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Hybrid coronary revascularization

Apostolos Roubelakis, Filip Casselman, Johan van der Merwe, Bernard Stockman, Ivan Degrieck, Frank Van Praet
OBJECTIVES: Robotic-enhanced minimally invasive direct coronary artery bypass grafting surgery (RE-MIDCAB) is based on the use of a robotic console and instrumentation for the dissection of the left internal thoracic artery (LITA). The LITA to left anterior descending (LAD) artery anastomosis is subsequently constructed through a mini thoracotomy. The purpose of this study is to present our experience of RE-MIDCAB outcomes in elderly patients. METHODS: From 2002 until 2015, 44 octogenarians (the mean age of 82...
December 27, 2016: Interactive Cardiovascular and Thoracic Surgery
Bobby Yanagawa, Rashmi Nedadur, John D Puskas
Off-pump coronary artery bypass graft (OPCAB) is currently performed routinely in a minority of specialized centers and in many more centers, utilized only when a porcelain aorta mandates a no-touch aortic technique. The OPCAB literature can be summarized as follows: (I) large-scale randomized trials in relatively low risk patients that include surgeons with a range of experience demonstrating no consistent beneficial differences in major cardiovascular and cerebrovascular outcomes but lower transfusion rates and shorter length of stay, tempered by some reports of higher rates of incomplete revascularization and lower rates of long term graft patency; (II) smaller randomized controlled trials (RCTs) from highly specialized programs demonstrating equivalent or superior outcomes with OPCAB and similar completeness of revascularization and graft patency; and (III) observational data from large databases demonstrating a consistent benefit of OPCAB, especially in higher-risk patient subsets...
November 2016: Journal of Thoracic Disease
Antonio Nenna, Mario Lusini, Salvatore Matteo Greco, Elvio Covino, Massimo Chello
No abstract text is available yet for this article.
October 2016: Journal of Geriatric Cardiology: JGC
Barry Hennigan, Keith G Oldroyd, Colin Berry, Nils Johnson, John McClure, Peter McCartney, Margaret B McEntegart, Hany Eteiba, Mark C Petrie, Paul Rocchiccioli, Richard Good, Martin M Lindsay, Stuart Hood, Stuart Watkins
BACKGROUND: Distal coronary to aortic pressure ratio (Pd/Pa) and instantaneous wave-free ratio (iFR) are indices of functional significance of a coronary stenosis measured without hyperemia. It has been suggested that iFR has superior diagnostic accuracy to Pd/Pa when compared with fractional flow reserve (FFR).We hypothesized that in comparison with FFR, revascularization decisions based on either binary cutoff values for iFR and Pd/Pa or hybrid strategies incorporating iFR or Pd/Pa will result in similar levels of disagreement...
November 2016: Circulation. Cardiovascular Interventions
Vladimir Dedovic, Goran Stankovic
Despite permanent improvement in success rate and technical developments, chronic total occlusion (CTO) remains undertreated by percutaneous coronary intervention (PCI). Dedicated CTO operators from Japan, Europe and USA perform these procedures with success rate beyond 90%, but there is still huge gap between this group of specialists and broader population of PCI operators. Recently proposed CTO scores can be used for patients' selection according to the CTO operators' experience. Patients with low CTO Score values may be suitable for less experienced operators at the beginning of the CTO PCI learning curve, while more complex CTOs (higher CTO Score values) should be differed to CTO experts...
March 2017: Panminerva Medica
Nikolaos A Papakonstantinou, Nikolaos G Baikoussis, Panagiotis Dedeilias, Michalis Argiriou, Christos Charitos
A hybrid strategy, firstly performed in the 1990s, is a combination of tools available only in the catheterization laboratory with those available only in the operating room in order to minimize surgical morbidity and face with any cardiovascular lesion. The continuous evolution of stent technology along with the adoption of minimally invasive surgical approaches, make hybrid approaches an attractive alternative to standard surgical or transcatheter techniques for any given set of cardiovascular lesions. Examples include hybrid coronary revascularization, when an open surgical anastomosis of the left internal mammary artery to the left anterior descending coronary artery is performed along with stent implantation in non-left anterior descending coronary vessels, open heart valve surgery combined with percutaneous coronary interventions to coronary lesions, hybrid aortic arch debranching combined with endovascular grafting for thoracic aortic aneurysms, hybrid endocardial and epicardial atrial fibrillation procedures, and carotid artery stenting along with coronary artery bypass grafting...
