scholarly journals Mid- and Long-Term Outcomes of Total Arterial Myocardial Revascularization in Patients Aged 70 Years and Older: A Single-Center Experience

2018 ◽  
Vol 67 (06) ◽  
pp. 444-449
Author(s):  
Jill Jussli-Melchers ◽  
Bernd Panholzer ◽  
Christine Friedrich ◽  
Ole Broch ◽  
Katharina Huenges ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
The Elderly ◽  
Long Term Results ◽  
Cardiac Events ◽  
Arterial Grafts ◽  
Single Center Experience ◽  
Preoperative Risk Factors

Abstract Background Patients receiving arterial grafts have superior late survival after coronary artery bypass graft (CABG) surgery. The aim of our study was to evaluate the mid- and long-term results of total arterial (TA) revascularization in the elderly. Methods Between January 2005 and December 2012, a retrospective study on age-, gender-, and EuroSCORE-matched patients aged 70 years and older was performed. Altogether, 356 patients who received isolated CABG were assigned to either TA group or control (CON) group. Results No significant differences were noted in regard to preoperative risk factors. The number of distal anastomoses was significantly higher in the CON group (3.6 ± 0.6 vs. 2.9 ± 0.8; p < 0.001). Postoperatively, no significant differences were noted in regard to morbidity or mortality. There were no significant differences in mortality rate at 1 year (5.6 vs. 5.2%; p = 0.98), or 5 years (9.0 vs. 12.1%; p = 0.39) between both groups. However, the TA group was associated with significantly higher rate of event-free survival (p = 0.017). Conclusion This study suggests that TA revascularization is an effective procedure. Lower rates of late cardiac events encourage the use of this concept for the elderly.

scholarly journals In situ skeletonized bilateral thoracic artery for left coronary circulation: a 20-year experience

2019 ◽  
Vol 57 (1) ◽  
pp. 160-167 ◽  
Author(s):  
Massimo Bonacchi ◽  
Edvin Prifti ◽  
Marco Bugetti ◽  
Francesco Cabrucci ◽  
Michael Cresci ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Circulation ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Adverse Cardiac Events

Abstract OBJECTIVES Our goal was to analyse the outcomes in a patient population using a standardized technique for coronary artery bypass grafting (CABG) consisting of total arterial myocardial revascularization utilizing the in situ skeletonized bilateral thoracic artery for left coronary circulation. We also explored potential predictors of long-time unfavourable outcomes. METHODS Patients undergoing total arterial myocardial revascularization using in situ skeletonized bilateral thoracic artery for left coronary circulation between January 1997 and May 2017 were included prospectively in this study. The median follow-up (100% complete) was 103 months (interquartile range 61–189 months) and ranged from 1 to 245 months. RESULTS A total of 1325 consecutive patients were recruited. During the follow-up period, there were 131 deaths (9.8%), 146 repeat revascularizations (11.0%) and 229 major adverse cardiac events (17.2%). The 18-year freedom from major adverse cardiac events was 62.6 ± 9.3%, 62.5 ± 6.3% and 53.9 ± 11.0%, respectively. Multivariable models showed that a left ventricular ejection fraction ≤35%, chronic obstructive pulmonary disease, peripheral vascular disease (P &lt; 0.001), chronic kidney disease and age ≥80 years (P = 0.002) were independent predictors of diminished long-term survival. Moreover, peripheral vascular disease and off-pump coronary artery bypass (both, P &lt; 0.001) predicted repeat revascularization. Finally, age ≥80 years, peripheral vascular disease, left ventricular ejection fraction ≤35%, off-pump coronary artery bypass and chronic pulmonary obstructive disease were independent predictors of major adverse cardiac events during the long-term follow-up period (all, P &lt; 0.001). CONCLUSIONS Coronary artery bypass using the in situ skeletonized bilateral thoracic artery for left coronary circulation configuration for total arterial myocardial revascularization resulted in satisfactory long-term results with a low incidence of death and late events and may represent a technique of choice in selected patients having CABG. Larger and long-term prospective studies are, however, warranted.

IMPACT OF COMPETITIVE FLOW ON HEMODYNAMICS OF LIMA-LAD GRAFTING WITH DIFFERENT STENOSIS: A NUMERICAL STUDY

2017 ◽  
Vol 17 (02) ◽  
pp. 1750040 ◽  
Author(s):  
LANLAN LI ◽  
YOUJUN LIU ◽  
XI ZHAO ◽  
BOYAN MAO ◽  
HUIXIA ZHANG
Keyword(s):  
Coronary Artery ◽  
Numerical Study ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Lumped Parameter Model ◽  
Arterial Grafts ◽  
Artery Graft ◽  
Stenosis Rate

