strategies.
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Affiliation(s)
- Kui Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Fu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qinyi Dai
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Taoshuai Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jubing Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yue Song
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Zhao Y, Fu W, Hou X, Zhang J, Biekan J, Zhang H, Wang H, Dong R. Myocardial infarct size for predicting improvements in cardiac function in patients with ischemic cardiomyopathy following coronary artery bypass grafting. Quant Imaging Med Surg 2023; 13:7814-7827. [PMID: 38106247 PMCID: PMC10722039 DOI: 10.21037/qims-23-159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/06/2023] [Indexed: 12/19/2023]
Abstract
Background This study used late gadolinium enhancement-cardiac magnetic resonance (LGE-CMR) to assess myocardial infarct size, with the data being employed to predict whether patients with ischemic cardiomyopathy (ICM) would experience improvements in left ventricular function at 6 months following coronary artery bypass grafting (CABG). Methods The data of patients with ICM with left ventricular ejection fraction (LVEF) ≤40% who underwent CABG were retrospectively analyzed. All patients underwent preoperative LGE-CMR imaging. Echocardiography results from 6 months post-CABG were used to assess improvements in LVEF, with improvement being defined as ΔLVEF ≥5%. The value of myocardial infarction segments and infarct size as predictors of improved cardiac function following CABG was analyzed. Results Of the included patients, 66.7% (52/78) exhibited improved cardiac function at 6 months post-CABG. LGE-CMR imaging data revealed that compared to improved group, the improved group had significantly more myocardial infarct segments [improved group: median 1.0, interquartile range (IQR) 0-3; nonimproved group: median 4.0, IQR 3.0-6.0; P<0.001] and significantly greater myocardial infarct size (improved group: 22.4%±8.2%; nonimproved group: 34.7%±5.9%; P<0.001). The area under the receive operating characteristic curve values for myocardial infarct size in predicting cardiac function improvement were significantly higher than those of myocardial infarct segments (0.88 vs. 0.81; P=0.041). The respective sensitivity and specificity values for using a myocardial infarct size cutoff of 26.4% in differentiating between these 2 patient groups were 92.3% and 71.2%, respectively. According to logistic regression analysis, myocardial infarct size was an independent predictor of nonimprovement in cardiac function [odds ratio (OR) =1.244; 95% confidence interval (CI): 1.114-1.389; P<0.001]. A median 1.6-year follow-up interval (range, 0.5-4.1 years) revealed that the incidences of major adverse cerebrovascular events and cardiovascular events were significantly higher in the nonimproved group (5.8% vs. 26.9%; P<0.001), with these individuals having a higher New York Heart Association grading than patients with improved cardiac function (P=0.019). Conclusions Myocardial infarct size can be measured to reliably predict improvements in cardiac function in patients with ICM following CABG. These results can guide clinicians in their efforts to identify those patients most likely to achieve positive outcomes following CABG.
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Affiliation(s)
- Yang Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Fu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Hou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianye Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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9
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Rustenbach CJ, Reichert S, Radwan M, Doll I, Mustafi M, Nemeth A, Marinos SL, Berger R, Baumbach H, Zdanyte M, Haeberle H, Caldonazo T, Saqer I, Saha S, Schnackenburg P, Djordjevic I, Krasivskyi I, Wendt S, Kuhn E, Higuita LMS, Doenst T, Hagl C, Wahlers T, Boburg RS, Schlensak C. On- vs. Off-Pump CABG in Heart Failure Patients with Reduced Ejection Fraction (HFrEF): A Multicenter Analysis. Biomedicines 2023; 11:3043. [PMID: 38002044 PMCID: PMC10669606 DOI: 10.3390/biomedicines11113043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE This study aimed to compare postoperative outcomes and 30-day mortality in patients with reduced ejection fraction (<40%) who underwent isolated coronary artery bypass grafting (CABG) with (ONCAB) and without (OPCAB) the use of cardiopulmonary bypass. METHODS data from four university hospitals in Germany, spanning from January 2017 to December 2021, were retrospectively analyzed. A total of 551 patients were included in the study, and various demographic, intraoperative, and postoperative data were compared. RESULTS demographic parameters did not exhibit any differences. However, the OPCAB group displayed notably higher rates of preoperative renal insufficiency, urgent surgeries, and elevated EuroScore II and STS score. During surgery, the ONCAB group showed a significantly higher rate of complete revascularization, whereas the OPCAB group required fewer intraoperative transfusions. No disparities were observed in 30-day/in-hospital mortality for the entire cohort and the matched population between the two groups. Subsequent to surgery, the OPCAB group demonstrated significantly shorter mechanical ventilation times, reduced stays in the intensive care unit, and lower occurrences of ECLS therapy, acute kidney injury, delirium, and sepsis. CONCLUSIONS the study's findings indicate that OPCAB surgery presents a safe and viable alternative, yielding improved postoperative outcomes in this specific patient population compared to ONCAB surgery. Despite comparable 30-day/in-hospital mortality rates, OPCAB patients enjoyed advantages such as decreased mechanical ventilation durations, shorter ICU stays, and reduced incidences of ECLS therapy, acute kidney injury, delirium, and sepsis. These results underscore the potential benefits of employing OPCAB as a treatment approach for patients with coronary heart disease and reduced ejection fraction.
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Affiliation(s)
- Christian Jörg Rustenbach
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Stefan Reichert
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Medhat Radwan
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Isabelle Doll
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Migdat Mustafi
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Attila Nemeth
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Spiros Lukas Marinos
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Rafal Berger
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Hardy Baumbach
- Independent Researcher, Roter-Stich 127, 70376 Stuttgart, Germany;
| | - Monika Zdanyte
- Department of Cardiology, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany;
| | - Helene Haeberle
- Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany;
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Jena University Hospital, 07743 Jena, Germany; (T.C.); (I.S.); (T.D.)
| | - Ibrahim Saqer
- Department of Cardiothoracic Surgery, Jena University Hospital, 07743 Jena, Germany; (T.C.); (I.S.); (T.D.)
| | - Shekhar Saha
- Department of Cardiac Surgery, LMU University Hospital, 80539 Munich, Germany; (S.S.); (P.S.); (C.H.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Philipp Schnackenburg
- Department of Cardiac Surgery, LMU University Hospital, 80539 Munich, Germany; (S.S.); (P.S.); (C.H.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany; (I.D.); (I.K.); (S.W.); (E.K.); (T.W.)
| | - Ihor Krasivskyi
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany; (I.D.); (I.K.); (S.W.); (E.K.); (T.W.)
| | - Stefanie Wendt
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany; (I.D.); (I.K.); (S.W.); (E.K.); (T.W.)
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany; (I.D.); (I.K.); (S.W.); (E.K.); (T.W.)
| | - Lina Maria Serna Higuita
- Institute for Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University of Tuebingen, 72074 Tübingen, Germany;
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, 07743 Jena, Germany; (T.C.); (I.S.); (T.D.)
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, 80539 Munich, Germany; (S.S.); (P.S.); (C.H.)
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany; (I.D.); (I.K.); (S.W.); (E.K.); (T.W.)
| | - Rodrigo Sandoval Boburg
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tübingen, Germany; (C.J.R.); (M.R.); (I.D.); (M.M.); (A.N.); (S.L.M.); (R.B.); (R.S.B.); (C.S.)
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10
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Robu M, Rădulescu B, Margarint I, Știru O, Antoniac I, Gheorghiță D, Voica C, Nica C, Cacoveanu M, Iliuță L, Iliescu VA, Moldovan H. Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary Arteries. J Cardiovasc Dev Dis 2023; 10:457. [PMID: 37998515 PMCID: PMC10672728 DOI: 10.3390/jcdd10110457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Coronary artery bypass grafting has evolved from all venous grafts to bilateral mammary artery (BIMA) grafting. This was possible due to the long-term patency of the left and right internal mammary demonstrated in angiography studies compared to venous grafts. However, despite higher survival rates when using bilateral mammary arteries, multiple studies report a higher rate of surgical site infections, most notably deep sternal wound infections, a so-called "never event". METHODS We designed a prospective study between 1 January 2022 and 31 December 2022 and included all patients proposed for total arterial myocardial revascularization in order to investigate the rate of surgical site infections (SSI). Chest closure in all patients was performed using a three-step protocol. The first step refers to sternal closure. If the patient's BMI is below 35 kg/m2, sternal closure is achieved using the "butterfly" technique with standard steel wires. If the patient's BMI exceeds 35 kg/m2, we use nitinol clips or hybrid wire cable ties according to the surgeon's preference for sternal closure. The main advantages of these systems are a larger implant-to-bone contact with a reduced risk of bone fracture. The second step refers to presternal fat closure with two resorbable monofilament sutures in a way that the edges of the skin perfectly align at the end. The third step is skin closure combined with negative pressure wound therapy. RESULTS This system was applied to 217 patients. A total of 197 patients had bilateral mammary artery grafts. We report only 13 (5.9%) superficial SSI and only one (0.46%) deep SSI. The preoperative risk of major wound infection was 3.9 +/- 2.7. Bilateral mammary artery grafting was not associated with surgical site infection in a univariate analysis. CONCLUSIONS We believe this strategy of sternal wound closure can reduce the incidence of deep surgical site infection when two mammary arteries are used in coronary artery bypass surgery.
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Affiliation(s)
- Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Bogdan Rădulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Irina Margarint
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
| | - Ovidiu Știru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Iulian Antoniac
- Faculty of Materials Science and Engineering, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (I.A.); (D.G.)
- Academy of Romanian Scientists, 54, Spl. Independentei, 050711 Bucharest, Romania
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (I.A.); (D.G.)
| | - Cristian Voica
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (C.V.); (C.N.); (M.C.)
| | - Claudia Nica
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (C.V.); (C.N.); (M.C.)
| | - Mihai Cacoveanu
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (C.V.); (C.N.); (M.C.)
| | - Luminița Iliuță
- Department of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.M.); (O.Ș.); (V.A.I.); (H.M.)
- Academy of Romanian Scientists, 54, Spl. Independentei, 050711 Bucharest, Romania
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (C.V.); (C.N.); (M.C.)
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11
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Soletti GJ, Dell’Aquila M, Harik L, Cancelli G, Alzghari T, Perezgrovas-Olaria R, Dimagli A, An KR, Leith J, Rossi CS, Barile CF, Demetres M, Lau C, Girardi LN, Gaudino M. The VEST External Support for Saphenous Vein Grafts in Coronary Surgery: A Review of Randomized Clinical Trials. J Cardiovasc Dev Dis 2023; 10:453. [PMID: 37998511 PMCID: PMC10672571 DOI: 10.3390/jcdd10110453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
Saphenous vein grafts (SVGs) are the most frequently used conduits in coronary artery bypass grafting (CABG), but their higher rate of occlusion compared to arterial conduits remains a concern. Previous studies have shown that SVG failure is mainly driven by intimal hyperplasia, an adaptative response to higher pressures of the arterial circulation. The VESTTM device (Vascular Graft Solutions, Tel Aviv, Israel), an external support designed to mitigate intimal hyperplasia in SVGs, has been tested in few clinical trials (RCTs). Herein, we descriptively evaluated the randomized evidence on the VEST device.
