scholarly journals Minimally Invasive CABG or Hybrid Coronary Revascularization for Multivessel Coronary Diseases: Which Is Best? A Systematic Review and Metaanalysis

2019 ◽  
Vol 22 (6) ◽  
pp. E493-E502
Author(s):  
Zhiyuan Guan ◽  
Zhe Zhang ◽  
Kaiyun Gu ◽  
Heqing Wang ◽  
Jin Lin ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Variable Cost ◽  
Bypass Grafting ◽  
Chest Drainage ◽  
Term Survival ◽  
Total Variable Cost ◽  
Hybrid Coronary Revascularization

Objectives: Minimally invasive coronary revascularization (MICR) involves minimally invasive direct coronary artery bypass grafting (MIDCAB) and robotic-assisted coronary artery bypass grafting (RCABG), and hybrid coronary revascularization (HCR) aims to combine MICR/RCABG on left anterior descending (LAD) and percutaneous coronary interventions (PCI) on non-LAD lesions. We performed a systematic review and metaanalysis to compare clinical outcome after MICR and HCR. Methods: A metaanalysis was carried out through searching PubMed, EMBASE, Web of Science, and Medline for comparative studies evaluating the primary and secondary clinical end points. Results: A systematic literature search identified 8 observational studies that satisfied our inclusion criteria, including being suitable for metaanalysis; the studies were between 1990 and 2018 and included 1084 cases of HCR and 2349 cases of MICR. Metaanalysis of these studies showed that HCR was associated with a reduced need for ICU LOS (WMD –11.46 hours, 95% CI, –18.76 ~ –4.25, P = .02), to hospital time (WMD –1.34 hours, 95% CI, –2.42 to 0.26, P < .01), and blood transfusion (OR 0.43, 95% CI, 0.31-0.59, P < .00001) than MICR. Comparisons of individual components showed no significant difference in terms of in-hospital mortality, MACCE, shock, myocardial infarction (MI), long-term survival, total variable cost, and surgical complications (including renal failure, chest drainage, bleeding). Conclusions: HCR was noninferior to MICR in terms of in-hospital mortality, MACCE, shock, MI, long-term survival, total variable cost, and surgical complications (including renal failure, chest drainage, bleeding), whereas HCR was associated with a reduced need for ICU LOS, hospital time, and blood transfusion than MICR and less infection than MICR. Further randomized studies are warranted to corroborate these observational data.

scholarly journals Short-term clinical outcomes and long-term survival of minimally invasive direct coronary artery bypass grafting

2018 ◽  
Vol 7 (5) ◽  
pp. 621-627 ◽  
Author(s):  
Shahzad G. Raja ◽  
Sheena Garg ◽  
Melissa Rochon ◽  
Siobhan Daley ◽  
Fabio De Robertis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Short Term ◽  
Term Survival

scholarly journals Incidence, Predictors, and Impact of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting in Military Veterans

2016 ◽  
Vol 43 (5) ◽  
pp. 397-403 ◽  
Author(s):  
Shuab Omer ◽  
Lorraine D. Cornwell ◽  
Ankur Bakshi ◽  
Eric Rachlin ◽  
Ourania Preventza ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Military Veterans ◽  
Survival Rates ◽  
Postoperative Atrial Fibrillation ◽  
Bypass Grafting ◽  
Term Survival ◽  
Long Term Survival

Little is known about the frequency and clinical implications of postoperative atrial fibrillation in military veterans who undergo coronary artery bypass grafting (CABG). We examined long-term survival data, clinical outcomes, and associated risk factors in this population. We retrospectively reviewed baseline, intraoperative, and postoperative data from 1,248 consecutive patients with similar baseline risk profiles who underwent primary isolated CABG at a Veterans Affairs hospital from October 2006 through March 2013. Multivariable logistic regression identified predictors of postoperative atrial fibrillation. Kaplan-Meier analysis was used to evaluate long-term survival (the primary outcome measure), morbidity, and length of hospital stay. Postoperative atrial fibrillation occurred in 215 patients (17.2%). Independent predictors of this sequela were age ≥65 years (odds ratios [95% confidence intervals], 1.7 [1.3–2.4] for patients of age 65–75 yr and 2.6 [1.4–4.8] for patients &gt;75 yr) and body mass index ≥30 kg/m2 (2.0 [1.2–3.2]). Length of stay was longer for patients with postoperative atrial fibrillation than for those without (12.7 ± 6.6 vs 10.3 ± 8.9 d; P ≤0.0001), and the respective 30-day mortality rate was higher (1.9% vs 0.4%; P=0.014). Seven-year survival rates did not differ significantly. Older and obese patients are particularly at risk of postoperative atrial fibrillation after CABG. Patients who develop the sequela have longer hospital stays than, but similar long-term survival rates to, patients who do not.