Background and Aims: Competitive flow exists in the native coronary artery when using artery graft in the coronary artery bypass graft (CABG), and it is a major factor affecting the long-term patency of the arterial grafts. The purpose of this study is to investigate the effects of the competitive flow on hemodynamic characteristics of left internal mammary artery (LIMA). Materials and methods: Seven three-dimensional (3D) LIMA-left anterior decending (LAD) grafting models with different diameter stenoses at the trunk of LAD were reconstructed, including 25%, 40%, 50%, 60%, 75%, 90% and 100%. The boundary conditions of these models were provided by the same lumped parameter model (LPM; 0D sub-model) of cardiovascular circulatory system, which is based on 0D/3D coupling method. Results: The simulation results show that competitive flow decreases when the stenosis rate increases and backflow exists in LIMA during systole when the degree of stenosis is below 50%; the wall shear stress (WSS) of the graft increases from 0.85[Formula: see text]Pa to 1.79[Formula: see text]Pa with the increase of the native coronary stenosis degree, while the oscillatory shear index (OSI) decreases from 0.1557 to 0.00213. Conclusions: Competitive flow may produce adverse hemodynamic effects on artery graft, especially when the stenosis degree is below 50%, competitive flow will significantly lead the long-term patency of the artery graft worse because of the backflow, low WSS and high OSI, and the effect of OSI is more obvious than WSS.

scholarly journals Myocardial revascularization in patients with type 2 diabetes mellitus: An overview of modern techniques

2016 ◽  
Vol 19 (5) ◽  
pp. 406-413 ◽  
Author(s):  
Elena Zelikovna Golukhova ◽  
Elena Vladislavovna Kuznetsova
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Vascular Lesions ◽  
Rapid Progression ◽  
Coronary Artery Lesions ◽  
Optimal Approach

For patients with coronary artery disease (CAD), in combination with diabetes mellitus, diffuse multivessel coronary artery lesions are common. Such patients are prone to a more rapid progression of atherosclerosis, significantly increasing the need for myocardial revascularization. The choice of an optimal approach determines the prognosis and course of CAD. The results of randomized trials show that the use of percutaneous coronary interventions with drug-eluting stents is appropriate for patients with one or two coronary artery lesions, but that coronary artery bypass graft surgery is preferred in cases of multivessel disease and significantly reduces the risk of long-term adverse events. It should also be noted that the use of modern generations of stents allows the achievement of comparable results in terms of long-term mortality, which was most convincingly demonstrated in patients with one or two vascular lesions.

Early invasive tactics for treatment of patients with various forms of unstable angina

2021 ◽  
pp. 7-11
Author(s):  
G. A. Gazaryan ◽  
I. V. Zakharov ◽  
A. S. Ermolov
Keyword(s):  
Unstable Angina ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Long Term Results ◽  
Invasive Treatment ◽  
Non Invasive ◽  
Percutaneous Coronary ◽  
Exertional Angina ◽  
Medicinal Therapy

The paper presents immediate and long-term results of early invasive treatment tactics in 467 patients with various forms of unstable angina (UA), including 129 patients with unstable rest angina, 225 patients with unstable exertional angina, and 93 patients with a new onset angina. Percutaneous coronary interventions on a symptom-affected artery at a single procedure were performed in 213 cases (48%), indications for coronary artery bypass grafting were identified in 182 patients (41%), and only in 52 cases (11%) the treatment was limited to medicinal therapy. Coronary angiography performed in the initial 12–48 hours makes it possible to identify the indications to myocardial revascularization, to avoid inconsistencies in the choice of optimal treatment tactics and non-invasive risk assessment.

scholarly journals Deterioration of Regional Wall Motion Immediately after Coronary Artery Bypass Graft Surgery Is Associated with Long-term Major Adverse Cardiac Events

2007 ◽  
Vol 107 (5) ◽  
pp. 739-745 ◽  
Author(s):  
Madhav Swaminathan ◽  
Richard W. Morris ◽  
Daniel D. De Meyts ◽  
Mihai V. Podgoreanu ◽  
James G. Jollis ◽  
...  
Keyword(s):  
Wall Motion ◽  
Primary Outcome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Regional Wall Motion ◽  
Cardiac Events ◽  
Cabg Surgery ◽  
Adverse Cardiac Events

Background Patients undergoing coronary artery bypass graft (CABG) surgery frequently develop wall motion abnormalities diagnosed by intraoperative transesophageal echocardiography. However, the relation between deterioration in wall motion and postoperative morbidity or mortality is unclear. Therefore, the authors hypothesized that deterioration in intraoperative left ventricular regional wall motion immediately after CABG surgery is associated with a higher risk of adverse cardiac events. Methods With institutional review board approval, data were gathered from 1,412 CABG surgery patients. Echocardiographic wall motion score (WMS) was derived using a 16-segment model. Outcomes data were gathered for up to 2 yr after surgery. The primary outcome, major adverse cardiac event, was a composite index of myocardial infarction, need for subsequent coronary revascularization, or all-cause mortality during the follow-up period. Results Two hundred twenty-one patients (16%) had 254 primary outcome events during follow-up. Postbypass WMS did not change in 812 patients (58%), deteriorated in 219 patients (16%), and improved in 368 patients (26%). Kaplan-Meier analysis showed that patients with deterioration in WMS after CABG experienced significantly lower major adverse cardiac event-free survival than patients with either no change or improvement in WMS (P = 0.004). Cox proportional hazards regression modeling revealed a significant association between deterioration in WMS and the composite adverse outcome (hazard ratio, 1.47 [1.06-2.03]; P = 0.02). Conclusions The authors confirmed their hypothesis that deterioration in wall motion detected by intraoperative echocardiography after CABG surgery is associated with increased risk of long-term adverse cardiac morbidity. Worsening wall motion after CABG surgery should be considered a prognostic indicator of adverse cardiovascular outcome.

Sign in / Sign up

Export Citation Format

Share Document