scholarly journals RESULTS OF FLOWMETRIC ASSESSMENT OF THE FUNCTION OF AUTOARTERIAL TRANSPLANTS DURING BYPASS SURGERY OF THE LEFT CORONARY ARTERY IN PATIENTS WITH HIGH SURGICAL RISK

2022 ◽  
Vol 14 (4) ◽  
Author(s):  
R.V. SIDOROV ◽  
V.A. SOROKINA ◽  
A.V. BASILEVICH ◽  
D.YU. POSPELOV ◽  
I.F. SHLYK ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Coronary Artery ◽  
Bypass Surgery ◽  
Surgical Risk ◽  
High Surgical Risk

Results of stenting of unprotected left main coronary artery stenosis in patients at high surgical risk

1998 ◽  
Vol 82 (8) ◽  
pp. 975-978 ◽  
Author(s):  
Carma Karam ◽  
Jean Fajadet ◽  
Bernard Cassagneau ◽  
Jean-Pierre Laurent ◽  
Christian Jordan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Left Main ◽  
Surgical Risk ◽  
Main Coronary Artery Stenosis ◽  
High Surgical Risk

Preoperative Use of Intra-Aortic Balloon Pump Support Reduced 30-Day Mortality in a Population with LVEF >35% and High Surgical Risk after Coronary Artery Bypass Graft Surgery

Cardiology ◽  
2020 ◽  
Vol 145 (5) ◽  
pp. 267-274 ◽  
Author(s):  
Héctor Hugo Escutia-Cuevas ◽  
Juan Antonio Suárez-Cuenca ◽  
Manuel Armando Espinoza-Rueda ◽  
Lecsy Macedo-Calvillo ◽  
Armando Castro-Gutiérrez ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ventricular Function ◽  
Coronary Artery Bypass ◽  
Mortality Risk ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Surgical Risk ◽  
Intra Aortic Balloon Pump ◽  
High Surgical Risk

Introduction: The intra-aortic balloon pump (IABP) is used to prevent complications after coronary artery bypass grafting (CABG) surgery, although some results are controversial and basal ventricular function may play a role. This study assessed the benefit of preoperative use of IABP, as stratified by the ventricular function, in a population submitted to high-surgical-risk CABG. Methods: Patients >18 years old, with multiple coronary artery disease and thus candidates for CABG, were included. Cardiogenic shock, acute myocardial infarction (AMI), acute ventricle mechanical dysfunction, severe aortic regurgitation, tachyarrhythmia, massive pulmonary embolism, coagulopathy, or low life expectancy were exclusion criteria. Results: One hundred and twenty-nine patients aged 65 years old with hypertension, dyslipidemia, type 2 diabetes mellitus, and mean left ventricular ejection fraction (LVEF) 46% constituted the study population. No difference was observed at 30-day mortality endpoint (IABP vs. no IABP, 17 vs. 24%, OR 0.63, p = 0.20; AMI 25 vs. 31%, OR 0.75, p = 0.29). After LVEF stratification, the subgroup of 48 (75%) patients under IABP support and LVEF >35% had a reduced 30-day mortality risk (LVEF ≤35% vs. LVEF >35%, 37.5 vs. 10.4%, OR 0.3, p = 0.03), independently from potential confounders and showing an interaction with European System for Cardiac Operative Risk Evaluation-II (EuroSCORE-II). At secondary endpoints, IABP use was associated with a lower prevalence of acute renal failure and renal replacement therapy, but with a longer stay in the intensive care unit and longer hospitalization time. Conclusion: The preoperative use of IABP was associated with an independent reduction of 30-day mortality risk in cases with LVEF >35% in a population submitted to high-surgical-risk CABG. Likewise, the use of IABP was associated with a lower risk of postoperative renal complications.

Abstract 13513: MitraClip ® for Functional Mitral Regurgitation: Outcomes in Over 600 Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Gorav Ailawadi ◽  
D. Scott Lim ◽  
Irving L Kron ◽  
Alfredo Trento ◽  
Saibal Kar ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Mitral Regurgitation ◽  
Nyha Class ◽  
Class I ◽  
Symptom Improvement ◽  
Surgical Risk ◽  
High Risk Patients ◽  
High Surgical Risk ◽  
Risk Patients

