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Francesco Nicolini, Daniela Fortuna, Giovanni Andrea Contini, Davide Pacini, Davide Gabbieri, Claudio Zussa, Rossana De Palma, Antonella Vezzani, Tiziano Gherli
OBJECTIVES: The aim of this study was to compare 5-year rates of overall death, cardiac-related death, myocardial infarction, repeat revascularization, stroke and new occurrence of postoperative renal failure in a large cohort of patients with coronary disease, treated with on- or off-pump coronary artery bypass grafting (CABG). METHODS: Two propensity score-matched cohorts, each of 560 patients, undergoing isolated surgical coronary revascularization at the regional public and private centres of Emilia-Romagna region (Italy) over the period 1 January 2003 - 31 December 2013, were used to compare long-term outcomes of on-pump CABG (6711 patients) and off-pump CABG (597 patients)...
September 2016: European Journal of Cardio-thoracic Surgery
Bobby Yanagawa, Subodh Verma, Peter Jüni, Derrick Y Tam, Amine Mazine, John D Puskas, Jan O Friedrich
OBJECTIVES: This meta-analysis examines whether there is any advantage of coronary artery bypass graft with bilateral internal thoracic artery (BITA) as an in situ versus composite graft. METHODS: We searched MEDLINE and EMBASE Databases from 1996 to 2016 for studies that compared coronary artery bypass graft with BITA as in situ versus composite graft. Data were extracted by 2 independent investigators and meta-analyzed with the use of random effects. RESULTS: Two randomized controlled trials (RCTs; n = 705), 2 matched (n = 1688), and 4 unadjusted observational studies (n = 3517) met inclusion criteria...
November 21, 2016: Journal of Thoracic and Cardiovascular Surgery
Chikara Ueki, Hiroaki Miyata, Noboru Motomura, Genichi Sakaguchi, Takehide Akimoto, Shinichi Takamoto
OBJECTIVE: Using data from the Japan Adult Cardiovascular Surgery Database, we evaluated the prognostic influence of off-pump technique in patients with low ejection fraction who underwent coronary artery bypass grafting. METHODS: We analyzed 2187 patients with an ejection fraction <0.30 who underwent primary, nonemergency, isolated coronary artery bypass grafting between 2008 and 2012, as reported in the Japan Adult Cardiovascular Surgery Database. Patients were divided into on-pump (n = 1134; 51...
April 2016: Journal of Thoracic and Cardiovascular Surgery
Rowlens M Melduni, Hartzell V Schaff, Hon-Chi Lee, Bernard J Gersh, Peter A Noseworthy, Kent R Bailey, Naser M Ammash, Stephen S Cha, Kaniz Fatema, Waldemar E Wysokinski, James B Seward, Douglas L Packer, Charanjit S Rihal, Samuel J Asirvatham
BACKGROUND: -Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive. METHODS: -Out of 10,633 adults who underwent CABG and/or valve surgery between January 2000 and December 2005, 9,792 patients with complete baseline characteristics, surgery procedure and follow-up data were included in this analysis. A propensity-score matching analysis based on 28 pretreatment covariates was performed and 461 matching pairs were derived and analyzed to estimate the association of LAA closure with early postoperative atrial fibrillation (POAF) (AF ≤30 days of surgery), ischemic stroke and mortality...
November 30, 2016: Circulation
Sleiman Sebastian Aboul-Hassan, Tomasz Stankowski, Jakub Marczak, Romuald Cichon
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether continuation of administration of preoperative aspirin until the day of coronary artery bypass grafting (CABG) could minimize postoperative mortality, prevalence of postoperative myocardial infarction (MI) with or without influence on postoperative bleeding, packed red blood cell (PRBC) transfusion and reoperation for bleeding. Altogether, 662 papers were found using the reported search, 7 of which represented the best evidence to answer the clinical question...
October 4, 2016: Interactive Cardiovascular and Thoracic Surgery
André Lamy, P J Devereaux, Dorairaj Prabhakaran, David P Taggart, Shengshou Hu, Zbynek Straka, Leopoldo S Piegas, Alvaro Avezum, Ahmet R Akar, Fernando Lanas Zanetti, Anil R Jain, Nicolas Noiseux, Chandrasekar Padmanabhan, Juan-Carlos Bahamondes, Richard J Novick, Liang Tao, Pablo A Olavegogeascoechea, Balram Airan, Toomas-Andres Sulling, Richard P Whitlock, Yongning Ou, Peggy Gao, Shirley Pettit, Salim Yusuf
Background We previously reported that there was no significant difference at 30 days or at 1 year in the rate of the composite outcome of death, stroke, myocardial infarction, or renal failure between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report the results at 5 years (the end of the trial). Methods A total of 4752 patients (from 19 countries) who had coronary artery disease were randomly assigned to undergo off-pump or on-pump CABG...