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Affiliation(s)
- Giovanni Jr. Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Michele Dell’Aquila
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Talal Alzghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Roberto Perezgrovas-Olaria
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Kevin R. An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Jordan Leith
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Camilla Sofia Rossi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Christopher F. Barile
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Centre, Weill Cornell Medicine, New York, NY 10021, USA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Leonard N. Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10021, USA
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12
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Yang Z, Shao Q, Li Q, Wang Y, Liu Z, Dong S, Ma X, Liang L, Liang J, Gao F, Yang L, Liu X, Li Y, Zhou Y, Ma X, Shi D, Wang Z. Comparison of percutaneous coronary intervention of native coronary artery versus bypass graft in patients with prior coronary artery bypass grafting. J Thorac Dis 2023; 15:5371-5385. [PMID: 37969312 PMCID: PMC10636451 DOI: 10.21037/jtd-23-473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/25/2023] [Indexed: 11/17/2023]
Abstract
Background Large number of patients with prior coronary artery bypass grafting (CABG) need repeat revascularization yearly, and percutaneous coronary intervention (PCI) is the optimal treatment strategy for such patients. However, it is still controversial whether PCI of native coronary artery or bypass graft is more beneficial. The aim of the study was to compare the clinical outcomes between native coronary artery vs. bypass graft PCI in patients with prior CABG. Methods A total of 1,276 patients with prior CABG who underwent index PCI of native coronary artery (n=1,072) or bypass graft (n=204) were retrospectively examined. Patients were divided into native group and graft group according to the target vessel. The outcomes of the two groups were compared by using inverse probability of treatment weighting (IPTW) and Cox regression analysis. The primary endpoint was the composite of major adverse cardiac and cerebrovascular events (MACCEs), which included all-cause death, non-fatal stroke, non-fatal myocardial infarction (MI), or target vessel revascularization (TVR). Results Compared with native group, patients in graft group had higher risk of slow-flow/no-reflow phenomenon (1.5% vs. 0.1%, P=0.011 before IPTW, and 2.2% vs. 0.1%, P<0.001 after IPTW) and peri-procedural stroke (0.3% vs. 0, P=0.021 after IPTW). During a median follow-up period of 43 months, there was similar risk of MACCE between two groups. Notably, patients in graft group had a significantly higher incidence of non-fatal MI compared with native group regardless with or without IPTW (7.8% vs. 3.8%, P=0.018 and 8.3% vs. 3.9%, P=0.030, separately). After adjusting for confounding by using Cox regression, bypass graft PCI was associated with a higher risk of non-fatal MI (HR: 2.091, 95% CI: 1.069-4.089; P=0.031), but similar results in MACCE (HR: 1.077, 95% CI: 0.817-1.419; P=0.599) compared with native group. Conclusions This study found that native coronary artery might be preferred for PCI in patients with prior CABG because of lower rates of slow-flow/no-reflow, peri-procedural stroke, and non-fatal MI at follow-up.
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Affiliation(s)
- Zhiqiang Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Qiaoyu Shao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
- Department of Cardiology, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qiuxuan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yufei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Zaiqiang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Shutong Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Xiaolong Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Lin Liang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jing Liang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Fei Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Lixia Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Xiaoli Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yueping Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
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13
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Nie C, Deng Y, Lu Y. Effect of skeletonisation and pedicled bilateral internal mammary artery grafting in coronary artery bypass surgery on post-operative wound infection: A meta-analysis. Int Wound J 2023; 21:e14424. [PMID: 37818829 PMCID: PMC10828717 DOI: 10.1111/iwj.14424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
The results showed that different internal thoracic artery (ITA) was associated with the rate of postoperative wound infection and the severity of pain following coronary artery bypass grafting (CABG). In order to ascertain if there was any genuine difference in the rate of postoperative infection and severity of the pain, we conducted a meta-analysis to evaluate if there was any actual difference in the wound complication that had been identified with the ITA method. Through EMBASE, Cochrane Library and Pubmed, and so forth, we systematically reviewed the results by August 2023, which compared the impact of skeletonised versus pedicled internal mammary artery (IMA) on wound complications following CABG. The trial data have been pooled and analysed in order to determine if a randomisation or fixed-effect model should be applied. The meta-analysis of data was performed with Revman 5.3 software. The results of this meta-study included 252 related articles from four main databases, and nine articles were chosen to be extracted and analysed. A total of 3320 patients were treated with coronary artery transplantation. Based on current data analysis, we have shown that the rate of postoperative wound infections is reduced by the use of the skeletonised internal mammary artery (SIMA) (OR, 1.84; 95% CI, 1.13, 3.01; p = 0.01). But the results showed that there were no statistically significant differences in the post-operation pain score of the patients (MD, 0.09; 95% CI, -0.58, 0.76; p = 0.79). Furthermore, the duration of the operation was not significantly different between the SIMA and pedicled internal mammary artery (PIMA) (MD, 3.30; 95% CI, -3.13, 9.73; p = 0.31). Overall, the SIMA decreased the rate of postoperative wound infection in CABG patients than the PIMA.
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Affiliation(s)
- Caihong Nie
- Traditional Chinese Medicine University of GuangzhouGuangzhouChina
| | - Yunping Deng
- Zhongnan University of Economics and LawWuhanChina
| | - Yongmei Lu
- Traditional Chinese Medicine University of GuangzhouGuangzhouChina
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14
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Lo Re V, Russelli G, Lo Gerfo E, Alduino R, Bulati M, Iannolo G, Terzo D, Martucci G, Anzani S, Panarello G, Sparacia G, Parla G, Avorio F, Raffa G, Pilato M, Speciale A, Agnese V, Mamone G, Tuzzolino F, Vizzini GB, Conaldi PG, Ambrosio F. Cognitive outcomes in patients treated with neuromuscular electrical stimulation after coronary artery bypass grafting. Front Neurol 2023; 14:1209905. [PMID: 37693766 PMCID: PMC10486105 DOI: 10.3389/fneur.2023.1209905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Objective Mechanisms of neurocognitive injury as post-operative sequelae of coronary artery bypass grafting (CABG) are not understood. The systemic inflammatory response to surgical stress causes skeletal muscle impairment, and this is also worsened by immobility. Since evidence supports a link between muscle vitality and neuroprotection, there is a need to understand the mechanisms by which promotion of muscle activity counteracts the deleterious effects of surgery on long-term cognition. Methods We performed a clinical trial to test the hypothesis that adding neuromuscular electrical stimulation (NMES) to standard rehabilitation care in post-CABG patients promotes the maintenance of skeletal muscle strength and the expression of circulating neuroprotective myokines. Results We did not find higher serum levels of neuroprotective myokines, except for interleukin-6, nor better long-term cognitive performance in our intervention group. However, a greater increase in functional connectivity at brain magnetic resonance was seen between seed regions within the default mode, frontoparietal, salience, and sensorimotor networks in the NMES group. Regardless of the treatment protocol, patients with a Klotho increase 3 months after hospital discharge compared to baseline Klotho values showed better scores in delayed memory tests. Significance We confirm the potential neuroprotective effect of Klotho in a clinical setting and for the first time post-CABG.
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Affiliation(s)
- Vincenzina Lo Re
- Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
| | | | - Emanuele Lo Gerfo
- Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
- Department of Research, IRCCS ISMETT, UPMC, Palermo, Italy
| | | | - Matteo Bulati
- Department of Research, IRCCS ISMETT, UPMC, Palermo, Italy
| | | | - Danilo Terzo
- Rehabilitation Service, IRCCS ISMETT, Palermo, Italy
| | - Gennaro Martucci
- Department of Anesthesiology and Intensive Care, IRCCS ISMETT, UPMC, Palermo, Italy
| | - Stefano Anzani
- Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
- Department of Research, IRCCS ISMETT, UPMC, Palermo, Italy
| | - Giovanna Panarello
- Department of Anesthesiology and Intensive Care, IRCCS ISMETT, UPMC, Palermo, Italy
| | - Gianvincenzo Sparacia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT, Palermo, Italy
| | - Giuseppe Parla
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT, Palermo, Italy
| | - Federica Avorio
- Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
| | - Giuseppe Raffa
- Cardiac Surgery Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, Palermo, Italy
| | - Michele Pilato
- Cardiac Surgery Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, Palermo, Italy
| | | | | | - Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT, Palermo, Italy
| | | | | | | | - Fabrisia Ambrosio
- Discovery Center for Musculoskeletal Recovery, Schoen Adams Research Institute at Spaulding, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
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15
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Saemann L, Wernstedt L, Pohl S, Stiller M, Willsch J, Hofmann B, Veres G, Simm A, Szabó G. Impact of Age on Endothelial Function of Saphenous Vein Grafts in Coronary Artery Bypass Grafting. J Clin Med 2023; 12:5454. [PMID: 37685521 PMCID: PMC10487541 DOI: 10.3390/jcm12175454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND An intact and functionally preserved endothelial layer in the graft is crucial for myocardial perfusion and graft patency after coronary artery bypass grafting (CABG). We hypothesized that old age is a risk factor for decreased endothelial function of bypass grafts. Thus, we investigated the impact of age in patients treated with CABG on endothelial function in saphenous vein grafts. METHODS We mounted the saphenous vein graft segments of CABG patients < 70 (n = 33) and ≥70 (n = 40) years of age in organ bath chambers and exposed them to potassium chloride (KCl) and phenylephrine (PE) to test the receptor-independent and -dependent contractility, followed by exposure to acetylcholine (ACh) and sodium nitroprusside (SNP) to test the endothelial-dependent and -independent relaxation. RESULTS The maximal contraction induced by KCl (2.3 ± 1.8 vs. 1.8 ± 2 g) was stronger in patients ≥ 70 years of age. The relative contraction induced by PE in % of KCl (167 ± 64 vs. 163 ± 59%) was similar between groups. Patients aged < 70 years showed a higher endothelial-dependent relaxation induced by acetylcholine than patients ≥ 70 years (51 ± 27 vs. 42 ± 18%). The relaxation induced by SNP was similar between both groups. CONCLUSIONS The endothelial function of saphenous vein bypass grafts decreases during aging. Thus, age should be considered when improving graft maintenance.
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Affiliation(s)
- Lars Saemann
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Lena Wernstedt
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Sabine Pohl
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Markus Stiller
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Jan Willsch
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Britt Hofmann
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Gábor Veres
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Andreas Simm
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Gábor Szabó
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
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16
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Yaghoobian R, Hosseini Dolama R, Soleimani H, Saeidi S, Mashayekhi M, Mirzayi P, Alavi Tabatabaei G, Hosseini K. Incidence of atrioventricular block after isolated coronary artery bypass grafting: a systematic review and pooled-analysis. Front Cardiovasc Med 2023; 10:1225833. [PMID: 37593149 PMCID: PMC10427724 DOI: 10.3389/fcvm.2023.1225833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023] Open
Abstract
Background and objectives Atrioventricular block (AVB) is a serious complication following coronary artery bypass grafting (CABG) surgery, and its high-grade form may necessitate the implantation of a permanent pacemaker (PPM). AVB is associated with increased morbidity and mortality rates. This study aims to estimate the incidence of AVB and subsequent PPM implantation after isolated CABG surgery. Material and methods We searched electronic databases of PubMed, Embase, and Scopus from inception to 18 November 2022. Clinical trials and observational studies reporting the incidence of post-CABG AVB or subsequent PPM implantation in adult patients were included. The total incidence for all included outcomes was calculated using the inverse variance method, and the I2 statistic was reported to evaluate the heterogeneity of studies. Results A total of 28 studies met the inclusion criteria. Four studies [3 cohorts, 1 randomized controlled trial (RCT)] reported AVB without specifying its type; one (cohort) reported different degrees of AVB, 20 (12 cohorts, 8 RCTs) reported complete heart block (CHB) (or AVB requiring temporary pacing), and nine (8 cohorts, 1 RCT) reported the number of PPM inserted due to AVB. The pooled incidence of AVB, CHB (or AVB requiring temporary pacing), and PPM due to AVB was 1.16%, 1.73%, and 0.58%, respectively. Meta-regression analysis revealed that age, gender, diabetes, hypertension, hyperlipidemia, or smoking were not significantly associated with AVB, CHB, or PPM implantation. Conclusion This study highlights the incidence of AVB and the need for PPM implantation following CABG surgery. The findings emphasize the importance of postoperative monitoring and surveillance to improve patient outcomes. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022377181, identifier PROSPERO CRD42022377181.
