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Bypass vs Angioplasty

Huifeng Zhang, Ming Ye, Gang Chen, Fang Liu, Lin Wu, Bing Jia
BACKGROUND: The hybrid technique combining balloon angioplasty for discrete coarctation (CoA) and surgical repair of a ventricular septal defect (VSD) is a novel treatment for patients with aortic CoA and VSD, but the efficacy of this approach is unknown. METHODS: We performed a retrospective analysis of 92 patients with short segment CoA and VSD who underwent complete repair between January 2004 and July 2014 in our center. Patients were divided into two groups according to the surgical approach employed: hybrid procedure (group A, n=39) and traditional midline surgical repair (group B, n=53)...
August 2016: Journal of Thoracic Disease
Jeremy D Darling, John C McCallum, Peter A Soden, John J Hon, Raul J Guzman, Mark C Wyers, Hence J Verhagen, Marc L Schermerhorn
OBJECTIVE: The effects of concomitant endovascular interventions on multiple infrapopliteal vessels are not well known, and the short-term and long-term sequelae of such procedures have not been reported. METHODS: From 2004 to 2014, 673 limbs in 528 patients underwent an infrapopliteal endovascular intervention for tissue loss (77%), rest pain (13%), stenosis of a previously treated vessel (5%), acute limb ischemia (3%), or claudication (2%). Outcomes included wound healing, RAS events (reintervention, major amputation, or stenosis [>3...
August 30, 2016: Journal of Vascular Surgery
Leszek Wrotniak, Anna Kabłak-Ziembicka, Agnieszka Rosławiecka, Piotr Musiałek, Paweł Bogacki, Mariusz Trystuła, Krzysztof Żmudka, Tadeusz Przewłocki
OBJECTIVE: A minor part of patients with subclavian or innominate artery occlusive disease (subclavian artery stenosis [SAS]) experience symptoms of vertebrobasilar insufficiency, upper extremity exertional ischemia (UEEI), or cardiac ischemia owing to subclavian-coronary steal (SCS) in some instances. The study aimed to assess the impact of percutaneous transluminal angioplasty (PTA) of symptomatic SAS on symptom resolution and to determine factors related with SAS recurrence. METHODS: Symptom resolution and incidence of restenosis (RS) were evaluated for up to 15 years in patients who had undergone successful PTA of SAS...
September 2016: Journal of Vascular Surgery
Yohei Sotomi, Rafael Cavalcante, David van Klaveren, Jung-Min Ahn, Cheol Whan Lee, Robbert J de Winter, Joanna J Wykrzykowska, Yoshinobu Onuma, Ewout W Steyerberg, Seung-Jung Park, Patrick W Serruys
OBJECTIVES: The study sought to validate the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score II mortality prediction model after percutaneous coronary intervention (PCI) or coronary artery bypass grafting in a large pooled population of patients with multivessel coronary disease (MVD) and/or unprotected left main disease (UPLMD) enrolled in the PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) and BEST (Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) randomized controlled trials...
August 8, 2016: JACC. Cardiovascular Interventions
Tadaki M Tomita, Heron E Rodriguez, Andrew W Hoel, Karen J Ho, William H Pearce, Mark K Eskandari
Importance: Vascular surgeons possess a skill set that allows them to assist nonvascular surgeons in the operating room. Existing studies on this topic are limited in their scope to specific procedures or clinical settings. Objective: To describe the broad spectrum of cases that require intraoperative vascular surgery assistance. Design, Setting, and Participants: A retrospective medical record review of patients undergoing nonvascular surgery procedures that required intraoperative vascular surgery assistance between January 2010 and June 2014 at a single urban academic medical center (Northwestern Memorial Hospital, Chicago, Illinois)...
August 3, 2016: JAMA Surgery
Marcus Vinícius Martins Cury, Francisco Cardoso Brochado-Neto, Marcelo Fernando Matielo, Rafael de Athayde Soares, Anna Karina Paiva Sarpe, Roberto Sacilotto
BACKGROUND: The aim of this study was to determine the outcomes of primary bypass graft surgery (BGS) compared to BGS after failed angioplasty (PTA). PATIENTS AND METHODS: Between January 2007 and January 2014, we performed 136 BGSs exclusively for the treatment of critical limb ischaemia. Two cohorts were identified: 1) primary BGS (n = 102; group I), and 2) BGS after prior PTA (n = 34; group II). Data were analysed retrospectively and the primary endpoints were the rates of secondary patency, amputation-free survival, freedom from major adverse outcomes (graft occlusion, amputation, or death), and overall survival, which were assessed with the Kaplan-Meier method...
