Mid-term follow-up of 183 arterial myocardial revascularization procedures

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

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Geographical differences in the ratio of percutaneous and surgical myocardial revascularization procedures in the treatment of coronary artery disease

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezx224 ◽

2017 ◽

Vol 52 (3) ◽

pp. 454-455 ◽

Cited By ~ 1

Author(s):

Raffaele Piccolo ◽

Stephan Windecker ◽

Philippe Kolh

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Myocardial Revascularization ◽

Geographical Differences ◽

Artery Disease ◽

Revascularization Procedures

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Early myocardial revascularization for postinfarction angina: Results and long-term follow-up

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(85)80318-1 ◽

1985 ◽

Vol 6 (5) ◽

pp. 1121-1125 ◽

Cited By ~ 24

Author(s):

Arun K. Singh ◽

Robert Rivera ◽

George N. Cooper ◽

Karl E. Karlson

Keyword(s):

Myocardial Revascularization ◽

Long Term Follow Up

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THE ROLE OF MYOCARDIAL REVASCULARIZATION IN THE SURVIVAL OF PATIENTS WITH ALTERED CORONARY BLOOD FLOW DETECTED BY TRANSTHORACIC ULTRASOUND

Siberian Medical Journal ◽

10.29001/2073-8552-2018-34-1-54-60 ◽

2019 ◽

Vol 34 (1) ◽

pp. 54-60

Author(s):

M. S. Kamenskikh ◽

A. V. Zagatina ◽

N. T. Zhuravskaya ◽

Yu. N. Fedotov ◽

D. V. Shmatov

Keyword(s):

Blood Flow ◽

Coronary Blood Flow ◽

Myocardial Revascularization ◽

Control Group ◽

P Value ◽

Coronary Events ◽

Group 2 ◽

Group 1 ◽

Flow Velocities

Aim of the study was to identify the effects of myocardial revascularization on the prognosis in patients with altered coronary blood flow detected by transthoracic ultrasound.Material and Methods. Four hundred and twelve (412) patients were included in the study. The inclusion criterion was coronary velocity more than 70 cm/s during echocardiography. The study population was divided into three groups: Group 1 comprised patients with high velocities in the coronary arteries detected by ultrasound, in whom myocardial revascularization was performed; Group 2 comprised patients with high velocities in the coronary arteries, in whom myocardial revascularization was not performed and; the Control Group comprised patients with normal coronary blood flow according to ultrasound. The follow-up period was 10–11 months.Results. Seventeen (17) deaths (4.7%) occurred during follow-up. Death rates were 1.6 vs. 8.1 vs. 0% in Group 1, Group 2 and the Control Group, respectively, with a p-value for the difference between Group 1 and Group 2 (p1) of <0.009; and a p-value for the differences compared with the Control group (р2) of <0.03. Death, myocardial infarction, pulmonary edema, and acute coronary syndrome were observed in 27 patients (7.7% of the study group with accelerated blood flow). The rates of these outcomes were 4.9 vs. 11.0 vs. 0% in Group 1, Group 2, and the Control Group, respectively (p1<0.05; p2<0.006). Discussion. The study showed high rates of mortality or acute coronary events in the group of patients with pathologically high coronary flow velocities. The positive effects of revascularization on survival in this group were verified.Conclusions: 1. Left artery coronary flow velocities over 70 cm/s indicate a high probability of death or acute coronary events within 10.5 months.2. Myocardial revascularization has a significant positive effect on the survival rate and incidence of acute coronary events in patients with coronary artery flow velocities greater than 70 cm/s.3. Patients with high coronary blood flow velocities should be referred to coronary angiography or other diagnostic tests without waiting for clinical manifestations and specific symptoms for coronary artery disease.

