Coronary Surgery Research Articles (Page 1)

Objective Multiple arterial grafting (MAG) has been suggested to confer long-term survival benefits for patients undergoing coronary artery bypass grafting (CABG), yet its short-term benefits remain uncertain. This study aims to analyze the impact of MAG on in-hospital outcomes and identify potential risk factors. Methods A retrospective analysis was conducted from all patients who underwent CABG surgery in our development from January 2022 to December 2024. A generalized mixed-effects model and sensitivity analysis were employed to evaluate the influence of the type of CABG bypass graft on in-hospital major adverse cardiac and cerebrovascular events (MACCEs), postoperative dialysis, intra-aortic balloon pump (IABP) use, re-thoracotomy for bleeding and sternal wound infection (SWI). Results A total of 960 patients were included in this study. Patients who received MAG surgeries had more coronary artery lesions observed preoperatively. Compared with patients who underwent single arterial grafting (SAG), those who received MAG surgery did not show significant differences in the incidence of in-hospital MACCEs, postoperative dialysis, IABP use, re-thoracotomy or SWI. Interestingly, good left ventricular function was associated with a reduced occurrence of postoperative dialysis, MACCEs, and IABP application. Chronic renal insufficiency emerged as a risk predictor of major in-hospital adverse events. Conclusion This single-center study did not find significant differences in short-term outcomes between MAG and SAG groups. However, caution should be exercised when applying these findings to other clinical environments and patient populations. Further multi-center, prospective randomized controlled trials (RCTs) are needed to validate and extend our results.

Rationale:Statin-associated myalgia are common, but rhabdomyolysis remains a rare and severe adverse effect. There are scant reports, both domestically and internationally, on rhabdomyolysis induced by the combination of atorvastatin and ticagrelor.Patient Concerns:A 57-year-old male patient with acute coronary syndrome underwent emergency percutaneous coronary intervention surgery. He was prescribed ticagrelor (90 mg twice daily) and atorvastatin (40 mg once daily). Three days after treatment initiation, his creatine kinase, creatinine, and myoglobin levels increased markedly, and he developed acute renal failure.Diagnoses:Rhabdomyolysis was diagnosed based on the medication history, significantly elevated creatine kinase and myoglobin levels, and the onset of acute renal failure.Interventions:Management included immediate drug discontinuation, aggressive fluid resuscitation, continuous renal replacement therapy, and extracorporeal membrane oxygenation.Outcomes:Despite these efforts, the patient died.Lessons:This case aims to alert clinicians to the potential for this rare but fatal adverse effect, particularly in high-risk patients receiving aggressive statin therapy. It also discusses the rationale for considering alternative lipid-lowering strategies in acute coronary syndrome patients with multiple risk factors for statin-induced myotoxicity to mitigate the risk of rhabdomyolysis.

Broadening the applicability of coronary surgery from minimally invasive approaches to the modern treatment of ventricular septal rupture.

Aim. Optimization of surgical coronary revascularization tactics for women and men, based on a comparative analysis of modern coronary surgery techniques from the CROWN-SAGA (Coronary Revascularization Outcomes Within Necessary Sex And Gender Aspects) study.Material and methods. Single-center CROWN-SAGA study (NCT06749171) presented a comparative analysis of the impact of preoperative profile and range of surgical techniques in coronary artery bypass grafting (CABG) surgery on short- and long-term outcomes in women and men. The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), stroke or transient ischemic attack (TIA) and repeat revascularization (major adverse cardiovascular and cerebrovascular events, MACCE) during the long-term follow-up. The secondary endpoint was allcause mortality during the long-term followup.Results. Among the included sample of 400 patients (200 women and 200 men) in the CROWNSAGA study, women were older than men and had less favorable preoperative profile. Short-term in-hospital outcomes in terms of mortality and MACCE were comparable between women and men. Over long-term follow-up, the incidence of MACCE was 21.2 % in women and 16.2 % in men (hazard ratio (HR) = 1.15 [95 % confidence interval (CI) 0.72; 1.82], p = 0.557) and the incidence of death was 11.1 % in women and 10.2 % in men (HR = 0.94 [95 % CI 0.51; 1.72], p = 0.83), women had higher risks of MI (HR = 6.66 [95 % CI 0.83; 53.28], p = 0,038), repeat revascularization (HR = 4.11 [95 % CI 1.18; 14.32], p = 0.016) and stroke (HR = 1.24 [95 % CI 0.59; 2.6], p = 0.567). ONCAB compared to OPCAB within the men cohort had a significantly lower risk of death (HR = 0.28 [95 % CI 0.09; 0.91], p = 0.03). Women had an increased risk of graft occlusion. All Off-pumps strata (OPCAB, NTA, MICSCAB) compared with ONCAB showed higher risk of adverse long-term outcomes among all patients in regard to MACCE (HR = 1.54 [95 % CI 0.95; 2.49], p = 0.08), death (HR = 2.17 [95 % CI 1.14; 4.14], p = 0.016) and graft occlusion. Predictor of long-term MACCE and death for women was use of composite grafts, while for men — ejection fraction (EF) ≤ 40 %, age > 70 years, and off-pump CABG. Considering the obtained data and identified predictors, CABG approach for both sexes implies complete coronary revascularization with an increased number of distal anastomoses, the use of arterial grafts, use of sequential grafts, limiting use of venous conduits, for women limiting use of composite grafting, while for men an adherence to an anoartic technique and the use of composite grafting.Conclusions. The developed algorithm for surgical management is based on a sex and gender approach and a comprehensive analysis of a wide range of CABG techniques aimed at improving patient outcomes after coronary revascularization, particularly reducing the burden of adverse CABG outcomes among women. Recommended approach for both women and men involves complete arterial revascularization and sequential anastomoses; for women we advise surgical techniques that reduce the risk of sternal and wound complications, along with limiting the use of composite grafts; for men the use of composite grafts is permissible and the no-touch-aorta (NTA) technique is advised.