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Affiliation(s)
- Ramin Yaghoobian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Hosseini Dolama
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Soleimani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeidi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Mashayekhi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Mirzayi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazaal Alavi Tabatabaei
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Rivinius R, Heil KM, Doesch AO. Surgical ventricular reconstruction for the treatment of advanced heart failure-return of the surgeons? J Thorac Dis 2023; 15:3538-3542. [PMID: 37559651 PMCID: PMC10407512 DOI: 10.21037/jtd-23-675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/02/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Karsten M. Heil
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas O. Doesch
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Pneumology and Oncology, Asklepios Hospital, Bad Salzungen, Germany
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18
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Atef H, Gaber M. Would the Actigraph Always be Sufficient for Sleep Analysis in Exercise-Based Studies? A Case Report of Negative Response of Sleep to Exercise. Sleep Sci 2023; 16:265-270. [PMID: 37425977 PMCID: PMC10325867 DOI: 10.1055/s-0043-1770808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Introduction Sleep deprivation is common after coronary artery bypass grafting (CABG). It is mostly managed well by exercise. The number of reported post-CABG cases that respond negatively to exercise is scanty. The etiology is usually associated with the underlying sleep pathology, and how it responds to exercise. Cases with undiagnosed central sleep apnea post CABG have not been reported before. Case description A medically stable male patient, 63 years old, hypertensive, but not diabetic, had entered coronary artery bypass grafting (CABG) 8 weeks before attending the outpatient cardiac rehabilitation unit and was referred for a cardiac rehabilitation program at this time. He entered a study in the cardiac rehabilitation center utilizing either aerobic or combined aerobic and resistance training for 10 weeks to improve sleep architecture and functional capacity post-CABG. After randomization, he entered the group doing combined aerobic and resistance exercises. All of the patients in this group improved except him, his sleep quality worsened, but his functional capacity improved. After a complete analysis of sleep on polysomnography, it was revealed that the patient had central sleep apnea that was mostly worsened by resistance training. The patient was withdrawn from the study by the 8th week, and his sleep condition improved gradually. After then, he was asked to attend the cardiac rehabilitation center again to share in aerobic exercise, having evidence that central sleep apnea does not respond negatively to this form of training. After 12 months of follow-up, the patient still shows no signs of sleep deprivation. Conclusion Sleep deprivation is prevalent in post-CABG patients, but with different presentations and it can generally improve by exercise. Identification of the underlying cause of the sleeping difficulty is a cornerstone of targeted treatment.
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Affiliation(s)
- Hady Atef
- School of Allied Health Professions (SAHP), Keele University, Staffordshire, ST5 5BG, United Kingdom
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Marwa Gaber
- Medical Research Institute, Alexandria University, Alexandria, Egypt
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19
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Hecker F, von Zeppelin M, Van Linden A, Scholtz JE, Fichtlscherer S, Hlavicka J, Walther T, Holubec T. Right-Sided Minimally Invasive Direct Coronary Artery Bypass: Clinical Experience and Perspectives. Medicina (Kaunas) 2023; 59:medicina59050907. [PMID: 37241139 DOI: 10.3390/medicina59050907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/29/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
Objective: Minimally invasive direct coronary artery bypass grafting (MIDCAB) using the left internal thoracic artery to the left descending artery is a clinical routine in the treatment of coronary artery disease. Far less is known on right-sided MIDCAB (r-MIDCAB) using the right internal thoracic artery (RITA) to the right coronary artery (RCA). We aimed to present our experience in patients with complex coronary artery disease who underwent r-MIDCAB. Materials and Methods: Between October 2019 and January 2023, 11 patients received r-MIDCAB using RITA to RCA bypass in a minimally invasive technique via right anterior minithoracotomy without using a cardiopulmonary bypass. Underlying coronary disease was complex right coronary artery stenosis (n = 7) and anomalous right coronary artery (ARCA; n = 4). All procedure-related and outcome data were evaluated prospectively. Results: Successful minimally invasive revascularization was achieved in all patients (n = 11). There were no conversions to sternotomy and no re-explorations for bleeding. Furthermore, no myocardial infarction, no strokes, and, most importantly, no deaths were observed. During the follow-up period (median 24 months), all patients were alive and 90% were completely angina free. Two patients received a repeated revascularization after surgery but independently from the RITA-RCA bypass, which was fully competent in both patients. Conclusion: Right-sided MIDCAB can be performed safely and effectively in patients with expected technically challenging percutaneous coronary intervention of the RCA and in patients with ARCA. Mid-term results showed high freedom from angina in nearly all patients. Further studies with larger patient cohorts and more evidence are needed to provide the best revascularization strategy for patients suffering from isolated complex RCA stenosis and ARCA.
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Affiliation(s)
- Florian Hecker
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60598 Frankfurt, Germany
| | - Mascha von Zeppelin
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60598 Frankfurt, Germany
| | - Arnaud Van Linden
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60598 Frankfurt, Germany
| | - Jan-Erik Scholtz
- Department of Radiology, University Hospital Frankfurt and Goethe University Frankfurt, 60388 Frankfurt, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt and Goethe University Frankfurt, 60388 Frankfurt, Germany
| | - Jan Hlavicka
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60598 Frankfurt, Germany
| | - Thomas Walther
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60598 Frankfurt, Germany
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60598 Frankfurt, Germany
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20
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Yi C, Junyi G, Fengju L, Qing Z, Jie C. Association between lipoprotein(a) and peripheral arterial disease in coronary artery bypass grafting patients. Clin Cardiol 2023; 46:512-520. [PMID: 36896666 DOI: 10.1002/clc.24003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE Peripheral arterial disease (PAD) affects a large population and is associated with various adverse clinical outcomes. Lipoprotein(a) has proatherogenic properties and is associated with PAD incidence and severity. The aim of this study is to explore the association between LP(a) and PAD in coronary artery bypass grafting (CABG) patients. METHODS A total of 1001 patients were included and divided into two groups: low Lp(a) group [LP(a) < 30 mg/dL] and high Lp(a) group [LP(a) ≥ 30 mg/dL]. A comparison of PAD incidence diagnosed by ultrasound was made between the groups. Multivariate logistic regression was conducted to explore the risk factors for PAD. During the analysis, the influence of diabetes mellitus (DM) and gender on LP(a) serum level was taken into consideration. RESULTS DM history (odds ratio [OR], 2.330, p = .000 for males; OR, 2.499, p = .002 for females) and age (OR, 1.101, p = .000 for males; OR, 1.071, p = .001 for females) were risk factors for PAD. LP(a) ≥ 30 mg/dL was a risk factor for PAD only in female patients (OR, 2.589, p = .003), while smoking history was a risk factor only in male patients (OR, 1.928, p = .000). LP(a) level was not associated with PAD severity in DM patients of both gender. As for female patients without DM, PAD was more severe in the high LP(a) group. CONCLUSIONS In CABG patients, DM history and age were risk factors for PAD. But a high level of LP(a) was a significant risk factor only in female patients. In addition, we are the first to propose a gender deviation in the correlation between LP(a) serum level and severity of PAD diagnosed by ultrasound.
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Affiliation(s)
- Cheng Yi
- Department of Diagnostic Ultrasound, Beijing Anzhen Hospital affiliated to Capital University of Medical Sciences, Beijing, China
| | - Gao Junyi
- Department of Cardiovascular Medicine, Beijing Shijitan Hospital affiliated to Capital University of Medical Sciences, Beijing, China
| | - Liu Fengju
- Department of Diagnostic Ultrasound, Beijing Anzhen Hospital affiliated to Capital University of Medical Sciences, Beijing, China
| | - Zhao Qing
- Department of Diagnostic Ultrasound, Beijing Anzhen Hospital affiliated to Capital University of Medical Sciences, Beijing, China
| | - Chen Jie
- Department of Diagnostic Ultrasound, Beijing Anzhen Hospital affiliated to Capital University of Medical Sciences, Beijing, China
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Aluthman U, Bafageeh SW, Ashour MA, Barnawi HI, Bogis AA, Alamri R, Elmahrouk AF, AlGhamdi SA, Ismaeil N, Shihata M, Jamjoom AA. A robotic-assisted hybrid coronary revascularization program: Establishment and early experience in the Middle East. J Card Surg 2022; 37:4783-4789. [PMID: 36349707 DOI: 10.1111/jocs.17123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hybrid coronary revascularization (HCR) is a technique that merges coronary artery bypass grafting surgery and percutaneous coronary intervention (PCI) approaches for the treatment of multivessel coronary artery disease. The surgical component of the procedure is minimally invasive and can be done using robotic technology that avoids the need for sternotomy. Our objective is to study all patients who underwent robotic-assisted HCR (RHCR) to evaluate the feasibility and safety of the procedure during the establishment phase. METHODS This study is a retrospective chart review conducted at King Faisal Specialist Hospital and Research Centre in Jeddah (KFSRC-J). The study focuses on patients who underwent RHCR between July 2018 to December 2020. The study was approved by the institutional review board #2020-103. RESULTS Robotic-assisted HCR was performed on 78 patients (mean age, 56 years (range, 43-72 years); 89.75% males) during the study phase. Left internal mammary artery grafting was used in all patients. There was no hospital mortality, and the mean hospital and intensive care unit (ICU) stay were 5.8 and 1.4 days, respectively. We found that 93.6% of the patients had no blood transfusion. There were no major adverse cardiac events (MACE) and perioperative MI recorded. There was a 3.8% rate of postoperative complications. The percentage of surgeries converted to conventional and re-exploration for bleeding were 1.2% and 2.6%, respectively. The average operation time was 164 min. CONCLUSION This study emphasizes on the safety and effectiveness of RHCR in treating patients with multivessel coronary artery disease. Moreover, robotic-assisted hybrid coronary revascularization offers an alternative, functionally complete revascularization option to a selected group of patients with minimal surgical trauma, short hospital and ICU length of stay, quick recovery, and little to no blood transfusion requirement.