January 2017: Journal of Cardiology
Javier G Poveda, Gustavo L Silva, Pedro C Silva, Ângelo Nobre
Our goal is to introduce a new hybrid coronary revascularization concept-coronary surgical stenting. The procedure was performed on a 78-year old woman with severe, long and calcified involvement of the proximal left anterior descending artery, chronic total occlusion of the mid-left anterior descending artery and severe disease in the distal left anterior descending artery. An off-pump minimally invasive procedure was performed through the fifth intercostal space, including concurrent surgical placement of a drug-eluting stent in the distal left anterior descending artery, through the left anterior descending artery graft incision, associated with the left internal mammary artery to the mid-left anterior descending artery graft...
September 27, 2016: Interactive Cardiovascular and Thoracic Surgery
Krzysztof Milewski, Paweł Gąsior, Stefan Samborski, Piotr P Buszman, Aleksandra Błachut, Adam Wojtaszczyk, Adam Młodziankowski, Artur Mendyk, Marek Król, Wojciech Wojakowski, Paweł E Buszman
INTRODUCTION: Despite the dominance of drug-eluting stents in modern interventional cardiology, there is still a niche for bare metal stents. AIM: The aim of the Polish NexGen registry was to evaluate the safety and efficacy of a new generation cobalt-chromium NexGen stent in a real life patient population. MATERIAL AND METHODS: A prospective multi-center registry was conducted in five clinical sites of American Heart of Poland. Three hundred and eighty-three patients who underwent percutaneous coronary intervention (PCI) with NexGen stent implantation were included...
2016: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
Hitoshi Yaku, Satoshi Numata, Sachiko Yamazaki
No abstract text is available yet for this article.
June 20, 2016: Nihon Rinsho. Japanese Journal of Clinical Medicine
Junjiro Kobayashi, Yusuke Shimahara, Tomoyuki Fujita, Hideaki Kanzaki, Makoto Amaki, Hiroki Hata, Yuta Kume, Kizuku Yamashita, Atsushi Okada
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become an alternative procedure for treating aortic stenosis (AS) in patients with advanced age and severe comorbidities. Ischemic heart disease (IHD) is present with AS in 40-50% of patients with typical angina. Considering the high operative mortality and morbidity rates in these patients, hybrid TAVI and off-pump CABG (OPCAB) have become realistic treatment options. METHODS AND RESULTS: Between August 2014 and November 2015, 12 patients were evaluated for simultaneous TAVI and OPCAB...
August 25, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Chenghui Zhou, Yunseok Jeon, Patrick Meybohm, Alexander Zarbock, Paul Jeffrey Young, Lihuan Li, Derek J Hausenloy
BACKGROUND: Remote ischemic conditioning (RIC) has been recognized an emerging non-invasive approach for preventing acute kidney injury (AKI) in patients undergoing either elective coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). On the other hand, accumulating evidence has indicated the involving role of pre-CABG contrast usage for coronary angiography in post-surgery AKI risk. Along with the shortening time delay of CABG after coronary angiography, and the prevalent hybrid coronary revascularization (HCR), the AKI prevention by RIC has faced challenges following coronary revascuralization...
November 1, 2016: International Journal of Cardiology
Rustem Dautov, Henrique Barbosa Ribeiro, Omar Abdul-Jawad Altisent, Luis Nombela-Franco, Claire Gibrat, Can Manh Nguyen, Stéphane Rinfret
The experience with the transradial approach in percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) in the United States is limited. We looked at the safety and feasibility of a home-made sheathless transradial technique (STT) with regular 8Fr catheters in CTO PCI. In March 2013, we developed an 8Fr STT for CTO PCI. We compared 119 patients who had the STT versus 122 treated with a standard transradial or transfemoral approach. The primary outcomes of interest were major vascular or bleeding site access complications...
September 15, 2016: American Journal of Cardiology
Anno Diegeler
No abstract text is available yet for this article.
July 26, 2016: Journal of the American College of Cardiology
John D Puskas, Michael E Halkos, Joseph J DeRose, Emilia Bagiella, Marissa A Miller, Jessica Overbey, Johannes Bonatti, V S Srinivas, Mark Vesely, Francis Sutter, Janine Lynch, Katherine Kirkwood, Timothy A Shapiro, Konstantinos D Boudoulas, Juan Crestanello, Thomas Gehrig, Peter Smith, Michael Ragosta, Steven J Hoff, David Zhao, Annetine C Gelijns, Wilson Y Szeto, Giora Weisz, Michael Argenziano, Thomas Vassiliades, Henry Liberman, William Matthai, Deborah D Ascheim
BACKGROUND: Hybrid coronary revascularization (HCR) combines minimally invasive surgical coronary artery bypass grafting of the left anterior descending artery with percutaneous coronary intervention (PCI) of non-left anterior descending vessels. HCR is increasingly used to treat multivessel coronary artery disease that includes stenoses in the proximal left anterior descending artery and at least 1 other vessel, but its effectiveness has not been rigorously evaluated. OBJECTIVES: This National Institutes of Health-funded, multicenter, observational study was conducted to explore the characteristics and outcomes of patients undergoing clinically indicated HCR and multivessel PCI for hybrid-eligible coronary artery disease, to inform the design of a confirmatory comparative effectiveness trial...