Coronary Artery Bypass Grafting using Bilateral Internal Thoracic Arteries through a Left-Sided Minithoracotomy: A Single-Center Starting Experience

2018 ◽  
Vol 67 (06) ◽  
pp. 437-443 ◽  
Author(s):  
Mahmoud Diab ◽  
Gloria Färber ◽  
Christoph Sponholz ◽  
Raphael Tasar ◽  
Thomas Lehmann ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Term Survival ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Sf 36

Abstract Background Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) is associated with the best long-term survival. However, using BITA increases the risk of sternal wound infections with conventional sternotomy. We describe here our initial results of minimally invasive CABG (MICS-CABG) using BITA. Methods Patients were operated through an incision similar to that of standard minimally invasive direct CABG. All operations were performed off-pump. We evaluated patient's quality of life (QoL) using the Medical Outcomes trust, 36-Item Short Form Health Survey (SF-36). Results Between February 2016 and August 2017, we performed 21 cases of MICS-CABG using BITA. There was no intraoperative complication and no conversion to sternotomy or to on-pump. Two patients required reexploration through the same minithoracotomy for postoperative bleeding. Two cases of early postoperative graft failure were identified. There was no stroke or in-hospital mortality. The median duration of follow-up was 13 months, with a maximum of 19 months. Relief of angina was achieved in all patients. There was one readmission for superficial wound infection, which was conservatively treated. An 84-year-old man died 4 months after the operation. The remaining 20 patients attested good QoL with the SF-36 questionnaire. Conclusions Myocardial revascularization using BITA can be safely achieved off-pump through a left-sided minithoracotomy with good postoperative and short-term outcomes.

Abstract 14484: The Association of Pre-operative Glycemic Control With Long-term Survival in Diabetic Patients After Coronary Artery Bypass Grafting

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Muhammad Sheikh ◽  
Salil V Deo ◽  
Varun Sundaram ◽  
Brigid Wilson ◽  
Jayakumar Sahadevan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Diabetic Patients ◽  
Bypass Grafting ◽  
Term Survival ◽  
Long Term Survival ◽  
Group Iii ◽  
Insulin Dependence

Introduction: We analyzed the national Veteran Affairs (VA) data to evaluate the association of preoperative glycated Hemoglobin (HbA1c) and long-term outcome after isolated coronary artery bypass grafting (CABG). Methods: Between January 2007 - December 2014, Veterans with diabetes mellitus (DM) that underwent isolated CABG were divided on into three groups (I: HbA1c < 8%, II: HbA1c 8 - 10% and III: HbA1c > 10%). Demographic and clinical differences between groups were evaluated with the t-test or chi-square test. The relationship of preoperative HbA1c and long-term survival was evaluated with a multivariable proportional hazards model; restricted cubic splines were used to model non-linear effects. The cumulative incidence of secondary end-points (myocardial infarction, urgent revascularization) for each group was modeled as a competing-risk analysis. Results: Overall, 3,210 patients (mean age 64.6 years, male 98.8%; insulin dependent - 53%) with DM underwent isolated CABG. Group III patients were younger (61 vs 65 years in group I). Median HbA1c levels were similar between races (white - 7.3% and blacks - 7.35%). Insulin dependence was higher in group III (79.3%) vs groups I (43.5%) and II (69.9%). In groups I,II and III, 5 and 10 year survival was 76.2%, 74.4%, 75.4% and 38.9%, 36.9% and 30.2% respectively. HbA1c was observed to have a J-shaped association with mortality with values < 6% and > 9% at higher risk of death. Left ventricular systolic dysfunction [HR 1.5 (1.3 - 1.7)], prior myocardial infarction [HR 1.3 (1.2 - 1.5)] and insulin dependence [HR 1.4 (1.2 - 1.5)] were also associated with lower survival. Myocardial infarction was observed in 9.8% , 13.4% and 12.8% patients in groups I, II and III respectively. Conclusions: Pre-operative HbA1c impacts long-term survival among diabetic patients undergoing CABG. We observed a J-shaped relationship between HbA1c and survival with values < 6% and > 9% associated with increased mortality.

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