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Affiliation(s)
- Uthman Aluthman
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Salman W Bafageeh
- College of Medicine, King Saud bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Mohammed A Ashour
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hani I Barnawi
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdulbadee A Bogis
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Rawan Alamri
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed F Elmahrouk
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Nabeel Ismaeil
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammad Shihata
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Zhang K, Fu W, Dai Q, Zheng J, Biekan J, Wang Y, Yan P, Gu X, Mu J, Dong R. The number of myocardial infarction segments connected to papillary muscle is associated with the improvement in moderate ischemic mitral regurgitation. Cardiovasc Diagn Ther 2022; 12:828-839. [PMID: 36605082 PMCID: PMC9808117 DOI: 10.21037/cdt-22-301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022]
Abstract
Background We evaluated whether the number of myocardial infarction (MI) segments connected to the papillary muscle (PM), as assessed using cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE), predicts whether moderate ischemic mitral regurgitation (IMR) improves after isolated coronary artery bypass grafting (CABG) to guide the choice of surgical strategy. Methods A total of 54 patients diagnosed with coronary heart disease (CHD) complicated with moderate IMR who underwent isolated CABG were selected continuously in this retrospective study at Beijing Anzhen Hospital. All patients underwent preoperative LGE. The patients were divided into the IMR improved group (37 patients) and the unimproved group (17 patients) according to 1-year postoperative echocardiography. The factors associated with no IMR improvement after isolated CABG were analyzed. There was no trial registration and no publication of the study protocol. Results The number of MI segments connected to PM was an independent risk factor for no IMR improvement after isolated CABG [odds ratio 4.39; 95% confidence interval (CI): 1.93-9.98; P<0.001]. The optimal receiver operating characteristic (ROC) curve cut-off value for no IMR improvement was ≥2 (sensitivity: 82.4%; specificity: 83.8%). Follow-up at 1-5 years (median, 2.8 years) showed that the incidences of major adverse cardiovascular and cerebrovascular events (5.4% vs. 23.5%; P=0.041) and New York Heart Association (NYHA) grade (P=0.026) were higher in the unimproved group. Conclusions In patients with CHD complicated with moderate IMR, the number of MI segments connected to PM is an independent risk factor for no IMR improvement after isolated CABG. Mitral valve surgery should be performed simultaneously with CABG in patients with ≥2 MI segments connected to the PM.
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Affiliation(s)
- Kui Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Fu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qinyi Dai
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jubing Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Yueli Wang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Pengyun Yan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Gu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junsheng Mu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Panahiazar M, Bishara AM, Chern Y, Alizadehsani R, Islam SMS, Hadley D, Arnaout R, Beygui RE. Gender-based time discrepancy in diagnosis of coronary artery disease based on data analytics of electronic medical records. Front Cardiovasc Med 2022; 9:969325. [PMID: 36505372 PMCID: PMC9729739 DOI: 10.3389/fcvm.2022.969325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Women continue to have worse Coronary Artery Disease (CAD) outcomes than men. The causes of this discrepancy have yet to be fully elucidated. The main objective of this study is to detect gender discrepancies in the diagnosis and treatment of CAD. Methods We used data analytics to risk stratify ~32,000 patients with CAD of the total 960,129 patients treated at the UCSF Medical Center over an 8 year period. We implemented a multidimensional data analytics framework to trace patients from admission through treatment to create a path of events. Events are any medications or noninvasive and invasive procedures. The time between events for a similar set of paths was calculated. Then, the average waiting time for each step of the treatment was calculated. Finally, we applied statistical analysis to determine differences in time between diagnosis and treatment steps for men and women. Results There is a significant time difference from the first time of admission to diagnostic Cardiac Catheterization between genders (p-value = 0.000119), while the time difference from diagnostic Cardiac Catheterization to CABG is not statistically significant. Conclusion Women had a significantly longer interval between their first physician encounter indicative of CAD and their first diagnostic cardiac catheterization compared to men. Avoiding this delay in diagnosis may provide more timely treatment and a better outcome for patients at risk. Finally, we conclude by discussing the impact of the study on improving patient care with early detection and managing individual patients at risk of rapid progression of CAD.
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Affiliation(s)
- Maryam Panahiazar
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of California, San Francisco, San Francisco, CA, United States,Institute for Computational Health Sciences (ICHS), School of Medicine, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Maryam Panahiazar ;
| | - Andrew M. Bishara
- Institute for Computational Health Sciences (ICHS), School of Medicine, University of California, San Francisco, San Francisco, CA, United States,Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States
| | - Yorick Chern
- Department of Bioengineering, University of California, Berkeley, Berkeley, CA, United States
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC, Australia
| | - Sheikh M. Shariful Islam
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Dexter Hadley
- Department of Clinical Sciences, College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Rima Arnaout
- Institute for Computational Health Sciences (ICHS), School of Medicine, University of California, San Francisco, San Francisco, CA, United States,Division of Cardiology, Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ramin E. Beygui
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Fu W, Zhao Y, Zhang K, Dai Q, Biekan J, Zheng J, Dong R, Mu J. Retrospective, observational analysis of cardiac function associated with global preoperative myocardial scar in patients with ischemic cardiomyopathy after coronary artery bypass grafting. J Thorac Dis 2022; 14:4319-4328. [PMID: 36524083 PMCID: PMC9745517 DOI: 10.21037/jtd-22-846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/23/2022] [Indexed: 12/31/2023]
Abstract
BACKGROUND Drawing on accumulated patient data from a hospital database, the goal of this retrospective study was to analyze cardiac function associated with global preoperative myocardial scarring assessed by cardiac magnetic resonance with late gadolinium enhancement (CMR-LGE) in patients with ischemic cardiomyopathy (ICM) after coronary artery bypass grafting (CABG). METHODS A total of 57 patients diagnosed with ICM who underwent isolated CABG at Beijing Anzhen Hospital between September 2017 and September 2019 were enrolled in this retrospective study. All these patients underwent a preoperative CMR-LGE examination. Based on postoperative echocardiography results at 6 months, cases were divided into the following 2 groups: improved cardiac function [a difference of left ventricular ejection fraction (LVEF) greater than or equal to 5%] and unimproved cardiac function. The factors contributing to these patients' unimproved cardiac function were investigated. RESULTS At 6 months after surgery, 64.9% (37/57) of cases had improved cardiac function, and 35.1% (20/57) had no improvement. There was no statistical difference between the 2 groups in the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (41.7±7.6 vs. 42.8±8.3; P=0.603), but compared to the improved group, preoperative myocardial scarring was significantly enlarged in the unimproved group (41.9%±6.4% vs. 27.8%±8.5%; P<0.001). In regression analysis, only preoperative myocardial scarring [odds ratio (OR) =1.44; 95% confidence interval (CI): 1.13-1.83; P=0.003] was associated with no change in cardiac function evaluated by echocardiography after CABG. The median follow-up of 1.6 years (range, 0.6-4.1 years) found that the unimproved group had a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) (8.1% vs. 25.0%; P=0.044), and that the New York Heart Association (NYHA) classification of the unimproved group was higher than that of the improved group (P=0.018). CONCLUSIONS In ICM patients, a greater amount of preoperative myocardial scarring is associated with unimproved cardiac function after CABG. The measurement of preoperative myocardial scarring may aid clinicians in identifying patients who would benefit from CABG.
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Affiliation(s)
- Wei Fu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kui Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qinyi Dai
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Jubing Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junsheng Mu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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25
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Koh HB, Jung CY, Kim HW, Kwon JY, Kim NH, Kim HJ, Jhee JH, Han SH, Yoo TH, Kang SW, Park JT. Preoperative Ionized Magnesium Levels and Risk of Acute Kidney Injury After Cardiac Surgery. Am J Kidney Dis 2022; 80:629-637.e1. [PMID: 35469966 DOI: 10.1053/j.ajkd.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/02/2022] [Indexed: 02/02/2023]
Abstract
RATIONALE & OBJECTIVE Although postoperative acute kidney injury (AKI) is a serious complication after cardiac surgery, preventive measures are limited. Despite the known association of preoperative low magnesium levels with cardiac surgery-related atrial fibrillation, the association between preoperative magnesium concentration and postoperative AKI has not been fully elucidated. This study evaluated the association between preoperative serum magnesium level and the development of AKI after cardiac surgery. STUDY DESIGN Retrospective observational cohort study. SETTING & PARTICIPANTS Patients aged≥18 years who underwent cardiac surgery at 2 South Korean tertiary hospitals between 2006 and 2020 were identified from medical records. Patients with missing information, an estimated glomerular filtration rate<15mL/min/1.73m2, receiving maintenance dialysis, or a history of AKI treated by dialysis within 1 year before surgery were excluded. EXPOSURE Preoperative serum magnesium levels. OUTCOME Postoperative AKI within 48 hours after surgery, defined using the Acute Kidney Injury Network (AKIN) criteria, and dialysis-treated AKI within 30 days after surgery. ANALYTICAL APPROACH Multivariable logistic regression analysis. RESULTS Among the 9,766 patients (median age, 64.0 years; 60.1% male), postoperative AKI and dialysis-treated AKI were observed in 40.1% and 4.3% patients, respectively. Postoperative AKI was more prevalent in patients with lower serum magnesium levels (44.9%, 41.4%, 39.4%, and 34.8% in quartiles 1-4, respectively). Multivariable logistic regression analysis revealed that the odds ratios (ORs) for postoperative AKI were progressively larger across progressively lower quartiles of serum magnesium concentration (adjusted ORs of 1.53 [95% CI, 1.33-1.76], 1.29 [95% CI, 1.12-1.48], 1.15 [95% CI, 1.01-1.31] for quartiles 1-3, respectively, relative to quartile 4, P for trend<0.001). Preoperative hypomagnesemia (serum magnesium level<1.09mg/dL) was also significantly associated with AKI (adjusted OR, 1.39 [95% CI, 1.10-1.77]) and dialysis-treated AKI (adjusted OR, 1.67 [95% CI, 1.02-2.72]). LIMITATIONS Causality could not be evaluated in this observational study. CONCLUSIONS Lower serum magnesium levels were associated with a higher incidence of AKI in patients undergoing cardiac surgery.
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Affiliation(s)
- Hee Byung Koh
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea
| | - Chan-Young Jung
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea
| | - Jae Yeol Kwon
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea
| | - Na Hye Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea
| | - Hyo Jeong Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, South Korea.
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Yang D, Zhang K, Li J, Wei D, Ma J, Wang Y, Yang Y, Li J, Bai Y, Zhang Y, Gao J, Wang L. Ninety-seven cases of experiences with the left thoracotomy approach for off-pump conventional revascularization: a retrospective cohort study. J Thorac Dis 2022; 14:3915-3923. [PMID: 36389332 PMCID: PMC9641355 DOI: 10.21037/jtd-22-1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive coronary surgery-coronary artery bypass grafting (MICS CABG) is well adopted in clinical practice. However, this procedure did not really achieve conventional complete revascularization. The present study aimed to explore the feasibility and safety of conventional revascularization via the left thoracotomy (8-10 cm) approach. METHODS From January 2020 to March 2022, a total of 97 consecutive patients who needed coronary artery revascularization were operated on using this technique. The patients' preoperative, intraoperative, postoperative, and follow-up data were collected. Perioperative variables were compared between the single graft and non-single graft groups. All patients received dual-source computerized tomographic angiography at 1-week postoperatively to evaluate the graft patency and detect pulmonary embolism and aortic dissection. The patients were followed up for 3-27 months. RESULTS The mean age of the entire cohort was 61.5±8.8 years, there were 16 (16.5%) female patients, and 1-4 grafts were performed per patient. There were no conversions to median sternotomy or on-pump CABG. The average number of grafts was 1.9±0.9, and that of the non-single graft group was 2.5±0.6. Among the 97 included patients, one patient in the single graft group suffered from aspiration pneumonia after a stroke and died. The 30-day mortality was 1.0% (one patient), one patient required re-exploration for bleeding (1.1%), and a total of 191 grafts were performed. All grafts were unobstructed except for one graft to the obtuse marginal branch (OM) (0.5%). Follow-up was performed by phone or via outpatient visits and was available for 92 patients (95%). During the follow-up period, 1 (1.1%) patient suffered an acute myocardial infarction and received percutaneous coronary intervention with no redo-surgery. All patients are alive and angina-free. CONCLUSIONS Left thoracotomy for conventional revascularization is a safe procedure for appropriately selected patients, with few early complications and good early and mid-term results. More cases are ongoing and long-term results are in observation.