15, 2016: New England Journal of Medicine
Dmitry Pevni, Benjamin Medalion, Rephael Mohr, Yanai Ben-Gal, Adam Laub, Avner Nevo, Amir Kramer, Yosef Paz, Nachum Nesher
BACKGROUND: Bilateral internal thoracic artery (BITA) grafting in patients with diabetes mellitus is controversial because of a higher risk for sternal infection. The purpose of this study is to compare the outcome of BITA grafting to that of single ITA (SITA) grafting in patients with diabetes. METHODS: Between 1996 and 2010, 964 diabetic patients with multivessel disease who underwent primary coronary artery bypass graft surgery with BITA were compared with 564 patients who underwent coronary artery bypass graft surgery with SITA and saphenous vein grafts...
September 1, 2016: Annals of Thoracic Surgery
Serenella Castelvecchio, Lorenzo Menicanti, Andrea Garatti, Roberto Tramarin, Marianna Volpe, Alessandro Parolari
Patients affected by diabetes usually have extensive coronary artery disease. Coronary revascularization has a prominent role in the treatment of coronary artery disease in the expanding diabetic population. However, diabetic patients undergoing coronary artery bypass grafting or percutaneous coronary intervention experience worse outcomes than nondiabetic patients. Several studies comparing coronary artery bypass grafting vs percutaneous coronary intervention in subgroups of diabetic patients demonstrated a survival advantage and fewer repeat revascularization procedures with an initial surgical strategy...
September 2016: Annals of Thoracic Surgery
Zhong-Guo Fan, Xiao-Fei Gao, Li-Wen Chen, Xiao-Bo Li, Ming-Xue Shao, Qian Ji, Hao Zhu, Yi-Zhi Ren, Shao-Liang Chen, Nai-Liang Tian
BACKGROUND: The effects of intra-aortic balloon pump (IABP) usage in patients with acute myocardial infarction remain controversial. This study sought to evaluate the outcomes of IABP usage in these patients. METHODS: Medline, EMBASE, and other internet sources were searched for relevant clinical trials. The primary efficacy endpoints (in-hospital, midterm, and long-term mortality) and secondary endpoints (reinfarction, recurrent ischemia, and new heart failure in the hospital) as well as safety endpoints (severe bleeding requiring blood transfusion and stroke in-hospital) were subsequently analyzed...
2016: Patient Preference and Adherence
Chikara Ueki, Genichi Sakaguchi, Takehide Akimoto, Yuko Ohashi, Hirofumi Sato
A hybrid procedure of beating-heart coronary artery bypass grafting (CABG) with the concomitant use of cardiopulmonary bypass termed on-pump beating-heart CABG (ON-BH CABG) has emerged as an alternative for high-risk patient populations. Although several studies have reported the advantage of ON-BH CABG in high-risk patients, the clinical benefit of ON-BH CABG is still under discussion. Here, we performed a meta-analysis of the data derived from published studies comparing the clinical outcomes of ON-BH CABG with that of conventional arrested heart CABG...
November 2016: European Journal of Cardio-thoracic Surgery
David Glineur, Spiridon Papadatos, Juan B Grau, Richard E Shaw, Cyrus E Kuschner, Gaby Aphram, Yves Mairy, Christophe Vanbelighen, Pierre Yves Etienne
OBJECTIVES: Bilateral internal thoracic artery (BITA) bypass provides long-term survival benefits over strategies that use single internal mammary arteries during coronary artery bypass grafting (CABG). However, the rate of adoption of this strategy remains very low. Moreover, optimal BITA configuration and the use of cardiopulmonary bypass still remain a matter of debate. We investigated the long-term results of a coronary revascularization strategy, utilising exclusively BITA-Y composite grafts using off-pump platform and sequential anastomoses...
October 2016: European Journal of Cardio-thoracic Surgery
Jiayang Wang, Wenyuan Yu, Mingxin Gao, Chengxiong Gu, Yang Yu
This meta-analysis investigated the effects of preoperative prophylactic intraaortic balloon pump placement on postoperative renal function and short-term death of high-risk patients undergoing coronary artery bypass grafting. We found that preoperative prophylactic intraaortic balloon pump support reduced the incidence of coronary artery bypass grafting-associated acute kidney injury and short-term death and dramatically decreased the incidence of postoperative renal replacement therapy by 82% compared with high-risk patients without the procedure...
May 2016: Annals of Thoracic Surgery
Daniel O Navia, Mariano Vrancic, Fernando Piccinini, Mariano Camporrotondo, Alberto Dorsa, Juan Espinoza, Mariano Benzadon, Juan Camou
BACKGROUND: We studied long-term survival using bilateral internal thoracic artery (BITA) grafting in a T-configuration exclusively versus using single internal thoracic artery (SITA) grafting in patients with multivessel disease. METHODS: Consecutive coronary operations performed at a single center between 1996 and 2014 were reviewed. Long-term survival among patients receiving coronary revascularization exclusively with BITA grafting in a T-configuration (n = 2,098) versus SITA grafts plus other types of conduits (saphenous vein graft [SVG] and radial artery [RA]) grafts (n = 1,659)...