Background: The treatment options for degenerative or primary mitral regurgitation (DMR) include mitral surgery and transcatheter edge-to-edge repair (MitraClip). However, the optimal therapy for patients with functional or secondary MR (FMR) remains unclear. The purpose of this study was to evaluate the 1 year outcomes of all patients with FMR undergoing MitraClip in the United States as part of the EVEREST (Endovascular Valve Edge-to-Edge Repair STudy) II study. Methods: Patients treated in the EVEREST II trial (randomized trial and continued access registries) with severe FMR were evaluated. Outcomes at 30 days and 1 year were analyzed and adjudicated by an independent core laboratory. Patients were further stratified by surgical risk (High risk= STS mortality score ≥12% or pre-specified risk factors). Results: A total of 619 patients (mean age=73.4 years) with FMR were treated with MitraClip. Comorbidities were common including coronary artery disease (81.1%), NYHA functional class III/IV (80.3%), and previous coronary artery bypass grafting (55.7%). Device implantation was achieved in 96.4% with a mean hospital stay of 3.3 days and an 87.2% discharge to home. At 30 days, mortality was 3.6% with a major adverse event rate of 9.2%. At 1 year, the survival was 78.3%, while the majority of survivors had MR≤2+ (84.5%) and significantly improved symptoms (83.2% NYHA Class I/II). The left ventricular end diastolic volume (LVEDV) improved from 162.5ml to 152.6ml (P<.001). When comparing high surgical risk patients (n=485; mean STS score=10.6±6.9%) to non-high risk patients (n=134), the 30 day mortality was similar (4.1% vs. 1.5%, P=.19), but the 1 year mortality was worse (22.7% vs. 13.4%, P=.02). Nevertheless, at 1 year, there were similar rates of MR reduction (MR≤2+: 83.9% vs. 87.3%) and improvement in LVEDV (-9.0ml vs -12.6ml). The non-high risk cases had greater symptom improvement (NYHA Class I/II: 91.2% vs. 80.2%, P=.001). Conclusions: MitraClip in patients with severe FMR is associated with excellent safety, positive ventricular remodeling, symptom improvement, and stable MR reduction at 1 year independent of surgical risk. Compared to high surgical risk patients, non-high risk patients may derive the greatest survival and symptom benefit.

A Global Vascular Guidelines–Based Bypass-Preferred Population and Their Surgical Risk Among CLTI Patients Treated With Endovascular Therapy in a Real-World Practice

2020 ◽  
Vol 27 (4) ◽  
pp. 608-613
Author(s):  
Shin Okamoto ◽  
Osamu Iida ◽  
Mitsuyoshi Takahara ◽  
Yosuke Hata ◽  
Mitsutoshi Asai ◽  
...  
Keyword(s):  
Decision Tree ◽  
Endovascular Therapy ◽  
Mortality Risk ◽  
Bypass Surgery ◽  
Recursive Partitioning ◽  
First Line ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Infection Stage ◽  
First Line Treatment

Purpose: To determine in a chronic limb-threatening ischemia (CLTI) population who underwent endovascular therapy (EVT) how many patients would have been categorized as preferred for bypass surgery according to the Global Vascular Guidelines (GVG) and ascertain their surgical risk. Materials and Methods: The current study analyzed 1043 CLTI patients who presented WIfI (wound, ischemia, and foot infection) stage ≥2 and underwent EVT between April 2010 and December 2017. Of these, 176 were excluded for lack of angiographic or other data, leaving 867 CLTI patients (mean age 74±10 years; 523 men) for stratification according to the GVG into bypass-preferred, indeterminate, or EVT-preferred groups. The GVG recommend bypass as the first-line treatment when the wound is severe (WIfI stage ≥3) and lesions are complex (GLASS stage III). Surgical risk was estimated using the modified PREVENT III risk score. To further stratify the bypass-preferred population according to mortality risk, a survival decision tree was constructed using recursive partitioning. Results: The bypass-preferred group accounted for 55% [95% confidence interval (CI) 51% to 58%] of the overall population. The decision tree analysis extracted a low-mortality risk subgroup with a survival rate of 99% (95% CI 98% to 100%) at 1 month and 80% (95% CI 73% to 87%) at 2 years. According to the PREVENT III score, 34% (95% CI 27% to 42%) of the low mortality risk subgroup were classified as high surgical risk. Conclusion: A high proportion of patients undergoing EVT were considered bypass preferred based on the GVG, and the survival of these patients was not significantly different whether they were high or low surgical risk.

scholarly journals Endovascular myocardial revascularization in patients with multivessel coronary artery disease with chronic total occlusion and high surgical risk

2020 ◽  
Vol 19 (6) ◽  
pp. 2697
Author(s):  
D. K. Vasiliev ◽  
B. A. Rudenko ◽  
A. S. Shanoyan ◽  
F. B. Shukurov ◽  
D. A. Feshchenko
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Myocardial Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
Total Occlusion ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Artery Disease

The main reason  for incomplete myocardial revascularization is the presence of chronic coronary total occlusion (CTO), which is detected in every fourth patient during coronary angiography. At the same time, a generally accepted approach  to the treatment of CTO has not yet been developed.Aim. To assess the rationale of complete myocardial revascularization in patients with multivessel coronary artery disease  (CAD) with chronic total occlusion and high surgical risk.Material and methods. This retrospective,  open-label,  non-randomized clinical trial was carried out included 180 patients multivessel CAD and CTO. The patients  underwent endovascular  surgery for complete myocardial revascularization. Depending on the success of surgery, the patients were divided into groups of complete and incomplete myocardial revascularization. Endpoints were death, acute coronary syndrome, re-revascularization after 1-year follow-up. Left ventricular (LV) contractility and clinical status  of patients  in the study groups after 1 year of observation was assessed.Results. The median follow-up was 12,1 months. The successful  rate of revascularization was 79,4%. The incidence of main composite endpoint in the group of complete myocardial revascularization was 5,59%, while in the group of incomplete revascularizations — 21,6% (p=0,005).Conclusion. The study showed  that low incidence  of intraoperative complications and a high successful  rate of revascularization are characteristic of complete myocardial revascularization in patients at high surgical risk with multivessel CAD and CTO. Complete myocardial revascularization leads to a significant decrease in the incidence of major coronary events.

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