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Affiliation(s)
- Dongyan Yang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Kai Zhang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Junshan Li
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Dong Wei
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Jing Ma
- Institute of Cardiovascular Diseases, Tianjin Chest Hospital, Tianjin, China
| | - Yulong Wang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Yin Yang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Jinghui Li
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Yunpeng Bai
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Yuhui Zhang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Jing Gao
- Institute of Cardiovascular Diseases, Tianjin Chest Hospital, Tianjin, China
| | - Lianqun Wang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
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Arif R, Warninck A, Farag M, Sommer W, Leuschner F, Frey N, Karck M, Warnecke G, Geis NA. Long-Term Patency of Venous Conduits Targeting the Right Coronary Artery System-Single Is Superior to Sequential bypass Grafting. J Cardiovasc Dev Dis 2022; 9. [PMID: 36135430 DOI: 10.3390/jcdd9090285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Little is known about the fate of bypass grafts to the right coronary system. To investigate the long-term patency of venous bypass grafts directed to the right coronary artery (RCA) based on postoperative angiograms and to identify predictors of graft occlusion. Methods: In this single-center study, all patients who underwent coronary angiography from 2005 to 2021 after previously undergoing isolated coronary artery bypass grafting (CABG) were included. The primary endpoint was graft occlusion over a median follow-up of 9.1 years. Results: Among a total of 1106 patients (17.0% women, 64 (57−71) years median age), 289 (26.1%) received a sequential vein graft and 798 (72.2%) a single graft. Multivariate regression revealed age (HR 1.019, CI 95% 1.007−1.032), the urgency of CABG (HR 1.355, CI 95% 1.108−1.656), and severely impaired left ventricular function (HR 1.883, CI 95% 1.290−2.748), but not gender and chronic total occlusion (CTO) as predictive factors for graft occlusion. Single conduits were found to be a predictor of graft patency (HR 0.575 CI 95% 0.449−0.737). The angiographic outcome showed an overall 10-year freedom from graft occlusion of 73.4% ± 1.6%. The 5-year (10-year) freedom from graft occlusion was 76.9% ± 2.8% (57.8% ± 4.0%) for sequential grafts and 90.4% ± 1.1% (77.8% ± 1.7%) for single grafts (log-rank p < 0.001). Conclusions: In symptomatic patients with renewed angiography, venous bypass grafting of the RCA showed acceptable long-term patency rates. Single bypass grafting of the RCA was superior to sequential grafting, which needs to be further investigated.
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28
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Liang L, Ma X, Kong Q, Xiao W, Liu J, Chi L, Zhu J. Comparing patient outcomes following minimally invasive coronary artery bypass grafting surgery vs. coronary artery bypass grafting: a single-center retrospective cohort study. Cardiovasc Diagn Ther 2022; 12:378-388. [PMID: 35800361 PMCID: PMC9253167 DOI: 10.21037/cdt-22-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/25/2022] [Indexed: 09/05/2023]
Abstract
BACKGROUND This present research was designed for comparing coronary artery disease (CAD) patient outcomes following minimally invasive coronary artery bypass grafting surgery (MICS) or coronary artery bypass grafting (CABG). METHODS From 2014-2017, 679 CAD patients underwent MICS (n=281) or CABG (n=398) and were evaluated for the present study. Patient data were analyzed using 1:1 propensity score-matched assessment and a multivariate Cox proportional hazards regression model, and primary study achievements comprised major adverse cardiac and cerebrovascular events (MACCEs), myocardial infarction (MI), cardiac death, heart failure (HF), revascularization, and stroke. The median follow-up period was 2.68 years. RESULTS CABG patients exhibited a trend towards higher cumulative overall rates of MACCEs at 2 years (CABG: 6.2% vs. MICS: 3.8%) and 4 years (CABG: 9.3% vs. MICS: 7.6%) [adjusted hazard ratio (HR): 1.33; 95% confidence interval (CI): 0.33-5.39 for CABG vs. MICS; P=0.687], although this difference was not significant. No significant differences in 2- or 4-year cardiac death rates were observed between groups (CABG: 3.5%, 5.6% vs. MICS 2.8%, 2.8%; adjusted HR: 0.23; 95% CI: 0.03-1.81 for CABG vs. MICS; P=0.160). Further, there existed no discrepancies in rates of MI (P=1.000), HF (adjusted HR: 4.76; 95% CI: 0.01-6.40 for CABG vs. MICS; P=0.996), stroke (adjusted HR: 9.58; 95% CI: 0.11-25.24 for CABG vs. MICS; P=0.320), or repeated revascularization (adjusted HR: 1.71; 95% CI: 0.01-7.21 for CABG vs. MICS; P=0.631) when comparing these patient groups. In a multivariable Cox proportional hazards regression analysis, patients that were male (adjusted HR: 5.28; 95% CI: 1.48-18.83; P=0.010) and cases with a history of previous MI epsiodes (adjusted HR: 3.20; 95% CI: 1.09-9.37; P=0.034) were found to be at a higher risk of MACCEs. CONCLUSIONS Follow-up data indicated that the MICS and CABG treatments could achieve similar outcomes.
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Affiliation(s)
- Lin Liang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qingyu Kong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Xiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiaji Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Liqun Chi
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junming Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Tawakol A, Osborne MT. Multimodal Imaging Insights Into Graft Vasculopathy and Progression of Native CAD Following CABG. JACC Cardiovasc Imaging 2022; 15:888-890. [PMID: 35512959 PMCID: PMC9210977 DOI: 10.1016/j.jcmg.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Ahmed Tawakol
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| | - Michael T Osborne
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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30
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Senage T, Gerrard C, Moorjani N, Jenkins DP, Ali JM. Early postoperative bleeding impacts long-term survival following first-time on-pump coronary artery bypass grafting. J Thorac Dis 2021; 13:5670-5682. [PMID: 34795917 PMCID: PMC8575859 DOI: 10.21037/jtd-21-1241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
Background Significant bleeding following cardiac surgery is a recognised complication, associated with a requirement for re-exploration and blood transfusion, both associated with increased morbidity and early mortality. The aim of this study was to examine the impact of the volume of early postoperative bleeding on long-term survival for patients undergoing coronary artery bypass grafting (CABG). Methods A retrospective analysis was performed of patients undergoing first-time isolated CABG at a single centre between January 2003 and April 2013, conditional from 30-day survival. Results Six thousand two hundred and sixty-five patients were analysed, with a mean Logistic EuroSCORE of 4.9%. The mean age was 67.8 years. Median follow-up was 11.5 years. The overall 10- and 15-year survival was 70.6% and 51.9% respectively. Following surgery, 4.6% (n=291) required return to theatre for re-exploration, and 43.6% (n=2,733) received at least one red cell transfusion. In multivariable analysis, the strongest correlates of mortality were age, smoking history, BMI, COPD, renal impairment, preoperative left ventricular function and preoperative haemoglobin (Hb) level. Twelve-hour blood loss was an additional predictor of inferior long-term survival. Five-year survival was 89.6% for patients with <500 mL blood loss, 86.8% for 500–1,000 mL and 83.8% for >1,000 mL. Re-exploration and receiving blood transfusion were not associated with reduced long-term survival. Conclusions Significant 12-hour blood loss is associated with inferior long-term survival following CABG. This observation supports efforts aimed at improving intra-operative haemostasis and aggressive management of patients with early signs of bleeding.
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Affiliation(s)
- Thomas Senage
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK.,SPHERE (MethodS in Patient-Centred Outcomes and Health Research), University of Nantes, Nantes, France
| | - Caroline Gerrard
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - David P Jenkins
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Jason M Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
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31
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Chan PG, Seese L, Aranda-Michel E, Sultan I, Gleason TG, Wang Y, Thoma F, Kilic A. Operative mortality in adult cardiac surgery: is the currently utilized definition justified? J Thorac Dis 2021; 13:5582-5591. [PMID: 34795909 PMCID: PMC8575804 DOI: 10.21037/jtd-20-2213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/13/2020] [Indexed: 11/16/2022]
Abstract
Background This study evaluated operative mortalities following adult cardiac surgical operations to determine if this metric remains appropriate for the modern era. Methods This was a retrospective review of Society of Thoracic Surgeons (STS) indexed adult cardiac operations that included coronary artery bypass grafting (CABG), aortic valve replacement (AVR), CABG + AVR, mitral valve repair (MVr), CABG + MVr, mitral valve replacement (MVR) and CABG + MVR, performed at a single institution between 2011 and 2017. The primary outcome was the timing and relatedness of operation mortality, as defined by the STS as mortality within 30-day or during the index hospitalization, compared to the index operation. The secondary outcomes evaluated cause of death and the rates of postoperative complications. Results A total of 11,190 index cardiac operations were performed during the study period and operative mortality occurred in 246 (2.2%) of patients. The distribution of operative mortalities included 83.7% (n=206) who expired within 30-day while an inpatient, 6.9% (n=17) died within 30-day as an outpatient, 11.2% (n=23) expired after 30-day. The most common causes of operative mortality were cardiac (38.7%, n=92), renal failure (15.6%, n=37), and strokes (13.9%, n=33). Furthermore, 98.4% (n=242) of deaths were attributable to the index operation. Postoperative complications occurred frequently in those with operative mortality, with blood transfusions (80.1%), reoperations (65.0%) and prolonged ventilation (62.2%) being most common. Conclusions Most of the operative mortalities seemed to be attributable to the index cardiac operation. We believe that the current definition of mortality remains appropriate in the modern era.
