scholarly journals 738–3 Long-term Survival with a Chronic Total Coronary Occlusion: A Comparison of Medical Therapy versus Angloplasty in Patients with Single Vessel Disease

1995 ◽  
Vol 25 (2) ◽  
pp. 149A
Author(s):  
Joseph A. Puma ◽  
Michael H. Sketch ◽  
James E. Tcheng ◽  
Laura H. Gardner ◽  
Charlotte L. Nelson ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Coronary Occlusion ◽  
Term Survival ◽  
Long Term Survival ◽  
Vessel Disease ◽  
Single Vessel ◽  
Chronic Total Coronary Occlusion ◽  
Single Vessel Disease

scholarly journals Sex-specific outcome after minimally invasive direct coronary artery bypass for single-vessel disease

2019 ◽  
Vol 30 (3) ◽  
pp. 380-387
Author(s):  
Christine Friedrich ◽  
Rouven Berndt ◽  
Assad Haneya ◽  
René Rusch ◽  
Rainer Petzina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Survival Rates ◽  
Vessel Disease ◽  
Single Vessel ◽  
Single Vessel Disease

Abstract OBJECTIVES Female gender is reported as an independent risk factor for a poor outcome after coronary artery bypass grafting. We analysed the influence of gender on surgical outcome in patients with single-vessel disease undergoing minimally invasive direct coronary artery bypass (MIDCAB). METHODS From January 1998 to December 2016, a total of 607 consecutive patients with single-vessel disease (31.9% women) underwent MIDCAB at our institution. Major adverse cardiac and cerebrovascular events (MACCE) were recorded during a median follow-up period of 8.0 years. Survival time was estimated for all patients and after applying propensity score matching (138 women vs 138 men). Multivariable Cox regression analysis identified risk factors predicting a long-term mortality rate. RESULTS In women, a longer surgical time (125 vs 113 min; P < 0.001) and a higher transfusion rate were recorded (13.0% vs 5.1%; P = 0.001) with similar rates of in-hospital deaths (1.0% vs 0.5%; P = 0.60) and MACCE (1.5% vs 0.7%; P = 0.39). Survival and MACCE-free survival during the follow-up period did not differ significantly between genders (P = 1.0, P = 0.36). Survival and MACCE-free survival rates after 5 years were 94% and 90% in women compared to 91% and 86% in men. Propensity score matching demonstrated improved long-term survival rates in women (P = 0.029). Insulin-dependent diabetes mellitus, postoperative atrial fibrillation and prolonged intensive care unit stay were associated with long-term deaths for both genders, whereas obesity, former myocardial infarction and preoperative atrial fibrillation were significant risk factors in men. CONCLUSIONS Female patients showed no adverse outcomes after MIDCAB, although risk factors were gender-specific. Overall, MIDCAB demonstrated excellent short- and long-term results as a treatment for single-vessel disease in both genders.

Open surgery versus TEVAR in complicated type B acute aortic syndromes: outcomes of a single referral center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Botta ◽  
G Gliozzi ◽  
L Di Marco ◽  
A Leone ◽  
C Amodio ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Medical Therapy ◽  
Open Surgery ◽  
Acute Type ◽  
Type B ◽  
Term Survival ◽  
Long Term Survival ◽  
Referral Center ◽  
Acute Aortic Syndromes

