scholarly journals Early and late outcomes of combined and staged surgeries in patients with concomitant atherosclerotic lesions of the coronary and brachiocephalic arteries

2022 ◽  
Vol 36 (4) ◽  
pp. 107-119
Author(s):  
A. V. Marchenko ◽  
A. S. Vronskiy ◽  
P. A. Myalyuk ◽  
R. N. Chebykin ◽  
V. N. Minasyan ◽  
...  
Keyword(s):  
Cardiovascular Surgery ◽  
Artery Bypass ◽  
Late Results ◽  
Early Postoperative Period ◽  
Long Term Results ◽  
Atherosclerotic Lesions ◽  
Cerebrovascular Events ◽  
Brachiocephalic Arteries ◽  
Federal Center

Objective. To study the early and late outcomes of surgical treatment of patients with concomitant atherosclerotic lesions of coronary and brachiocephalic arteries while choosing a treatment strategy based on the developed diff erentiated approach algorithm.Material and Methods. The study comprised 243 patients with combined atherosclerotic lesions of the coronary and carotid arteries examined during the period from 01.07.2014 to 01.01.2021. Patients underwent revascularization surgeries based on the algorithm for choosing the volume and stages of surgical intervention, which was previously developed in the Federal Center for Cardiovascular Surgery named after S.G. Sukhanov. A single-stage combined surgery of coronary artery bypass grafting (CABG) and carotid endarterectomy (CEE) was performed in 104 patients (42.8%); 139 patients (57.2%) received staged revascularization including 102 patients (73.4%) who received CABG as the fi rst step and 37 patients (26.6%) who received CEE as the fi rst step of surgery. The endpoints for both early and late results were death from all causes, stroke, transient ischemic attack (TIA), acute myocardial infarction (AMI), and combined endpoint that included all of the above. Average follow-up time was 41.1 ± 21.8 months.Results. No fatal outcomes were in any group during the early postoperative period. At the hospital stage, there were 5 cases (2.1%) of stroke, 1 case (0.4%) of TIA, and 3 cases (1.2%) of acute MI. Long-term results were evaluated in 225 patients (92.3%). The overall survival rate was 93.8%. There were 5 cases (2.4%) of MI, 11 cases (4.9%) of stroke, and 1 case (1.0%) of TIA. No signifi cant diff erences were observed in immediate and long-term endpoints between the groups of staged and combined interventions as compared to immediate (AMI: p = 0.680; TIA: p = 0.500; acute cerebrovascular events: p = 0.567; combined: p = 0.940) and long-term results (deaths: 0.860; AMI: p = 0.906; TIA: p = 0.528; acute cerebrovascular events: p = 0.378; combined: p = 0.669).Conclusion. Based on successful experience with treating the concomitant atherosclerotic lesions of the coronary and brachiocephalic arteries, the proposed algorithm allowed to perform safe procedures in both arterial basins and to achieve satisfactory results in in-hospital and long-term periods in the Federal Center for Cardiovascular Surgery named after S.G. Sukhanov (Perm).

Early and long-term results of coronary artery bypass grafting in dialysis patients

2000 ◽  
Vol 70 (3) ◽  
pp. 813-818 ◽  
Author(s):  
Dion L Franga ◽  
John M Kratz ◽  
A.Jackson Crumbley ◽  
James L Zellner ◽  
Martha R Stroud ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Results ◽  
Bypass Grafting ◽  
Dialysis Patients ◽  
Artery Bypass Grafting

scholarly journals The effect of coronary stent type on the long-term results of coronary artery bypass surgery after stenting clinically related artery in acute coronary syndrome in patients with multivessel coronary artery disease

2019 ◽  
Vol 34 (3) ◽  
pp. 144-152
Author(s):  
A. V. Bocharov ◽  
L. V. Popov
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Stents ◽  
Long Term Results ◽  
Bare Metal ◽  
Coronary Syndrome

Justification. The results of endovascular revascularization are largely determined by the type of stents used. The use of baremetal coronary stents significantly worsens the long-term results of endovascular treatment of coronary artery disease. Given the widespread use of bare-metal coronary stents in the Russian Federation for the treatment of coronary artery disease and acute coronary syndrome, in particular, the issue of the impact of the above-mentioned endovascular interventions on the long-term results of coronary artery bypass grafting (CABG) performed after endovascular revascularization of the clinically related artery in patients with acute coronary syndrome and multivessel lesions does not lose relevance.Aim. To compare the long-term results of the staged strategies of revascularization of the coronary bed: CABG performed after stenting the clinically related artery with third-generation biodegradable polymer-based sirolimus-eluting stents for acute coronary syndrome and CABG performed after stenting the clinically related artery with bare-metal coronary stents for acute coronary syndrome.Material and Methods. The analysis used the data of two-year follow-up of patients who underwent two-stage revascularization: at the first stage, patients received stenting of the clinically related artery for acute coronary syndrome and, at the second stage, they received coronary artery bypass grafting no later than 90 days from the date of stenting. The study included 218 patients with multivessel lesions of the coronary bed, admitted with clinical manifestation of acute coronary syndrome. The long-term follow-up period was 24 months. The following end points were analyzed: cardiovascular mortality, myocardial infarction, re-revascularization, and combined MACCE end point (cardiovascular mortality, myocardial infarction, acute cerebrovascular accident, and re-revascularization). The observation was carried out at the hospital stage and, then, on an outpatient basis once every three months.Results. There were no significant differences between the groups. The frequency of repeated revascularization, including repeated revascularization of the stented artery, and recurrence of angina were significantly higher in the group with baremetal coronary stents. There were no significant differences between the groups in regard to cardiovascular mortality, nonfatal myocardial infarction and acute cerebrovascular accidents. The frequency of MACCE events was significantly higher in the group of bare-metal coronary stents, mainly due to the frequency of repeated revascularizations.Conclusion. Coronary artery bypass grafting performed in the early period after stenting of the clinically related artery using bare-metal coronary stents in patients with acute coronary syndrome and multivessel lesions was associated with a significantly larger number of repeated coronary revascularizations and higher rate of recurrent angina compared to a similar strategy, but with the use of modern third-generation biodegradable polymer-based sirolimus-eluting stents.