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Affiliation(s)
- Patrick G Chan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laura Seese
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yisi Wang
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Floyd Thoma
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Beirne AM, Rathod KS, Castle E, Andiapen M, Richards A, Bellin A, Hammond V, Godec T, Moon JC, Davies C, Bourantas CV, Wragg A, Ahluwalia A, Pugliese F, Mathur A, Jones DA. The BYPASS-CTCA Study: the value of Computed Tomography Cardiac Angiography (CTCA) in improving patient-related outcomes in patients with previous bypass operation undergoing invasive coronary angiography: Study Protocol of a Randomised Controlled Trial. Ann Transl Med 2021; 9:1395. [PMID: 34733947 PMCID: PMC8506557 DOI: 10.21037/atm-21-1455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/17/2021] [Indexed: 11/12/2022]
Abstract
Background Patients with ischaemic heart disease and previous coronary artery bypass grafting (CABG) often need coronary evaluation by means of invasive coronary angiography (ICA). ICA in such patients is technically more challenging and carries a higher risk of complications including kidney damage, myocardial infarction, stroke and death. Improvements in Computed Tomography Cardiac Angiography (CTCA) technology have ensured its emergence as a useful clinical tool in CABG assessment, allowing for its potential use in planning interventional procedures in this patient group. Methods The BYPASS-CTCA study is a prospective, single centre, randomised controlled trial assessing the value of upfront CTCA in patients with previous surgical revascularisation undergoing ICA procedures. A total of 688 patients with previous CABG, requiring ICA for standard indications, will be recruited and randomised to receive ICA alone, or CTCA prior to angiography. Subjects will be followed up over a 12-month period post procedure. The primary endpoints are ICA procedural duration, incidence of contrast-induced nephropathy (CIN) and patient satisfaction scores post ICA. Secondary endpoints include contrast dose (mL) and radiation dose (mSv) during ICA, number of catheters used, angiography-related complications and cost-effectiveness of CTCA (QALY) over 12 months. Discussion The study will investigate the hypothesis that CTCA prior to ICA in patients with previous CABG can reduce procedural duration, post-procedural kidney damage and improve patient satisfaction, therefore strengthening its role in this group of patients. Trial Registration The study is registered on ClinicalTrials.gov which is a resource maintained by the U.S. National Library of Medicine. Registration number NCT03736018.
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Affiliation(s)
- Anne-Marie Beirne
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Krishnaraj S Rathod
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Emily Castle
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mervyn Andiapen
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Amy Richards
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Anna Bellin
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Victoria Hammond
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Thomas Godec
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, UK
| | - James C Moon
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Ceri Davies
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Christos V Bourantas
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Andrew Wragg
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Amrita Ahluwalia
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Francesca Pugliese
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, UK
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Brad Meers J, Snyder SW, Hasan R, Zheng Y, Davies J, Zaky A. Hemodynamic Instability Resulting From Pseudomalfunction of a Leadless Pacemaker During Off-Pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2021; 36:2588-2592. [PMID: 34895966 DOI: 10.1053/j.jvca.2021.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- J Brad Meers
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
| | - Scott W Snyder
- Center of Educational Accountability, School of Education, University of Alabama at Birmingham, Birmingham, AL
| | - Ragib Hasan
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, AL
| | - Yuliang Zheng
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, AL
| | - James Davies
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Ahmed Zaky
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
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Abstract
The etiology of coronary artery disease (CAD) is multifactorial, stemming from both modifiable and nonmodifiable risk factors such as age. Several studies have reported the effects of age on various outcomes of coronary artery bypass grafting (CABG). This article reviews age-related outcomes of CABG and offers direction for further studies in the field to create comprehensive, evidence-based guidelines for the treatment of CAD. Ninety-two primary sources were analyzed for relevance to the subject matter, of which 17 were selected for further analysis: 14 retrospective cohort studies, 2 randomized clinical trials, and 1 meta-analysis. Our review revealed four broad age ranges into which patients can be grouped: those with CAD (1) below the age of 40 years, (2) between the ages of 40 and 60 years, (3) between the ages of 60 and 80 years, and (4) at or above 80 years. Patients below the age of 40 years fare best overall with total arterial revascularization (TAR). Patients between the ages of 40 and 60 years also fare well with the use of multiarterial grafts (MAGs) whereas either MAGs or single-arterial grafts may be of significant benefit to patients at or above the age of 60 years, with younger and diabetic patients benefitting the most. Arterial grafting is superior to vein grafting until the age of 80 years, at which point there is promising evidence supporting the continued use of the saphenous vein as the favored graft substrate. Age is a factor affecting the outcomes of CABG but should not serve as a barrier to offering patients CABG at any age from either a cost or a health perspective. Operative intervention starts to show significant mortality consequences at the age of 80 years, but the increased risk is countered by maintenance or improvement to patients' quality of life.
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Affiliation(s)
- Pavan Ashwini Anand
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Suresh Keshavamurthy
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Ellis M. Shelley
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Sibu Saha
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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Van den Eynde J, Vaesen Bentein H, Decaluwé T, De Praetere H, Wertan MC, Sutter FP, Balkhy HH, Oosterlinck W. Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis. J Thorac Dis 2021; 13:4260-4270. [PMID: 34422354 PMCID: PMC8339757 DOI: 10.21037/jtd-21-775] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/11/2021] [Indexed: 12/07/2022]
Abstract
Background Learning curves are inevitably encountered when first implementing an innovative and complex surgical technique. Nevertheless, a cluster of failures or complications should be detected early, but not deter learning, to ensure safe implementation. Here, we aimed to examine the presence and impact of learning curves on outcome after robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB). Methods A retrospective analysis of the first 300 RA-MIDCAB surgeries between July 2015 and December 2020 was performed. Learning curves were obtained via logarithmic regression for surgical time. Cumulative sum (CUSUM) analysis was performed for (I) major complications including MI, stroke, repeat revascularization, and mortality, and (II) other complications, including prolonged ventilation, pneumonia, pleura puncture, lung herniation, pericarditis, pleuritis, arrhythmia, wound complications, and delirium. Expected and unacceptable rates were set at 12% and 20%, respectively, for major complications, and at 40% and 60% for other complications, based on historical data in conventional coronary artery bypass grafting (CABG). Results Demographic characteristics did not differ between terciles, except for more smokers in the first tercile, and less hypercholesterolemia and more complex procedures in the third tercile. The mean surgical time for all operations was 258±81 minutes, ranging from 127 to 821 minutes. A learning curve was only observed in the first tercile. Subgroup analysis revealed that this learning curve was only observed for procedures consisting of single internal mammary artery (SIMA) with 1 or 2 distal anastomoses but not with bilateral internal mammary arteries (BIMA) or more than 2 distal anastomoses. CUSUM analysis showed that the cumulative rate of major and other complications never crossed the lines for unacceptable rates. Rather, the lower 95% confidence boundary was crossed after 50 cases, indicating improvement in safety. Conclusions These results suggest that integration of RA-MIDCAB in the surgical landscape can be safely achieved and complication rates can quickly be reduced below those expected in traditional CABG. Collective experience plays a key role in overcoming the learning curve when more complex procedures and cases are introduced.
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Affiliation(s)
- Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Hannah Vaesen Bentein
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Tom Decaluwé
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Herbert De Praetere
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - MaryAnn C Wertan
- Division of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Francis P Sutter
- Division of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Husam H Balkhy
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Wouter Oosterlinck
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Harvey R, Chellappa V, Mofidi S, Scovotti J, Neelankavil JP, Saddic L. Intraoperative diastolic function assessed by TEE does not agree with preoperative diastolic function grade in CABG patients. Echocardiography 2021; 38:1282-1289. [PMID: 34255390 DOI: 10.1111/echo.15137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/26/2021] [Accepted: 05/31/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To compare the agreement of the 2016 ASE/EACVI guidelines for grading diastolic dysfunction (DD) with the most commonly used intraoperative transesophageal echocardiography (TEE)-based diastolic function grading algorithm in cardiac surgical patients, and to describe the contribution of the echocardiographic variables used in the algorithms to any observed differences. DESIGN Retrospective data analysis. SETTING University tertiary medical center. PARTICIPANTS Hundred and one patients undergoing coronary artery bypass grafting (CABG) at a single institution from June 2017 to February 2019. INTERVENTIONS Preoperative transthoracic echocardiography (TTE) diastolic function grade determined by the 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines was compared to intraoperative diastolic function grade obtained by TEE. MEASUREMENTS AND MAIN RESULTS Incidence of DD on preoperative TTE was only 19.8%, while 62.3% of patients were graded as having DD on the intraoperative TEE exam. There was grade agreement between TTE and TEE in only 47/101 patients (46.5%). The McNemar test showed poor agreement between the two algorithms (OR for disagreement = 15.33, CI = 4.77-49.30; p < 0.0001). Despite the low incidence of DD on preoperative TTE, mean lateral e' values were significantly lower on TTE compared to TEE (7.7 cm/s vs 9.5 cm/s; p = < 0.0001). CONCLUSIONS There is strong disagreement between TTE and TEE-based DD grading algorithms. Due to the different echocardiographic variables used in each and the unique clinical settings in which they are applied, they produce fundamentally different results.
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Affiliation(s)
- Reed Harvey
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Vivek Chellappa
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sean Mofidi
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer Scovotti
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jacques P Neelankavil
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Louis Saddic
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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37
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Guo H, Wang S, Ren C, Yu J, Wei Z, Ma H, Lai Y. Obstructive sleep apnea is associated with postoperative dialysis in patients who underwent coronary artery bypass grafting. Ann Palliat Med 2021; 10:6307-6315. [PMID: 34237955 DOI: 10.21037/apm-21-180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The incidence of obstructive sleep apnea (OSA) is significantly higher in patients who undergo coronary artery bypass grafting (CABG). OSA is correlated with a higher incidence of postoperative complications in patients undergoing CABG. However, whether OSA is associated with a decrease in renal function and a higher incidence of dialysis after CABG remains unclear. METHODS Data from 178 consecutive patients who underwent isolated CABG at Anzhen Hospital between June 2019 and June 2020 were analyzed. Polysomnography was performed in all the patients. RESULTS A total of 142 (79.8%) patients were diagnosed with OSA, 78 with mild OSA, and 64 with moderate-to-severe OSA. Compared to patients without OSA, the level of creatinine was significantly increased, and the level of estimated glomerular filtration rate (eGFR) was decreased in patients with OSA. In addition, the percentage of patients undergoing dialysis during the perioperative period increased with the severity of OSA (0.0% vs. 2.6% vs. 18.8%, P=0.02). Multiple linear regression analysis showed that age (β=-0.29, P<0.001), male sex (β=-0.17, P=0.02), apnea-hypopnea index (AHI) (β=-0.35, P<0.001), and creatinine (β=-0.78, P<0.001) were independently associated with a decrease in eGFR (adjusted R2=0.376, P<0.001). However, in the multivariate logistic regression model, we found that the level of eGFR (OR =0.94, 95% CI: 0.89-0.99, P=0.02) and AHI (OR =1.07, 95% CI: 1.01-1.13, P=0.02) were independently associated with dialysis after CABG. CONCLUSIONS OSA is associated with a decrease in renal function and is an independent risk factor for postoperative dialysis in patients who undergo CABG.
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Affiliation(s)
- Hongchang Guo
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Shengwei Wang
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Changwei Ren
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Jianbo Yu
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Zhipeng Wei
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Hehe Ma
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Yongqiang Lai
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
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38
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Hou X, Zhang K, Liu T, Li Y, Zhao Y, Song B, Huang Z, Xu S, Zheng J, Dong R. The expansion of no-touch harvesting sequential vein graft after off-pump coronary artery bypass grafting. J Card Surg 2021; 36:2381-2388. [PMID: 33960508 PMCID: PMC8252464 DOI: 10.1111/jocs.15577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
Background and Aim of the Study Many studies support that the no‐touch (NT) procedure can improve the patency rate of vein grafts. However, it is not clear that the sequential vein graft early expansion in the NT technique during off‐pump coronary artery bypass grafting (CABG). This study will explore this issue. Methods This was a prospective single‐center randomized controlled clinical trial. A total of 100 patients undergoing off‐pump CABG with the sequential saphenous graft were randomly assigned to two groups: the NT and conventional (CON) groups. Perioperative and postoperative data were collected during the hospital stay. The mean diameter of sequential grafts was measured using cardiac computed tomography angiography 3 months after the operation. Results There was a significant difference in the average diameter of sequential grafts between the two groups (NT: [2.98 ± 0.42], CON: [3.26 ± 0.51], p = .005). There was no difference in occlusion of sequential venous grafts between the two groups (NT: 4/48 [8.3%], CON: 5/49 [10.2%], p = 1.000). There were differences in surgery time between the two groups (NT: 220 [188,240], CON: 190 [175,230], p = .009). Conclusions The sequential graft early expansion in the NT technique is not as pronounced as that in the conventional technique, which may have a long‐term protective effect on the grafts.