Abstract Background While patients with uncomplicated acute Type B aortic syndromes (ATBAS) are usually managed with optimal medical therapy, complicated ATBAS require a quick intervention to prevent life-threatening complications. If anatomical features are favorable, TEVAR is the preferred treatment option. Nevertheless, open surgery still plays a significant role in selected cases. The optimal approach to complicated ATBAS remains matter of debate. Purpose We retrospectively evaluated our seventeen-years' experience as regional referral center for acute aortic syndromes to analyze the outcomes of TEVAR and open surgery in cases of complicated ATBAS. Methods Between January 2000 and December 2016, 199 patients with ATBAS were referred to our hospital: 133 aortic dissections, 53 intramural hematomas, 13 penetrating ulcers. All patients were evaluated by a multidisciplinary aortic team. 113 patients (56.8%) received the optimal medical therapy being uncomplicated, while 86 (43.2%) patients admitted with or developing a complicated form of ATBAS underwent TEVAR or open surgery during the same hospital admission. Open surgical repair was performed in cases of unsuitable anatomy for TEVAR, retrograde involvement of the arch, ascending aorta ectasia or aneurysm. In-hospital outcomes, long term survival and freedom from reoperation were analyzed and compared between the groups. Results No differences were observed in terms of in-hospital mortality between uncomplicated and complicated ATBAS (13.3% versus 14.0% respectively [p=0.890]). Complicated ATBAS were treated for unstable anatomical evolution (34 patients), refractory pain or uncontrollable hypertension (19 patients), visceral or peripheral malperfusion (18 patients) or impending rupture in 15 patients. Sixty-eight patients (79%) underwent TEVAR while 18 underwent open surgery (16 frozen elephant trunk [FET] and 2 descending thoracic aorta replacement). Operative timing from the onset of symptoms did not differ between two groups (9+10 (TEVAR) versus 14+16 (Open) days [p=0.233]). In-hospital mortality was 13.2% in TEVAR group versus 16.7% in open surgery (p=0.709). Postoperative myocardial infarction, visceral and peripheral ischemia and neurological outcomes were similar in two groups (p>0.05), but acute kidney injury was higher in open surgery cohort (p=0.027). One, 5 and 10-years survival of uncomplicated ATBAS (medical therapy) were 75%, 58%, 34% vs. 76%, 65%, 58% in TEVAR and 83%, 76%, 76% in open surgery groups (Log rank p=0.329). Comparing TEVAR and open surgery, freedom from endovascular reoperation at 1 and 5 years was 86%, 78% vs. 66%, 60% respectively (Log rank p=0.091). Conclusions Surgical treatment options (open and TEVAR) modify the natural history of complicated acute type B aortic syndromes. Open surgery represents a good option in selected cases with in-hospital and long-term survival at least comparable to TEVAR. Funding Acknowledgement Type of funding source: None

Abstract 2883: Long-term Survival and Cardiac Troponin T Elevation in On- and Off-pump Coronary Artery Bypass Surgery

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jeremiah R Brown ◽  
Felix Hernandez ◽  
John D Klemperer ◽  
Robert A Clough ◽  
Francis V DiPierro ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Troponin T ◽  
Artery Bypass ◽  
Cardiac Troponin T ◽  
Term Survival ◽  
Long Term Survival ◽  
Off Pump ◽  
Vessel Disease ◽  
Disease Characteristics

Introduction: The long-term clinical usefulness of conventional coronary artery bypass graft surgery (CCAB) and off-pump surgery (OPCAB) remains controversial. Long-term survival and cardiac troponin T (cTnT) elevation following CCAB and OPCAB has not been assessed. We tested the hypothesis that long-term survival was similar for CCAB and OPCAB patients when stratified by the presence or absence of cTnT elevation. Methods: In this prospective cohort, we followed 1511 non-emergent patients with 2 or 3 vessel disease (778 CCAB and 733 OPCAB) from a single hospital in Northern New England by surgeons using both procedures between 2000–2004 to determine if 6-year survival was similar for CCAB and OPCAB patients. Postoperative cTnT elevation was defined at ≥1 (ng/μL). Data was linked to the Social Security Administration Death Master File. Kaplan-Meier and log-rank techniques were used. Cox’s proportional hazard models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95%CI), adjusting baseline patient and disease characteristics. Results: Patients were similar with regard to baseline disease characteristics, comorbidities, cardiac history, function and anatomy. CCAB was associated with higher 6-year survival compared with OPCAB regardless of troponin elevation (Figure , p<0.0001). Adjusted HR (CCAB cTnT <1 as referent) were 1.57 (1.05–2.36) for OPCAB cTnT<1, 1.52 (0.95–2.43) for CCAB cTnT ≥1, and 2.50 (1.37–4.58) for OPCAB cTnT≥1. Conclusion: In summary, CCAB results in better survival over OPCAB in patients presenting with two or three vessel disease undergoing non-emergent cardiac surgery.

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