Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis

Vascular ◽  
2020 ◽  
Vol 28 (6) ◽  
pp. 808-815
Author(s):  
Andreas Tzoumas ◽  
Stefanos Giannopoulos ◽  
Nektarios Charisis ◽  
Pavlos Texakalidis ◽  
Damianos G Kokkinidis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Coronary Artery Bypass Graft ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Artery Disease

Background Coronary artery disease requiring coronary artery bypass graft (CABG) frequently coexists with critical carotid stenosis. The most optimized strategy for treating concomitant carotid and coronary artery disease remains debatable. Objective The aim of this meta-analysis was to compare synchronous CAS and CABG versus staged CAS and CABG for patients with concomitant coronary artery disease and carotid artery stenosis in terms of peri-operative (30-day) and long-term clinical outcomes. Methods This study was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane database until December 2019. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity. Results Four studies comprising 357 patients were included in this meta-analysis. Patients who were treated with the synchronous approach had a statistically significant higher risk for peri-operative stoke (OR: 3.71; 95% CI: 1.00–13.69; I2 = 0%) compared tο the staged group. Peri-operative mortality (OR: 4.50; 95% CI: 0.88–23.01; I2 = 0%), myocardial infarction (MI) (OR: 1.54; 95% CI: 0.18– 13.09; I2 = 0%), postoperative bleeding (OR: 0.27;95% CI: 0.02–3.12; I2 = 0%), transient ischemic attacks (TIA) (OR: 0.60; 95% CI: 0.04– 9.20; I2 = 0.0%), acute kidney injury (AKI) (OR: 0.34; 95% CI: 0.03–4.03; I2 = 0.0%) and atrial fibrillation rates (OR:0.27; 95% CI: 0.02–3.12; I2 = 0.0%) were similar between the two groups. Synchronous CAS-CABG and staged CAS followed by CABG were associated with similar rates of late mortality (OR: 3.75; 95% CI: 0.50–27.94; I2 = 0.0%), MI (OR: 0.33; 95% CI: 0.01–12.03; I2 = 0.0%) and stroke (OR:3.58; 95% CI:0.84–15.20; I2 = 0.0%) after a mean follow-up of 47 months. Conclusion The simultaneous approach was associated with an increased risk of 30-day stroke compared to staged CAS and CABG. However, no statistically significant difference was found in long-term results of mortality, MI and stroke between the two approaches. Future studies are warranted to validate our results.

Postoperative complications associated with coronary artery bypass graft surgery and their therapeutic interventions

2020 ◽  
Vol 16 (5) ◽  
pp. 481-496 ◽  
Author(s):  
Ali Pooria ◽  
Afsoun Pourya ◽  
Alireza Gheini
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Adverse Events ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Wide Range ◽  
Artery Disease

Coronary artery disease is one of the commonest surgery demanding cardiovascular diseases. Coronary artery bypass graft surgery is practiced all over the world for the treatment of coronary artery disease. Systemic trauma during the surgery is associated with a wide range of complications, some of which are fatal. Preoperative risk factors such as age, previous illness and obesity are common predictors of these adverse events. Advances in therapeutic medicine have allowed timely treatment of these adverse events and co-morbidities. This review summarizes some of the most occurring complications associated with coronary artery bypass graft and corresponding treatment options.

SYNTAX score and coronary artery bypass graft surgery in Bangladesh

2019 ◽  
Vol 27 (7) ◽  
pp. 542-547
Author(s):  
Redoy Ranjan ◽  
Asit Baran Adhikary
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Syntax Score ◽  
Artery Bypass Graft ◽  
Artery Disease

Background The SYNTAX score is a helpful tool for determining the optimal myocardial revascularization strategy in complex coronary artery disease. The aim of this study was to assess whether the SYNTAX score predicts postoperative mortality in patients undergoing coronary artery bypass grafting. Methods The study included 1100 consecutive patients referred for coronary artery bypass graft surgery over a 4-year period. Angiographic data were interpreted by both experienced intervention cardiologists and cardiac surgeons. The patients were divided into three groups based on SYNTAX score tertiles: low ≤22 ( n =  560), intermediate 23–32 ( n =  360), and high ≥33 ( n =  180). Results Compared to patients with a low SYNTAX score, those with intermediate and high scores were significantly older ( p <  0.001), had a lower left ventricular ejection fraction ( p <  0.001), higher pulmonary artery pressure ( p <  0.001), and higher incidences of acute coronary syndrome and left main coronary artery disease. A significantly higher EuroSCORE ( p =  0.003) was also observed in patients with a higher SYNTAX score. Patients with intermediate and high SYNTAX scores had higher 5-year mortality rates (18.6% and 19.5%, respectively) than patients with low SYNTAX scores (9.5%, p <  0.05). In multivariate analysis, SYNTAX score was not an independent predictor of late mortality. Conclusion Although SYNTAX score is not independently predictive of late mortality in patients with complex coronary artery disease undergoing myocardial revascularization surgery, patients with lower SYNTAX scores had a lower mortality rate after coronary artery bypass graft surgery.

scholarly journals Different expression of Micro RNA-126, 133a and 145 in aorta and saphenous vein samples of patients undergoing coronary artery bypass graft surgery

2019 ◽  
Vol 11 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Ahmadreza Jodati ◽  
Seyed Mohammadbagher Pirouzpanah ◽  
Nazila Fathi Maroufi ◽  
Masoud Pezeshkian ◽  
Naser Safaie ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Saphenous Vein ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Artery Disease

Introduction: microRNAs (miRNAs) are highly conserved, noncoding RNA molecules that regulate gene expression on the post-transcriptional level. Some evidence indicates that microRNAs dysfunction plays a crucial role in human disease development. The role of microRNAs in cardiac growth, hypertrophy, heart failure, cardiovascular complications in diabetes and many other hearth conditions are demonstrated. In this study we aimed to evaluate the expression of six microRNAs (mir-100, mir-126, mir-127, mir-133a, mir-133b and mir-145) that have been shown to overexpress in aortic and carotid plaques. Methods: Thirty Coronary Artery Disease patients who underwent elective coronary artery bypass graft surgery were enrolled in the study. The expression patterns of six miRNAs (mir-100, mir-126, mir-127, mir-133a, mir-133b, and mir-145) were examined in 30 patients of whom we obtained aorta and saphenous vein samples. Results: In three miRNAs, mir-100, mir-127 and mir-133b, we did not obtain expression data from real-time experiments. We found that the expression level of mir-126, mir-133a and mir145 were lower in aorta in comparison with saphenous vein. Mir-126 was highly expressed in saphenous vein samples (13.8±1.1) when compared with aorta samples (20.2±1.1), although mir133a was highly expressed in saphenous vein samples (16.1±0.5) when compared with the aorta (17.9±1.5). Expression of mir-145 saphenous vein samples was also dramatically higher than aorta (7.2±0.5 versus 10.8±0.6) that was statistically significant (P<0.05). Conclusion: Understanding the role of miRNAs in cardiovascular physiology and diseases might suggest miRNA- based therapeutic methods in the management of coronary artery disease.

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