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Affiliation(s)
- Xuejian Hou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kui Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Taoshuai Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bangrong Song
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhuhui Huang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shijun Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jubing Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Liu Y, Wang LF, Yang XC, Su PX, Li KB, Wang HS, Chen ML, Xu L, Zhong JC. In-hospital outcome of primary PCI for patients with acute myocardial infarction and prior coronary artery bypass grafting. J Thorac Dis 2021; 13:1737-1745. [PMID: 33841964 PMCID: PMC8024815 DOI: 10.21037/jtd-20-1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background This study aims to analyze the in-hospital outcome of primary percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) and prior coronary artery bypass grafting (CABG). Methods This was a retrospective study. From January 2011 to December 2018, the data of 78 consecutive patients (study group) with prior CABG, who received primary coronary angiography in the setting of ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI), were screened. The study group was compared with another well-matched 78 patients without a history of CABG (control group). The information of the coronary angiograms and clinical data of both groups were analyzed. Multivariate conditional logistic regression models were constructed to test the association between PCI success rate and the prior CABG at age ≥65 and <65 years, respectively. Results The results revealed that the primary PCI success rate in the study group was significantly lower than in the control group (67.9% vs. 92.3%, P<0.001) and in-hospital mortality was significantly higher than in control group (11.5% vs. 2.5%, P=0.03). The multivariate logistic regression analysis indicated that the primary PCI success rate was significantly associated with the history of prior CABG both in young patients [age <65 years; odds ratio (OR) =5.26, 95% confidence interval (CI): 1.69–16.47] and elderly (age ≥65 years; OR =13.76, 95% CI: 2.72–69.75). Conclusions The patients who receive primary PCI with AMI and prior CABG have poor in-hospital outcomes, with low PCI success rates and high mortality.
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Affiliation(s)
- Yu Liu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Le-Feng Wang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xin-Chun Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Pi-Xiong Su
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kui-Bao Li
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong-Shi Wang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mu-Lei Chen
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li Xu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiu-Chang Zhong
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Tang Y, Fan X, Zhang B, Zhang J, Xue Q, Xu Z, Han L. Aspirin plus ticagrelor or clopidogrel on graft patency one year after coronary bypass grafting: a single-center, randomized, controlled trial. J Thorac Dis 2021; 13:1697-1705. [PMID: 33841960 PMCID: PMC8024791 DOI: 10.21037/jtd-20-3407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Dual antiplatelet therapy (DAPT) improves early post-operative graft patency, but the optimal DAPT strategy for the patients after coronary artery bypass grafting (CABG) has not been confirmed. We sought to evaluate the effect of aspirin plus ticagrelor versus aspirin plus clopidogrel on saphenous vein graft (SVG) patency within 1 year after CABG. Methods Between October 2017 and December 2018, 147 consecutive patients undergoing elective CABG at Changhai Hospital were randomized into two groups: group AT, receiving aspirin 100 mg/d plus ticagrelor 2×90 mg/d; group AC, receiving aspirin 100 mg/d plus clopidogrel 75 mg/d. Both DAPTs should be administered within 24 h when clinical stability was ensured. 64-multislice computed tomography angiography (MSCTA) was used to assess the graft patency at 12 months after CABG.CYP2C19 gene variants were measured to assess the clopidogrel efficacy on graft patency. Results Among the 147 participants who completed the study, one (0.7%) patient from the AC group died at 5 weeks after surgery due to severe infection. All other patients were treated with DAPT for 12 months and underwent 64-MSCTA according to schedule. There were no significant differences in pre-operative characteristics and intraoperative transit-time flow measurement findings between the two groups. Besides, no significant differences in the incidence of major adverse cardiac events (MACEs) and major bleeding were observed. A 64-MSCTA showed that SVG patency was 91.0% (141 of 155) in the AT group and 89.9% (161 of 179) in the AC group (P=0.751). No significant associations were found between different CYP2C19 genotypes and SVG patency (P>0.05). Conclusions Either aspirin plus ticagrelor or aspirin plus clopidogrel can maintain a fairly high graft patency rate in the early phase after CABG, regardless of CYP2C19 genotypes.
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Affiliation(s)
- Yangfeng Tang
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xinli Fan
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Boyao Zhang
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jiajun Zhang
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Qin Xue
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhiyun Xu
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lin Han
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
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Abazid RM, Khatami A, Romsa JG, Warrington JC, Akincioglu C, Stodilka RZ, Fox S, Kiaii B, Vezina WC. Hiatal hernia after robotic-assisted coronary artery bypass graft surgery. J Thorac Dis 2021; 13:575-581. [PMID: 33717530 PMCID: PMC7947528 DOI: 10.21037/jtd-20-2557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of the present study is to determine the incidence/progression of hiatal hernia (HH) after robotic-assisted coronary artery bypass grafting (RA-CABG) surgery. Methods We reviewed the pre- and post-operative computed tomography (CT) of 491 patients who underwent RA-CABG between 2000 and 2017. Post-operative CT was acquired prospectively in a research protocol. CT was reviewed to assess the presence and the size of HH. Results We found 444/491 (90.4%) had pre-operative CT, while 201/491 (40.9%) had post-operative CT. In total, 155/491 (31.6%) had both pre- and long-term post-operative CT with a mean follow-up of 6.2 (±3.5) years. HH was more prevalent on post-operative CT, 64/155 (41.3%) compared to pre-operative CT, 44/155 (28.4%), P<0.0001. The diameter of pre-existing HH 2.8 (±1.8) cm was significantly greater after surgery 3.9 (±2.5) cm, P<0.0001. As well the volume of the pre-existing HH 5.8 (4.4-9.2) mL (quartile) was significantly greater after surgery 14.1 (7.2-64.9) mL, P<0.0001. 20/155 (12.9%) had a newly developed HH after RA-CABG. A binary multivariate regression including HH risk factors showed that male gender is a predictor of developing a HH after RA-CABG with Hazard Ratio of 3.038, confidence interval (1.10-8.43), P=0.033. Conclusions RA-CABG is associated with an increased risk of developing HH and increases the size of pre-existing HH.
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Affiliation(s)
- Rami M Abazid
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - Alireza Khatami
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - Jonathan G Romsa
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - James C Warrington
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - Cigdem Akincioglu
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - Robert Z Stodilka
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - Stephanie Fox
- Division of Cardiac Surgery, London Health Sciences Centre, London, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, London Health Sciences Centre, London, Canada.,Division of Cardiac Surgery, University of California, Davis Medical Center, Sacramento, CA, USA
| | - William C Vezina
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
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Sellke FW. Secondary prevention after coronary artery bypass grafting: Anticoagulation and antiplatelet therapy is only one factor. J Card Surg 2021; 36:1100-1102. [PMID: 33506999 DOI: 10.1111/jocs.15286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel/ticagrelor/prasugrel does not lead to improved graft patency rates or clinical outcomes after coronary artery bypass grafting (CABG) over aspirin monotherapy, at least for on pump CABG. The protective effects of DAPT tended to be observed to be greater extent in patients undergoing off pump CABG. In general, the addition of the potent thienopyridines increased the risk of major bleeding, although the incidence of major bleeding is relatively low after either on pump or off pump surgical revascularization. There is a lack of evidence that anticoagulation post-CABG provides any protection against graft failure, but it may decrease the incidence of major adverse cardiovascular events. However, antiplatelet and anti thrombotic therapy after CABG is only one component of secondary prevention that needs to be taken into consideration when optimizing the long-term outcomes of patients after CABG.
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Affiliation(s)
- Frank W Sellke
- Division of Cardiothoracic Surgery, Alpert Medical School of Brown University, Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence, Rhode Island, USA
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43
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Zhu P, Dai Y, Qiu J, Xu H, Liu J, Zhao Q. Prognostic implications of left ventricular geometry in coronary artery bypass grafting patients. Quant Imaging Med Surg 2020; 10:2274-2284. [PMID: 33269226 DOI: 10.21037/qims-19-926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The prognostic implications of left ventricular (LV) mass and geometry have been confirmed in populations with different cardiac diseases. However, the prognostic value of LV geometry in coronary artery bypass grafting (CABG) patients is unclear. Methods A total of 2,517 patients undergoing CABG between January 2012 and September 2016 in our cardiac surgery unit were included. Patients were divided into the following 4 groups according to left ventricular mass index (LVMi) and relative wall thickness (RWT): normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Results The median follow-up period was 47.0 months (interquartile range was 32.5-61.3 months). Compared to the normal geometry group, the concentric remodeling group [hazard ratio (HR): 3.023; 95% confidence interval (CI): 1.134-8.060], the eccentric hypertrophy group (HR: 3.422; 95% CI: 1.395-8.398), and the concentric hypertrophy group (HR: 5.399; 95% CI: 2.289-12.735) have higher main adverse cardiovascular and cerebrovascular event (MACCE) risk. Moreover, increased MACCE risk was associated with higher LVMi (HR: 1.015 per 1 g/m2 increase in LVMi; 95% CI: 1.005-1.026) and RWT (HR: 1.991 per 0.1-U increase in RWT; 95% CI: 1.343-2.952). We observed similar results concerning mortality. Adding LV geometry to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II significantly improved the area under the curve (AUC) for MACCE (from 0.621 to 0.703; P=0.042). The addition of LV geometry showed significant integrated discrimination improvement (IDI) and net reclassification improvement (NRI) for MACCE (IDI: 0.043, P<0.001; NRI: 0.200, P<0.001) and death (IDI: 0.018, P=0.020; NRI: 0.308, P=0.002), as was the addition of LVMi and RWT. Conclusions LV geometry is an independent and incremental prognostic factor for MACCE and death in CABG patients.
