scholarly journals Robotic Hybrid Coronary Revascularization - a need for strategy specific data.

2021 ◽  
Author(s):  
Pradeep Narayan ◽  
Gianni Angelini
Keyword(s):  
Coronary Revascularization ◽  
Entire Group ◽  
Long Term Outcomes ◽  
Surgical Revascularization ◽  
Specific Data ◽  
Endoscopic Techniques ◽  
Surgical Incisions ◽  
Hybrid Coronary Revascularization ◽  
Definition Of

Robotic totally endoscopic techniques to perform the LITA to LAD graft, coupled with PCI, provides the least invasive option to achieve hybrid coronary revascularization (HCR). Shorter hospital stay and reduced need for blood transfusions have been consistently being reported by several studies along with similar long-term outcomes. Considerable variations exist in the definition of HCR which can be single or two-staged with surgical revascularization being carried out after PCI or vice versa. Variations also exist with respect to usage of cardiopulmonary bypass, surgical incisions, and use of minimally invasive robotic techniques. The different strategies of HCR do not lead to similar outcomes and the findings of one strategy cannot be extrapolated to the entire group. Studies reporting different strategies of HCR, should ideally provide more granular data when reporting outcomes.

scholarly journals Complete surgical revascularization: different definitions, same impact?

2021 ◽  
Author(s):  
Paulo Oliveira ◽  
Márcio Madeira ◽  
Sara Ranchordas ◽  
Marta Marques ◽  
Manuel Almeida ◽  
...  
Keyword(s):  
Coronary Revascularization ◽  
Myocardial Scintigraphy ◽  
Complete Revascularization ◽  
Long Term Outcomes ◽  
Surgical Revascularization ◽  
Multivariable Analyses ◽  
Definition Of ◽  
Long Term Mortality

Abstract Objectives: There are several different definitions of complete revascularization on coronary surgery across the literature. Despite the importance of this definition there is no agreement on which one has the most impact. The aim of this study was to evaluate which definition of complete surgical revascularization correlates with early and late outcomes. Methods: All consecutive patients submitted to isolated CABG from 2012 to 2016 with previous myocardial scintigraphy were evaluated. Exclusion criteria: emergent procedures and previous cardiac surgery procedures. Population of 162 patients, follow-up complete in 100% patients; median 5,5 IQR 4,4-6,9 years. Each and all of the 162 patients were classified as complying or not with the four different definitions: Numerical, Functional, Anatomical Conditional and Anatomical unconditional. Univariable and multivariable analyses were developed to detect if any definition was a predictor of perioperative and long-term outcomes. Results: Complete functional revascularization was a predictor of increased survival (HR 0.47 CI95: 0,226-0,969; p=0.041). No other definitions showed effect on follow-up mortality. Age and cardiac dysfunction increased long-term mortality. The definition of complete revascularization did not have an impact on MACCE or need for revascularization Conclusions: An uniformly accepted definition of complete coronary revascularization is lacking. This research raises awareness about the importance of viability guidance for CABG.

scholarly journals PREDICTORS OF LONG–TERM OUTCOMES IN HYBRID CORONARY REVASCULARIZATION

2013 ◽  
Vol 61 (10) ◽  
pp. E1703
Author(s):  
Mark R. Vesely ◽  
Eric Lehr ◽  
Nikolaos Bonaros ◽  
Thomas Schachner ◽  
Guy Friedrich ◽  
...  
Keyword(s):  
Coronary Revascularization ◽  
Long Term Outcomes ◽  
Hybrid Coronary Revascularization

scholarly journals Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease

2021 ◽  
Author(s):  
Rutao Wang ◽  
Scot Garg ◽  
Chao Gao ◽  
Hideyuki Kawashima ◽  
Masafumi Ono ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Revascularization ◽  
Long Term Outcomes ◽  
Vital Status ◽  
Increased Risk ◽  
Artery Disease ◽  
The Impact

Abstract Aims To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Methods The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Results Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08–1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83–1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in ≥ 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11–4.23, p < 0.001) compared to those without CVD. Conclusions The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization. Trial registration SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract

Anoxic Brain Injury

2018 ◽  
pp. 58-67
Author(s):  
Jonathan Elmer ◽  
Jon C. Rittenberger
Keyword(s):  
Cardiac Arrest ◽  
Best Practice ◽  
Coronary Revascularization ◽  
Temperature Management ◽  
Long Term Outcomes ◽  
Initial Management ◽  
Short And Long Term ◽  
Patterns Of Injury ◽  
Active Temperature

