415 Clinical outcomes and Patient satisfaction with Bilateral Radial Artery harvest in coronary surgery

Aim Coronary artery bypass graft surgery remains an effective treatment strategy for complex coronary disease.There paucity of data regarding the use of bilateral radial artery conduits with wound, neurological and functional complications following surgical revascularisation. Method We reviewed the outcomes with retrospective analysis of prospectively collected clinical data from our database and identified 30 patients who underwent CABG requiring the use of bilateral radial harvest.Patient satisfaction was assessed using a quality of life questionnaire with the descriptors on a Likert Scale. Results The mean duration of follow-up was 29.8 ± 8.5 months.The mean age of patients was 69.0 ± 10.8 years.The commonest indications for bilateral radial harvest were existing bilateral varicose veins or previous bilateral vein surgery (combined 74% of cases) precluding venous conduit use. Three out of 24 (12.5%) patients reported arm pain or discomfort ‘rarely’ or ‘sometimes’ whilst all the others (87.5%) were asymptomatic.Three patients (12.5%) reported long term permanent sensory deficit with a further six (25%) patients having some other less significant sensory loss. Significant motor dysfunction was reported in one patient (4.2%) whilst 5 (20.8%) reported milder forms of motor deficit. 95.8% of patients considered the aesthetic outcome of the radial harvest site appearance to be at least acceptable (54.1% rated the appearance as excellent). One patient (4.2%) reported a ‘moderate’ functional change otherwise, the remaining patients reported ‘minimal’(12.5%) or ‘no change’ (83%). Conclusions Open bilateral radial artery is acceptable to patients as a conduit choice when alternatives are not favourable for surgical revascularisation.

Normal inflammatory markers in giant cell arteritis with long-standing cranial and symptomatic large-vessel involvement

We report the case of a 78-year-old woman who presented with cardiovascular risk factors and a history of an atypical transient ischaemic attack. She was referred by her primary care physician to the vascular surgery department at our institution for evaluation of progressive weakness, fatigue, arm claudication and difficulty assessing the blood pressure in her right arm. She was being considered for surgical revascularisation, but a careful history and review of her imaging studies raised suspicion for vasculitis, despite her normal inflammatory markers. She was eventually diagnosed with biopsy-proven giant cell arteritis with diffuse large-vessel involvement. Her symptoms improved with high-dose glucocorticoids.

Myocardial Work and Left Ventricular Contractile Reserve During Stress Echocardiography: An Angiographic Validation

Objective This study sought to determine the contractile reserve (CR) response to exercise stress echocardiography (ESE) quantified by the novel parameter, non-invasive myocardial work (MW), in subjects with angiographically proven coronary artery disease (CAD). Methods CR was measured by the relative change in ejection fraction (EF), global longitudinal strain (GLS) and MW indices from rest to peak exercise in 304 patients referred for clinically indicated ESE. Positive ESE patients proceeded to coronary angiography and further risk stratified based on either percutaneous or surgical intervention. Results CR and global work index (CR) significantly decreased with exercise induced ischaemia and angiographically proven significant CAD (CR -1.6±3.5%; CR -8.6±511mmHg% decrement, p<0.001) compared to non-ischaemic patients (CR 1.4±2.2%; CR 398±404mmHg% improvement). Global constructive work (CR) was significantly higher (p<0.0001) in non-ischaemic (818±457mmHg%) and blunted in ischaemic patients (208±550mmHg%). CR (AUC 0.81; 95%CI 0.74-0.88) was superior to CR (AUC 0.75; 95%CI:0.67-0.83), CR (AUC 0.73, 95%CI:0.64-0.82) and CR (AUC 0.71; 95%CI:0.62-0.81, p<0.001) to detect inducible ischaemia. Subgroup analysis showed patients requiring surgical revascularisation demonstrated a significantly lower CR (-11.5±7.6%, p<0.05) as a result of reduced CR (281±573mmHg%, p<0.05) and increased global wasted work (CR, 289±151mmHg%, p=0.09). Conclusion Multivessel disease requiring surgical revascularisation have the greatest reduction in CR. MW may potentially improve detection of ischaemia and further risk stratification during ESE to maximise the benefits of revascularisation.

Safety and feasibility evaluation of planning and execution of surgical revascularisation solely based on coronary CTA and FFRCT in patients with complex coronary artery disease: study protocol of the FASTTRACK CABG study

IntroductionThe previously published SYNTAX III REVOLUTION trial demonstrated that clinical decision-making between coronary artery bypass graft (CABG) and percutaneous coronary intervention based on coronary CT angiography (CCTA) had a very high agreement with the treatment decision derived from invasive coronary angiography (ICA). The study objective of the FASTTRACK CABG is to assess the feasibility of CCTA and fractional flow reserve derived from CTA (FFRCT) to replace ICA as a surgical guidance method for planning and execution of CABG in patients with three-vessel disease with or without left main disease.Methods and analysisThe FASTTRACK CABG is an investigator-initiated single-arm, multicentre, prospective, proof-of-concept and first-in-man study with feasibility and safety analysis. Surgical revascularisation strategy and treatment planning will be solely based on CCTA and FFRCT without knowledge of the anatomy defined by ICA. Clinical follow-up visit including CCTA will be performed 30 days after CABG in order to assess graft patency and adequacy of the revascularisation with respect to the surgical planning based on non-invasive imaging (CCTA) with functional assessment (FFRCT) and compared with ICA. Primary feasibility endpoint is CABG planning and execution solely based on CCTA and FFRCT in 114 patients. Primary safety endpoint based on 30 day CCTA is graft assessment and topographical adequacy of the revascularisation procedure. Automatic non-invasive assessment of functional coronary anatomy complexity is also evaluated with FFRCT for functional Synergy Between percutaneous coronary intervention With Taxus and Cardiac Surgery Score assessment on CCTA. CCTA with FFRCT might provide better anatomical and functional analysis of the coronary circulation leading to appropriate anatomical and functional revascularisation, and thereby contributing to a better outcome.Ethics and disseminationEach patient has to provide written informed consent as approved by the ethical committee of the respective clinical site. Results will be submitted for publication in peer-reviewed journals and will be disseminated at scientific conferences.Trial registration numberNCT04142021.