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Affiliation(s)
- Pengxiong Zhu
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanan Dai
- School of Management, Fudan University, Shanghai, China
| | - Jiapei Qiu
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Xu
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Zhao
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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44
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Pang PYK, Teow CKJ, Huang MJ, Naik MJ, Lim SL, Chao VTT, Tan TE, Chua YL, Sin YK. Long-term prognosis in patients with end-stage renal disease after coronary artery bypass grafting. J Thorac Dis 2020; 12:6722-6730. [PMID: 33282373 PMCID: PMC7711392 DOI: 10.21037/jtd-20-2046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Coronary artery bypass grafting (CABG) is beneficial in selected patients with ESRD. This study investigates the survival outcomes and prognostic factors in ESRD patients who underwent CABG. Methods A retrospective analysis was performed for 149 patients with ESRD who underwent isolated CABG between 2006 and 2015. Results Mean age was 59.4±8.7 years and 106 patients (71.1%) were male. Operative mortality occurred in 20 patients (13.4%). Overall survival was 81.1%±3.2% at 1 year, 41.5%±4.3% at 5 years and 19.2%±4.2% at 10 years. Median survival was 4.3 years. Multivariable analysis identified age [P=0.001, odds ratio (OR): 1.15 per 1-year increase, 95% confidence interval (CI): 1.06-1.25], preoperative left ventricular ejection fraction (LVEF) (P=0.020, OR: 0.94, 95% CI: 0.89-0.99) and non-elective status of operation (P=0.049, OR: 3.34, 95% CI: 1.00-11.1) as predictors of operative mortality. Cox regression analysis identified age [P<0.001, hazard ratio (HR): 1.05 per 1-year increase, 95% CI: 1.03-1.08], New York Heart Association (NYHA) class III or IV status (P=0.010, HR: 1.75, 95% CI: 1.15-2.67) and the use of a left internal mammary artery (LIMA) to left anterior descending artery (LIMA-LAD) graft (P=0.029, HR: 0.42, 95% CI: 0.19-0.92) as factors influencing long-term survival. Conclusions CABG is associated with high operative mortality and poor long-term survival in ESRD patients. Age and NYHA class influenced late survival. LIMA-LAD grafting conferred a long-term survival advantage.
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Affiliation(s)
- Philip Y K Pang
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Christopher K J Teow
- Ministry of Health Holdings, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ming Jie Huang
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Madhava J Naik
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - See Lim Lim
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Victor T T Chao
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Teing Ee Tan
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Yeow Leng Chua
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Yoong Kong Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
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Kotfis K, Jamioł-Milc D, Skonieczna-Żydecka K, Folwarski M, Stachowska E. The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients 2020; 12:nu12103105. [PMID: 33053694 PMCID: PMC7600335 DOI: 10.3390/nu12103105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Abstract
Background and aim: Preoperative fasting leads to metabolic stress and causes insulin resistance in patients undergoing cardiac surgery. The aim of this study was to assess the effect of preoperative oral carbohydrate loading (OCH) on outcome in patients undergoing planned cardiac surgery by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods: Systematic search of PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was performed to identify relevant RCTs from databased inception until 05/03/2020. We included studies that compared outcome measures between OCH with control (placebo or standard starvation). We conducted a random-effect meta-analysis of clinical and biochemical parameters. Results: Nine studies (N = 9) were included with a total of 507 patients. OCH significantly decreased aortic clamping duration (n = 151, standardized mean difference (SMD) = −0.28, 95% confidence interval (CI) = −0.521 to −0.038, p = 0.023 and differences in means (DM) = −6.388, 95%CI = −11.246 to −1.529, p = 0.010). Patients from treatment groups had shorter intensive care unit (ICU) stay (n = 202, SMD = −0.542, 95%CI = −0.789 to −0.295, p < 0.001 and DM = −25.925, 95%CI = −44.568 to −7.283, p = 0.006) and required fewer units of insulin postoperatively (n = 85, SMD = −0.349, 95%CI = −0.653 to −0.044, p = 0.025 and DM = −4.523, 95%CI = −8.417 to −0.630, p = 0.023). The necessity to use inotropic drugs was significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI = 0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a significant effect. Conclusions: Preoperative OCH in patients undergoing cardiac surgery demonstrated a 20% reduction in the use of inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease in aortic clamping duration and a 35% decrease of postoperative insulin requirement.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Dominika Jamioł-Milc
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (E.S.)
- Correspondence: ; Tel.: +48-91-441-48-06; Fax: +48-91-441-48-07
| | - Karolina Skonieczna-Żydecka
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (E.S.)
| | - Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, 80-210 Gdansk, Poland;
- Home Enteral and Parenteral Nutrition Unit, General Surgery, Nicolaus Copernicus Hospital, 80-210 Gdansk, Poland
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (E.S.)
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Zhu Y, Xue Q, Zhang M, Hu J, Liu H, Wang R, Wang X, Han L, Zhao Q. Effect of ticagrelor with or without aspirin on vein graft outcome 1 year after on-pump and off-pump coronary artery bypass grafting. J Thorac Dis 2020; 12:4915-4923. [PMID: 33145065 PMCID: PMC7578459 DOI: 10.21037/jtd-20-1177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background In the present post hoc analysis of the DACAB trial, we evaluated the effects of ticagrelor with or without aspirin on 1-year vein graft outcomes after coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass (CPB) (on-pump and off-pump). Methods The DACAB trial was a multicenter, randomized, open-label, parallel control study enrolling 500 patients with 1,460 vein grafts undergoing CABG. For current post-hoc study, all patients in the DACAB study were included in the analysis to compare the effects of different antiplatelet regimens under on/off pump. Patients were randomly assigned to 1 of 3 antiplatelet treatment regimens (ticagrelor plus aspirin, T + A; ticagrelor alone, T; or aspirin alone, A) within 24 hours after CABG, and were stratified into on-pump and off-pump subgroups. The primary outcome was 1-year vein graft patency rate. Results Totally 121 patients underwent on-pump CABG (39 with 121 vein grafts in T + A, 36 with 101 vein grafts in T, and 46 with 137 vein grafts in A) and 379 patients underwent off-pump CABG (129 with 336 vein grafts in T + A, 130 with 387 vein grafts in T, and 120 with 348 vein grafts in A). Compared with A, T + A showed a higher 1-year vein graft patency rate in both on-pump (adjusted OR for non-patency =0.62, 95% CI: 0.16–2.45) and off-pump (adjusted OR for non-patency =0.35, 95% CI: 0.20–0.62) subgroups, P interaction =0.647; whereas T did not in either on-pump (adjusted OR for non-patency = 0.92, 95% CI: 0.31–2.76) or off-pump (adjusted OR for non-patency =0.58, 95% CI: 0.34–1.00) subgroups, P interaction =0.430. Conclusions In the DACAB trial, for patients underwent either on-pump or off-pump CABG, ticagrelor plus aspirin showed consistent benefit for achieving 1-year vein graft patency, with particular benefit being seen in the off-pump.
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Affiliation(s)
- Yunpeng Zhu
- Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Xue
- Department of Cardiovascular Surgery, Changhai Hospital of Shanghai, Shanghai, China
| | - Minlu Zhang
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Junlong Hu
- Department of Cardiovascular Surgery, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Hao Liu
- Department of Cardiothoracic Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Wang
- Department of Cardiovascular Surgery, Nanjing First Hospital, Nanjing, China
| | - Xiaowei Wang
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, Nanjing, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital of Shanghai, Shanghai, China
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Li ZZ, Wu XY, Tao Y, Wang S, Yin CQ, Gao YL, Cheng YT, Li Z, Ma CS. Revascularization versus drug therapy for coronary artery disease in patients aged over 80 years: a real-world study. Cardiovasc Diagn Ther 2020; 10:512-519. [PMID: 32695630 DOI: 10.21037/cdt-20-185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Revascularization for the treatment of coronary artery disease (CAD) is advancing rapidly and is used increasingly in old patients. This study aimed to compare the efficacy and safety of revascularization with drug therapy in CAD patients aged over 80 years at a real-world clinical setting. Methods A total of 501 CAD patients aged over 80 years were consecutively enrolled from January 2011 to January 2016 in Anzhen Hospital (Beijing, China), Capital Medical University. The patients were treated with percutaneous coronary intervention (PCI) (n=283), coronary artery bypass grafting (CABG) (n=106), or drug therapy (n=112). All-cause mortality, cardiovascular-related mortality, readmission rate, and Seattle Angina Questionnaire (SAQ) score were compared between the three treatment methods. Results A total of 411 patients (82.04%) were followed with a median duration of 25 months. All-cause mortality and cardiovascular-related mortality in the drug therapy group were significantly higher than the PCI and CABG groups (both P<0.05). Readmission rate for cardiovascular events in the CABG group was significantly lower than the PCI and drug therapy groups (both P<0.05). Scores of physical limitation, angina frequency, treatment satisfaction, and disease perception of the SAQ in the PCI and CABG groups were significantly higher than the drug therapy group (both P<0.05). Scores of angina stability did not differ significant between the three groups (P=0.127). Conclusions Revascularization is superior to drug therapy in efficacy and safety in the treatment of oldest-old patients with CAD.
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Affiliation(s)
- Zhi-Zhong Li
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiang-Yu Wu
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Tao
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Su Wang
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Cheng-Qian Yin
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu-Long Gao
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu-Tong Cheng
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhao Li
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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48
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Robinson NB, Gaudino M. Shunting away from transradial arterial access? J Card Surg 2020; 35:2353-2354. [PMID: 32667072 DOI: 10.1111/jocs.14868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
Due to its increased safety and decrease in significant vascular complications and bleeding events, the use of the radial artery for percutaneous coronary intervention (PCI) is increasing. Transradial access (TRA), however, is not without consequence. TRA arteries when used for coronary artery bypass grafting (CABG) are associated with decreased graft patency rates. Here we comment on a case report in which a patient developed a clinically significant arteriovenous fistula following TRA treated with surgical ligation. We offer insights on the increased use of the radial artery in both PCI and CABG.
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Affiliation(s)
- N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
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Abstract
Pyoderma gangrenosum (PG) can mimic early postoperative sternal wound infections. Steroid therapy is the only method of treatment for this condition, which recognizes the fact that steroids can lead to immunosuppression and potentially inhibit healing after major surgery.
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Affiliation(s)
- Hashem Aliter
- Division of Cardiac surgery, Dalhousie University, Halifax, Canada
| | - Ali Idris
- Division of Cardiac surgery, Dalhousie University, Halifax, Canada
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50
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Abstract
Background To compare the clinical outcomes, quality of saphenous vein (SV) grafts, and wound complications between endoscopic vein harvesting (EVH) technique and open vein harvesting (OVH) technique in patients with coronary artery bypass graft (CABG) surgery. Methods We reviewed one hundred patients with multi-vessel coronary artery disease who underwent elective CABG and agreed to preserve their SV specimens for study. Fifty patients (OVH group) underwent OVH, and the remaining (EVH group) underwent EVH. The median follow-up time was 12 months. Clinical outcomes, 1-year graft patency rates, endothelium integrity of SV grafts and wound complications were assessed. Results The follow-up time was 12 [12-13] months. Recurrence of angina was observed in 5 patients, with 3 (6.1%) in EVH group and 2 (4%) in OVH group (P=0.68). The endothelium integrity of specimens before distension was similar in both the groups (EVH: 81.1%±6.11% vs. OVH: 80.8%±6.58%, P=0.83). After distension, the endothelium integrity was still similar (EVH: 70.7%±9.73%; OVH: 68.3%±9.60%; P=0.22). Grafts of 5 (11.6%) patients in EVH group were classified as occluded, and 4 (9.8%) patients in OVH group showed occlusion of SV grafts (P=1.0). After day 7, the postoperative leg pain was significantly milder in EVH group than OVH group (1.16±0.76 vs. 2.50±0.91, P<0.01). Conclusions These findings suggest that EVH is not associated with worse clinical outcomes or conduit quality. However, it may have advantage in wound healing.
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Affiliation(s)
- Jun Ran
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yun Liu
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Yuan Li
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qi Li
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yajie Tang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Long Deng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yunhu Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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