2016: VASA. Zeitschrift Für Gefässkrankheiten
Morton Leibowitz, Tomas Karpati, Chandra J Cohen-Stavi, Becca S Feldman, Moshe Hoshen, Haim Bitterman, Samy Suissa, Ran D Balicer
IMPORTANCE: International guidelines recommend treatment with statins for patients with preexisting ischemic heart disease to prevent additional cardiovascular events but differ regarding target levels of low-density lipoprotein cholesterol (LDL-C). Trial data on this question are inconclusive and observational data are lacking. OBJECTIVE: To assess the relationship between levels of LDL-C achieved with statin treatment and cardiovascular events in adherent patients with preexisting ischemic heart disease...
August 1, 2016: JAMA Internal Medicine
Lukla Biasi, Sanjay D Patel, Talia Lea, Tommaso Donati, Konstantinos Katsanos, Judith S Partridge, Jugdeep K Dhesi, Hany Zayed
BACKGROUND: The incidence of Critical Limb Ischaemia (CLI) is exponentially rising among our aging population. There is a paucity of scientific evidence on best management and clinical outcome of infra-popliteal (IP) revascularisation in elderly CLI patients. METHODS: A prospectively collected database was analysed to identify consecutive octogenarian and nonagenarian patients who underwent IP revascularisation (bypass or angioplasty) for CLI (Rutherford 4-6) in a single centre between 2010-2014...
May 19, 2016: Journal of Cardiovascular Surgery
William P Robinson, Rupal K Patel, Jesse A Columbo, Julie Flahive, Francesco A Aiello, Donald T Baril, Andres Schanzer, Louis M Messina
BACKGROUND: Most existing series of acute aortic occlusion (AAO) predate the changes in surgical and endovascular therapy of the last 2 decades. We examined the contemporary management and outcomes of AAO. METHODS: We reviewed consecutive patients with AAO at a tertiary referral center from 2004 to 2012. Outcomes were stratified and compared according to etiology and procedure performed. RESULTS: AAO in 29 patients was due to in situ thrombosis in 21 (72%) and embolism in 8 (28%) patients...
July 2016: Annals of Vascular Surgery
Chaim Locker, Hartzell V Schaff, Richard C Daly, Joseph A Dearani, Malcolm R Bell, Robert L Frye, Kevin L Greason, John M Stulak, Lyle D Joyce, Alberto Pochettino, Zhuo Li, Ryan J Lennon, Amir Lerman
OBJECTIVE: To compare long-term survival with multiple arterial coronary artery bypass grafting (CABG) (MultArt) versus percutaneous coronary intervention (PCI) in patients with multivessel disease (MVD). METHODS: We reviewed 12,615 patients with MVD with isolated primary CABG or PCI from 1993 to 2009. Patients with CABG (n = 6667) were grouped according to the number of arterial grafts into left internal thoracic artery (LITA)/saphenous vein (SV) (n = 5712) or MultArt (n = 955); patients with PCI (n = 5948) were grouped into balloon angioplasty (BA) (n = 1020), drug-eluting stent (DES) (n = 1686), and bare metal stent (BMS) (n = 3242)...
August 2016: Journal of Thoracic and Cardiovascular Surgery
Kevin Phan, Dong Fang Zhao, Jessie J Zhou, Aran Karagaratnam, Steven Phan, Tristan D Yan
BACKGROUND: Patients with end-stage renal disease (ESRD) indicated for dialysis are increasingly requiring cardiac valve surgery. The choice of bioprosthetic or mechanic valve prosthesis for such patients requires careful risk assessment. A systematic review and meta-analysis was performed to assess current evidence available. METHODS: A comprehensive search from six electronic databases was performed from their inception to February 2015. Results from patients with ESRD undergoing cardiac surgery for bioprosthetic or mechanical valve replacement were identified...
May 2016: Journal of Thoracic Disease
Céline Vetter, Elizabeth E Devore, Lani R Wegrzyn, Jennifer Massa, Frank E Speizer, Ichiro Kawachi, Bernard Rosner, Meir J Stampfer, Eva S Schernhammer
IMPORTANCE: Prospective studies linking shift work to coronary heart disease (CHD) have been inconsistent and limited by short follow-up. OBJECTIVE: To determine whether rotating night shift work is associated with CHD risk. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 189,158 initially healthy women followed up over 24 years in the Nurses' Health Studies (NHS [1988-2012]: N = 73,623 and NHS2 [1989-2013]: N = 115,535)...
April 26, 2016: JAMA: the Journal of the American Medical Association
Konstantinos Tselios, Dafna D Gladman, Jiandong Su, Murray B Urowitz
OBJECTIVE: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are used as an adjuvant treatment in lupus nephritis (LN) patients with proteinuria. The primary aim of this study was to discover whether ACE inhibitors/ARBs have an atheroprotective effect similar to other, at-risk, populations. METHODS: A total of 144 patients (cases; mean ± SD age at onset 34 ± 12.1 years, followup 14.9 ± 8.6 years) with LN who were treated with ACE inhibitors/ARBs for at least 5 years were enrolled...