July 26, 2016: Journal of the American College of Cardiology
Keita Kikuchi
INTRODUCTION: We report our clinical results of off-pump minimally invasive coronary artery bypass grafting( MICS CABG) under direct vision as our initial experience. SURGERY: An 8-10 cm incision was made in the left 4-5th intercostal space (ICS). Bilateral internal thoracic artery (BITA) were harvested under direct vision with the use of 32 cm Harmonic scalpel through the surgical port. And the right lung is displaced by a tissue stabilizer via subxiphoid incision...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Imthiaz Manoly, Ragheb Hasan, Andrew Brazier, Vasim Farooq, Thomas Thompson, Devinda Karunaratne, Heather Naylor, Douglas Fraser
INTRODUCTION: Patients with complex coronary artery disease and severe aortic stenosis unsuitable for conventional cardiac surgery pose a significant treatment challenge. This is especially difficult for patients where percutaneous revascularization is technically very challenging and/or would not offer as complete revascularisation compared to surgical revascularisation. In addition, patients who are unsuitable for transfemoral transcatheter aortic valve implantation (TAVI) pose an additional technical challenge, particularly with dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI)...
July 12, 2016: Catheterization and Cardiovascular Interventions
Zachary L Steinberg, Thomas K Jones, William L Lombardi
Kawasaki disease is a self-limiting vasculitis presenting in childhood that can lead to aneurysms of the coronary arteries. Patients who develop giant coronary aneurysms have a high incidence of coronary stenoses and occlusions resulting in myocardial ischemia. The mainstay of treatment for these lesions is surgical bypass due to complex coronary anatomy and a high rate of chronic total occlusions precluding traditional percutaneous coronary intervention techniques. We report the first successful percutaneous revascularization of two chronically occluded giant coronary aneurysms using the Hybrid Interventional Strategy for approaching chronic total occlusions...
October 2016: Pediatric Cardiology
Jessika Iwanski, Raymond K Wong, Douglas F Larson, Alice S Ferng, Raymond B Runyan, Steven Goldstein, Zain Khalpey
Transmyocardial revascularization (TMR) has emerged as an additional therapeutic option for patients suffering from diffuse coronary artery disease (CAD), providing immediate angina relief. Recent studies indicate that the volume of surgical cases being performed with TMR have been steadily rising, utilizing TMR as an adjunctive therapy. Therefore the purpose of this review is to provide an up-to-date appreciation of the current state of TMR and its future developmental directions on CAD treatment. The current potential of this therapy focuses on the implementation of stem cells, in order to create a synergistic angiogenic effect while increasing myocardial repair and regeneration...
2016: SpringerPlus
D Heber, M Hacker
Ischemic heart disease still represents the leading cause of death in the western world despite a decrease of mortality in the last decade. For the diagnostics of coronary artery morphology, invasive coronary angiography represents the gold standard. Nevertheless, in recent years the importance of functional diagnostics of the coronary arteries has increased and various imaging procedures for the measurement of fractional flow reserve (FFR) during coronary angiography were established and recommended for ischemia testing in the actual guidelines on myocardial revascularization...
August 2016: Herz
Si-Hyuck Kang, In-Ho Chae, Jin-Joo Park, Hak Seung Lee, Do-Yoon Kang, Seung-Sik Hwang, Tae-Jin Youn, Hyo-Soo Kim
OBJECTIVES: This study sought to perform a systematic review and network meta-analysis to compare the relative safety and efficacy of contemporary DES and BVS. BACKGROUND: To improve outcomes of patients undergoing percutaneous coronary revascularization, there have been advances in the design of drug-eluting stents (DES), including the development of drug-eluting bioresorbable vascular scaffolds (BVS). METHODS: Prospective, randomized, controlled trials comparing bare-metal stents (BMS), paclitaxel-eluting stents (PES), sirolimus-eluting stents (SES), Endeavor zotarolimus-eluting stents (E-ZES), cobalt-chromium (CoCr) everolimus-eluting stents (EES), platinum-chromium (PtCr)-EES, biodegradable polymer (BP)-EES, Resolute zotarolimus-eluting stents (R-ZES), BP biolimus-eluting stents (BP-BES), hybrid sirolimus-eluting stents (H [Orsiro]-SES), polymer-free sirolimus- and probucol-eluting stents, or BVS were searched in online databases...
June 27, 2016: JACC. Cardiovascular Interventions
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