Cardiac arrest is common and deadly. Fortunately, with advances in care, short- and long-term outcomes of those resuscitated after cardiac arrest are steadily improving. Initial management focuses on general critical care support of multisystem organ dysfunction and diagnostic workup to identify the etiology of cardiac arrest. Thereafter, provision of a comprehensive bundle of care including active temperature management, coronary revascularization, delayed multimodal neurological prognostication, and best practice neurocritical care can result in a substantial proportion of patients experiencing favorable recovery despite patterns of injury once thought to be incompatible with survival.

scholarly journals CHA2DS2-VAS-HSF Score as a Predictor for Contrast- Induced Nephropathy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

2019 ◽  
Vol 39 (2) ◽  
Author(s):  
Herman William Parlindungan ◽  
Refli Hasan ◽  
Cut Aryla Andra ◽  
Nizam Zikri Akbar ◽  
Ali Nafiah Nasution ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Serum Creatinine ◽  
Coronary Revascularization ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Contrast Induced Nephropathy ◽  
Coronary Syndrome ◽  
Major Cardiovascular Events ◽  
Percutaneous Coronary

Background: Contrast-Induced Nephropathy (CIN) is a serious problem that can be found in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). The development of CIN in hospitalized patients even with coronary revascularization can immediately increase morbidity and mortality both during treatment and long-term outcomes. In a recent study, a CHA2DS2-VASC-HSF score was reported to predict coronary artery severity and major cardiovascular events (MACE) as well as CIN in AMI patients without atrial fibrillation. The purpose of this study was to investigate the CHA2DS2-VASC score as a predictor of CIN in AMI patients undergoing PCI procedures. Methods: This study was an ambispective cohort study of 53 AMI patients who were treated at cardiac care and underwent PCI procedures. The CHA2DS2-VASC-HSF score was calculated for each patient. From this study found 14 cases (26.4%) with a total CIN prevalence of 16.83%. CIN is defined as an increase in serum creatinine> 0.5 mg / dL or an increase in serum creatinine> 25% from baseline within 24 hours post PCI. Results: Through the analysis of the ROC curve, we established the CHA2DS2- VASC-HSF score cut point> 5 as a predictor of CIN with a sensitivity of 78.57% and specificity of 66.6 %% (AUC 0.818, 95%: CI 3.018-6.142, p <0.001). By getting the equation from the linear regression assessment we also found the probability of the occurrence of CIN in accordance with the CHA2DS2-VASC-HSF score. Conclusion: CHA2DS2-VASC score has a positive correlation with CIN. Therefore, this score can be used as a simple scoring system and can predict the incidence of CIN in AMI patients undergoing PCI procedures.

scholarly journals Long-Term Outcomes in Puerto Ricans with Rheumatoid Arthritis (RA) Receiving Early Treatment with Disease-Modifying Anti-Rheumatic Drugs using the American College of Rheumatology Definition of Early RA

2017 ◽  
Vol 11 (1) ◽  
pp. 136-144
Author(s):  
Noemí Varela-Rosario ◽  
Mariangelí Arroyo-Ávila ◽  
Ruth M. Fred-Jiménez ◽  
Leyda M. Díaz-Correa ◽  
Naydi Pérez-Ríos ◽  
...  
Keyword(s):  
Early Treatment ◽  
Puerto Ricans ◽  
Long Term Outcomes ◽  
Physical Damage ◽  
Early Ra ◽  
American College Of Rheumatology ◽  
The Mean ◽  
Disease Modifying ◽  
Definition Of

Background: Early treatment of rheumatoid arthritis (RA) results in better long-term outcomes. However, the optimal therapeutic window has not been clearly established. Objective: To determine the clinical outcome of Puerto Ricans with RA receiving early treatment with conventional and/or biologic disease-modifying anti-rheumatic drugs (DMARDs) based on the American College of Rheumatology (ACR) definition of early RA. Methods: A cross-sectional study was performed in a cohort of Puerto Ricans with RA. Demographic features, clinical manifestations, disease activity, functional status, and pharmacotherapy were determined. Early treatment was defined as the initiation of DMARDs (conventional and/or biologic) in less than 6 months from the onset of symptoms attributable to RA. Patients who received early (< 6months) and late (≥6 months) treatments were compared using bivariate and multivariate analyses. Results: The cohort comprised 387 RA patients. The mean age at study visit was 56.0 years. The mean disease duration was 14.9 years and 337 (87.0%) patients were women. One hundred and twenty one (31.3%) patients received early treatment. In the multivariate analysis adjusted for age and sex, early treatment was associated with better functional status, lower probability of joint deformities, intra-articular injections and joint replacement surgeries, and lower scores in the physician’s assessments of global health, functional impairment and physical damage of patients. Conclusion: Using the ACR definition of early RA, this group of patients treated with DMARDs within 6 months of disease had better long-term outcomes with less physical damage and functional impairment.

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