May 2016: Annals of Thoracic Surgery
Milan Milojevic, Stuart J Head, Catalina A Parasca, Patrick W Serruys, Friedrich W Mohr, Marie-Claude Morice, Michael J Mack, Elisabeth Ståhle, Ted E Feldman, Keith D Dawkins, Antonio Colombo, A Pieter Kappetein, David R Holmes
BACKGROUND: There are no data available on specific causes of death from randomized trials that have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI). OBJECTIVES: The purpose of this study was to investigate specific causes of death, and its predictors, after revascularization for complex coronary disease in patients. METHODS: An independent Clinical Events Committee consisting of expert physicians who were blinded to the study treatment subclassified causes of death as cardiovascular (cardiac and vascular), noncardiovascular, or undetermined according to the trial protocol...
January 5, 2016: Journal of the American College of Cardiology
Siamak Mohammadi, François Dagenais, Pierre Voisine, Eric Dumont, Eric Charbonneau, Mohamed Marzouk, Andreas Paramythiotis, Dimitri Kalavrouziotis
BACKGROUND: Bilateral internal mammary artery (BIMA) grafting has been associated with improved long-term outcomes after CABG. We sought to evaluate the early results and long-term survival among coronary artery bypass graft patients who underwent in-situ BIMA grafting with the radial artery (RA) as an additional arterial conduit compared with those who underwent BIMA with additional saphenous vein graft (SVG). METHODS: Between 1991 and 2013, 1,750 consecutive patients with triple-vessel disease or left main plus right coronary system disease underwent primary isolated in-situ BIMA grafting with at least one internal mammary artery to the left anterior descending artery...
March 2016: Annals of Thoracic Surgery
Guo-Wei He, David P Taggart
Spasm of arterial grafts in coronary artery bypass grafting surgery is still a clinical problem, and refractory spasm can occasionally be lethal. Perioperative spasm in bypass grafts and coronary arteries has been reported in 0.43% of all coronary artery bypass grafting surgery, but this may be an underestimate. Spasm can develop not only in the internal mammary artery but more frequently in the right gastroepiploic and radial artery. The mechanism of spasm can involve many pathways, particularly those involving regulation of the intracellular calcium concentration...
March 2016: Annals of Thoracic Surgery
Fraser D Rubens, Li Chen, Michael Bourke
BACKGROUND: Skeletonization is a technique of bilateral internal thoracic artery (BITA) harvest that preserves sternal blood flow. We sought to identify the relationship of skeletonization and sternal wound infection in a population undergoing BITA harvest. METHODS: Demographics and outcomes were recorded from patients undergoing coronary artery bypass graft surgery with BITA using either skeletonized (n = 531) or nonskeletonized (n = 970) techniques. The primary outcome was total infection...
May 2016: Annals of Thoracic Surgery
Robert H Habib, Kamellia R Dimitrova, Sanaa A Badour, Maroun B Yammine, Abdul-Karim M El-Hage-Sleiman, Darryl M Hoffman, Charles M Geller, Thomas A Schwann, Robert F Tranbaugh
BACKGROUND: Treatment of multivessel coronary artery disease with traditional single-arterial coronary artery bypass graft (SA-CABG) has been associated with superior intermediate-term survival and reintervention compared with percutaneous coronary intervention (PCI) using either bare-metal stents (BMS) or drug-eluting stents (DES). OBJECTIVES: This study sought to investigate longer-term outcomes including the potential added advantage of multiarterial coronary artery bypass graft (MA-CABG)...
September 29, 2015: Journal of the American College of Cardiology
Ivana Petrovic, Dusko Nezic, Miodrag Peric, Predrag Milojevic, Olivera Djokic, Dragana Kosevic, Nebojsa Tasic, Bosko Djukanovic, Petar Otasevic
BACKGROUND: There is ongoing debate regarding the efficacy of the radial artery (RA) as an aortocoronary conduit, with few solid data regarding long-term clinical results. We sought to determine if the use of the RA as the second arterial conduit, beside left internal thoracic artery (LITA), would improve long-term clinical outcome after CABG as compared to saphenous vein graft (SVG). METHODS: Between March 2001 and November 2003, 200 patients underwent isolated CABG and were randomized in 1:1 fashion to receive either LITA and RA grafts or LITA and SVGs...
2015: Journal of Cardiothoracic Surgery
Raffaele Piccolo, Gennaro Giustino, Roxana Mehran, Stephan Windecker
Stable coronary artery disease is the most common clinical manifestation of ischaemic heart disease and a leading cause of mortality worldwide. Myocardial revascularisation is a mainstay in the treatment of symptomatic patients or those with ischaemia-producing coronary lesions, and reduces ischaemia to a greater extent than medical treatment. Documentation of ischaemia and plaque burden is fundamental in the risk stratification of patients with stable coronary artery disease, and several invasive and non-invasive techniques are available (eg, fractional flow reserve or intravascular ultrasound) or being validated (eg, instantaneous wave-free ratio and optical coherence tomography)...
August 15, 2015: Lancet
2015-09-19 06:58:59
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