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Coronary-coronary bypass grafting: artery or vein?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320941689 ◽

2020 ◽

Vol 28 (6) ◽

pp. 316-321

Author(s):

Vladlen Bazylev ◽

Evgeny Rosseikin ◽

Dmitriy Tungusov ◽

Artur Mikulyak

Keyword(s):

Myocardial Revascularization ◽

Coronary Bypass ◽

Long Term Results ◽

Bypass Grafting ◽

Coronary Bypass Grafting ◽

Coronary Bypass Grafts ◽

Long Term Follow Up ◽

Observation Period

Background The method of coronary-coronary bypass grafting was described in 1987 but has not been widely used, and there are only a few studies that report good short-term and mid-term results as well as some individual cases of long-term follow-up. In our medical institution, we carried out an analysis of the long-term results of coronary-coronary bypass grafting, which are presented in this study. Methods This was a retrospective single-center study on 95 patients who underwent coronary-coronary bypass grafting as a supplement to the standard coronary bypass grafting procedure. All patients underwent angiographic assessment of the coronary bypass grafts during the long-term follow-up period. The observation period was up to 123 months. Angiographic assessment of 109 coronary-coronary grafts was carried out. Results Twelve (7.6%) arterial and 11 (19.3%) venous conduits were found to be occluded, and 8 (10.3%) arterial and 10 (31.3%) venous coronary-coronary grafts were occluded during the observation period. Conclusion Arterial coronary-coronary artery bypass grafting represents an alternative technique that allows complete myocardial revascularization.

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P2685Improving myocardial perfusion in refractory angina: extracorporeal shockwave myocardial revascularization in a monocentric cohort

European Heart Journal ◽

10.1093/eurheartj/ehz748.1003 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S D'Amico ◽

G Alunni ◽

M D'Amico ◽

M Fu ◽

D Celentani ◽

...

Keyword(s):

Treatment Group ◽

Myocardial Perfusion ◽

Medical Therapy ◽

Nyha Class ◽

Myocardial Revascularization ◽

Hospitalization Rate ◽

Control Group ◽

Refractory Angina ◽

Nitroglycerin Consumption

Abstract Background The incidence of patients with refractory angina (RA) is increasing. Medical therapy for RA is limited and prognosis is poor. Experimental data and small clinical studies suggest that the use of Extracorporeal shockwave myocardial revascularization (ESMR) may contribute to angiogenesis and improve symptoms in patients with RA. Purpose The aim of this study was to assess the efficacy of ESMR in the improvement of myocardial perfusion and symptoms in patients with RA. Methods Patients with RA despite optimal medical therapy and not suitable for further myocardial revascularization were enrolled and underwent ESMR. Characteristics such as angina class scores (CCS class score), nitroglycerin consumption and hospitalization rate among cases (patients with RA who received ESMR) and controls (patients with RA who did not receive ESMR) were compared at baseline and 6 months after ESMR therapy. In patients receiving ESMR the effect of on cardiac perfusion was assessed at six months. Results Among screened patients, 159 met the inclusion/exclusion criteria. 151 patients were enrolled in the present study and 121 treated with ESMR. There were 121 patients in the treatment group and 29 patients in the control group. The mean age of the patients was 70±8.8 years in the case group and 71±5.3 years in the control group. Other characteristics were similar in both groups. After ESMR myocardial perfusion by SPECT significantly improved: mean SSS was reduced from 21.2±9.42 to 14.2±10, with a 33% relative reduction (p=0.0001). Clinical follow up of both group demonstrated a significant improvement CCS class score at six months (1.5±0.6 in treatment and 1.92±0.69 in controls; p 0.0013) a significant improvement NYHA class score (1.4±0.6 in cases and 1.73±0.59 in controls; p 0.008); also, nitroglycerin consumption (29% in case cases, and 44.8% in controls; P 0.15) and hospitalization rate were reduced in the treatment group compared to control (16% vs. 37.9%; P 0.02). Clinical outcome of two groups at 6 months follow up Treatment group (n=121) Control group (n=29) p CCS class 1.5±0.6 1.92±0.7 <0.001 NYHA class 1.4±0.6 1.7±0.6 <0.008 Nitrates uptake 35 (29%) 13 (45%) <0.15 Admission to emergency department 20 (16%) 11 (38%) <0.02 SPECT results after 6 months follow up Conclusion ESMR therapy is a non-invasive safe and potentially effective new option for patients with refractory angina. This study confirms the beneficial effect of ESMR therapy on cardiac symptoms, myocardial perfusion and hospitalizations in patients with refractory angina.

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