October 2016: Arthritis Care & Research
Abdulla A Damluji, Sydney F Pomenti, Archana Ramireddy, Mohammed S Al-Damluji, Carlos E Alfonso, Alan H Schob, Steven P Marso, Ian C Gilchrist, Mauro Moscucci, David E Kandzari, Mauricio G Cohen
Our aim was to evaluate the influence of chronic total occlusions (CTOs) on long-term clinical outcomes of patients with coronary heart disease and diabetes mellitus. We evaluated patients with coronary heart disease and diabetes mellitus enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes, who underwent either prompt revascularization (PR) with intensive medical therapy (IMT) or IMT alone according to the presence or absence of CTO. Of 2,368 patients enrolled in the trial, 972 patients (41%) had CTO of coronary arteries...
April 1, 2016: American Journal of Cardiology
Albert W Chan, Jan Kornder, Helen Elliott, Robert I Brown, Jean-Francois Dorval, Jay Charania, Ruth Zhang, Lillian Ding, Akbar Lalani, Robin A Kuritzky, Gerald J Simkus
OBJECTIVES: This study sought to compare the 1-year survival of patients diagnosed with ST-segment elevation myocardial infarction (STEMI) and transferred via pre-hospital triage strategy for primary percutaneous coronary intervention (PCI) with those transferred via inter-hospital transfer within a large suburban region in Canada. BACKGROUND: Primary angioplasty is the preferred therapy for STEMI if it is done within 90 min of door-to-balloon time by an experienced team in a high-volume center...
December 2012: JACC. Cardiovascular Interventions
Shehzad Sami, James T Willerson
In Part 1 of this review, we discussed how plaque rupture is the most common underlying cause of most cases of unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI) and how early risk stratification is vital for the timely diagnosis and treatment of acute coronary syndromes (ACS). Now, in Part 2, we focus on the medical therapies and treatment strategies (early conservative vs early invasive) used for UA/NSTEMI. We also discuss results from various large randomized controlled trials that have led to the contemporary standards of practice for, and reduced morbidity and death from, UA/NSTEMI...
2010: Texas Heart Institute Journal
Radosław Krecki, Jarosław Drozdz, Piotr Szcześniak, Jarosław D Kasprzak, Jan Z Peruga, Piotr Lipiec, Karina Wierzbowska-Drabik, Jakub Foryś, Daria Orszulak-Michalak, Maria Krzemińska-Pakuła
BACKGROUND: Treatment of chronic diseases, such as atherosclerosis, usually leads to significant short-term improvement. Mid- and long-term results are not always as satisfactory. That is why improvement of quality of life should be the leading qualification criterion for invasive procedures, which sometimes carry a risk of complications. AIM: To determine the quality of life in patients with stable, multivessel coronary artery disease (MCAD), treated surgically or medically...
January 2010: Kardiologia Polska
Henry A Tran, Scott D Barnett, Sharon L Hunt, Andrew Chon, Niv Ad
OBJECTIVES: Percutaneous intervention for coronary revascularization is associated with an increased risk of repeat revascularization, especially in patients with diabetes mellitus. In this study we sought to examine the effect of previous percutaneous intervention on the rate of adverse perioperative outcome and intermediate-term survival in patients undergoing coronary artery bypass surgery. METHODS: Between January 1, 2001, and December 31, 2006, 1758 consecutive patients with diabetes mellitus who underwent first-time isolated coronary artery bypass surgery were identified...
August 2009: Journal of Thoracic and Cardiovascular Surgery
Timothy W Schloss, Brian F Gage, Michael W Rich
The value of invasive therapy in elderly patients with acute myocardial infarction is controversial. The authors performed a retrospective chart review of 140 consecutive patients 80 years and older who were hospitalized with acute myocardial infarction. Hospital outcomes and long-term survival were compared in 79 patients referred for cardiac catheterization during hospitalization with outcomes in 61 patients managed conservatively. Vital status as of December 2003 was determined from the Social Security Death Index...
March 2007: American Journal of Geriatric Cardiology
Judith S Hochman, Lynn A Sleeper, John G Webb, Vladimir Dzavik, Christopher E Buller, Philip Aylward, Jacques Col, Harvey D White
CONTEXT: Cardiogenic shock remains the major cause of death for patients hospitalized with acute myocardial infarction (MI). Although survival in patients with cardiogenic shock complicating acute MI has been shown to be significantly higher at 1 year in those receiving early revascularization vs initial medical stabilization, data demonstrating long-term survival are lacking. OBJECTIVE: To determine if early revascularization affects long-term survival of patients with cardiogenic shock complicating acute MI...
June 7, 2006: JAMA: the Journal of the American Medical Association
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