scholarly journals Mid-term and long-term results of off-pump coronary artery bypass grafting for patients with left main disease

2015 ◽  
Vol 21 (3) ◽  
pp. 179-184
Author(s):  
Tomohiro Mizuno ◽  
Keishi Oi ◽  
Masafumi Yashima ◽  
Tsuyoshi Hachimaru ◽  
Daiju Watanabe ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Long Term Results ◽  
Bypass Grafting ◽  
Left Main ◽  
Left Main Disease ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

scholarly journals Effect of preoperative atrial fibrillation on long-term results after Off Pump Coronary Artery Bypass

2021 ◽  
Vol 38 (6) ◽  
pp. 5-15
Author(s):  
Soslan T. Enginoev ◽  
Dmitriy A. Kondratiev ◽  
Gasan M. Magomedov ◽  
Tamara K. Rashidova ◽  
Bakytbek K. Kadyraliev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Results ◽  
Off Pump ◽  
Group I ◽  
Pump Coronary Artery Bypass

Objective. To study the effect of preoperative atrial fibrillation (AF) on the risk of stroke and long-term mortality after Off Pump Coronary Artery Bypass (OPCAB). Materials and methods. A retrospective analysis of the results of OPCAB in 212 patients with coronary artery disease (CAD), who were operated on from May 2009 to November 2013, was carried out. After propensity score matching, patients were divided into 2 groups: Group I 82 patients with sinus rhythm (SR) before surgery, Group II (control) 102 patients with AF before surgery. The average age of the included patients was 61 6.7 years, with 95 % CI: 6062. Fifty-four (29.3 %) patients were over 65 years of age. There were 162 men (88 %) and 22 women (12 %). The median follow-up was 93.5 (66.7102.0) months. Results. The time spent in the clinic was statistically significantly shorter in the SR group than in the AF group (10 (911) and 14 (1116) hours, respectively, p 0.001). There was no statistically significant difference in the number of perioperative myocardial infarctions (in the group with SR it occurred in 1 (1.2 %) patient, in the group with AF 2 (2 %), p = 0.7), strokes (in the group with SR 1 (1.2 %), in the group with AF 3 (2.9 %), p = 0.6), as well as a 30-day mortality (in the group with SR it was 0 %, in the group with AF 3 (2.9 %), p = 0.2). In the long-term postoperative period, there were statistically significantly fewer strokes in the group with SR than in the group with AF (in the group with SR, the 10-year stroke freedom was 88.8 %, and in the group with AF 71.8 %, p = 0.018), and also better long-term survival in the group with sinus rhythm (in the group with SR, the 10-year survival rate was 79 %, in the group with AF 63.9 %, p = 0.016). Conclusions. In the group with preoperative AF, the frequency of distant strokes and deaths is higher than in patients with sinus rhythm.

scholarly journals Long-term outcomes after coronary artery bypass surgery in patients with diabetes

2020 ◽  
Vol 30 (5) ◽  
pp. 685-690
Author(s):  
Tomas Andri Axelsson ◽  
Jonas A Adalsteinsson ◽  
Linda O Arnadottir ◽  
Dadi Helgason ◽  
Hera Johannesdottir ◽  
...  
Keyword(s):  
Overall Survival ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Outcomes ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Patients With Diabetes

Abstract OBJECTIVES Our aim was to investigate the outcome of patients with diabetes undergoing coronary artery bypass grafting (CABG) surgery in a whole population with main focus on long-term mortality and complications. METHODS This was a nationwide retrospective analysis of all patients who underwent isolated primary CABG in Iceland between 2001 and 2016. Overall survival together with the composite end point of major adverse cardiac and cerebrovascular events was compared between patients with diabetes and patients without diabetes during a median follow-up of 8.5 years. Multivariable regression analyses were used to evaluate the impact of diabetes on both short- and long-term outcomes. RESULTS Of a total of 2060 patients, 356 (17%) patients had diabetes. Patients with diabetes had a higher body mass index (29.9 vs 27.9 kg/m2) and more often had hypertension (83% vs 62%) and chronic kidney disease (estimated glomerular filtration rate ≤60 ml/min/1.73 m2, 21% vs 14%). Patients with diabetes had an increased risk of operative mortality [odds ratio 2.52, 95% confidence interval (CI) 1.27–4.80] when adjusted for confounders. 5-Year overall survival (85% vs 91%, P < 0.001) and 5-year freedom from major adverse cardiac and cerebrovascular events were also inferior for patients with diabetes (77% vs 82%, P < 0.001). Cox regression analysis adjusting for potential confounders showed that the diagnosis of diabetes significantly predicted all-cause mortality [hazard ratio (HR) 1.87, 95% CI 1.53–2.29] and increased risk of major adverse cardiac and cerebrovascular events (HR 1.47, 95% CI 1.23–1.75). CONCLUSIONS Patients with diabetes have significantly lower survival after CABG, both within 30 days and during long-term follow-up.

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