Minimally invasive coronary artery bypass grafting (MICS CABG) offers the benefits of surgical revascularization without sternotomy but remains underutilized due to technical demands and a lack of structured training. This review outlines a stepwise framework for safe adoption. Studies and real-world experience confirm that off-pump CAB (OPCAB) proficiency, systematic technical progression, and mentorship in high-volume centers are essential for safe learning. Recent training innovations and simulator-based techniques improve outcomes and reduce complications during the learning curve. Wider adoption of MICS CABG hinges on structured training rooted in OPCAB, technical sequencing, and surgical mentorship. Programs emphasizing patient safety, proper case selection, and skill development can expand access to minimally invasive coronary surgery.

Background:Combined valve and coronary surgery is technically complex, and the prognosis for such patients remains poor. This study aimed to analyze the short-term prognostic effects of histidine–tryptophan–ketoglutarate (HTK) cardioplegia versus 1:4 cold blood (CB) cardioplegia in patients requiring combined valve and coronary surgery.Methods:This retrospective cohort study categorized patients undergoing valve surgery combined with coronary artery bypass grafting (CABG) into two groups: the HTK group (n = 504) and the CB group (n = 188), based on the type of cardioplegia used. Propensity score matching (PSM) was employed to adjust for baseline differences between the groups. The primary endpoints included operative mortality, postoperative myocardial infarction (PMI), postoperative acute kidney injury (AKI), and postoperative atrial fibrillation (POAF). Secondary endpoints included stroke incidence, ventilation time, aortic cross-clamp time, and intensive care unit (ICU) length of stay (LOS).Results:After PSM, patients with HTK experienced significantly lower rates of AKI and POAF (p < 0.05). Troponin I (TnI) and creatine kinase-MB (CK-MB) measurements at 48 and 72 hours postoperatively were lower in the HTK group compared with the CB group (p < 0.05). However, no significant difference in PMI incidence was detected (p = 0.368). Additionally, the HTK group demonstrated shorter mechanical ventilation times (p = 0.01) and ICU stays (p = 0.009).Conclusions:HTK cardioplegia reduced postoperative ventilation time, ICU LOS, and the incidence of AKI and POAF compared with CB cardioplegia in patients undergoing valve surgery combined with CABG. HTK cardioplegia is effective, safe, and superior to CB cardioplegia in improving short-term outcomes in these patients.

Patients benefit from antiplatelet therapy after coronary-artery bypass grafting (CABG) for an acute coronary syndrome. Whether the addition of ticagrelor to aspirin, as compared with aspirin alone, further reduces the risk of adverse cardiovascular outcomes is unclear. In this open-label, registry-based, clinical trial conducted at 22 Nordic cardiothoracic surgery centers, we randomly assigned patients in a 1:1 ratio to receive either ticagrelor plus aspirin or aspirin alone for 1 year after CABG for an acute coronary syndrome. The primary outcome was a composite of death, myocardial infarction, stroke, or repeat revascularization, evaluated at 1 year. A key secondary outcome was net adverse clinical events, defined as a primary-outcome event or major bleeding. A total of 2201 patients were randomly assigned to receive ticagrelor plus aspirin (1104 patients) or aspirin alone (1097 patients). The mean age of the patients was 66 years, and 14.4% were women. A primary-outcome event occurred in 53 patients (4.8%) in the ticagrelor-plus-aspirin group and 50 (4.6%) in the aspirin-alone group (hazard ratio, 1.06; 95% confidence interval [CI], 0.72 to 1.56; P = 0.77). Net adverse clinical events occurred in 9.1% of patients in the ticagrelor-plus-aspirin group and 6.4% in the aspirin-alone group (hazard ratio, 1.45; 95% CI, 1.07 to 1.97). Major bleeding occurred in 4.9% of patients in the ticagrelor-plus-aspirin group and 2.0% in the aspirin-alone group (hazard ratio, 2.50; 95% CI, 1.52 to 4.11). Among patients who underwent CABG for an acute coronary syndrome, ticagrelor plus aspirin did not result in a lower incidence of death, myocardial infarction, stroke, or repeat coronary revascularization than aspirin alone at 1 year. (Funded by the Swedish Research Council and others; TACSI ClinicalTrials.gov number, NCT03560310; EudraCT number, 2017-001499-43; EU Clinical Trials number, 2023-508551-40-00.).

Oral anticoagulation in patients with atrial fibrillation and heart valve prosthesis: A substudy from the Left Atrial Appendage Occlusion Study (LAAOS) III trial.

We compared early outcomes of total arch repair (TAR) and ascending aorta replacement (AAR) for acute aortic dissection type A (AADA) using the nationwide Japan Cardiovascular Surgery Database (JCVSD) and examined the role of the frozen elephant trunk (FET) technique in TAR. Of 17,075 JCVSD patients undergoing urgent or emergent conventional surgery for AADA in 2013-2016, redo cases and those undergoing valve/root or coronary surgery were excluded (included n = 12,288). Four propensity score-matched analyses for treatment with AAR or TAR (n = 4272 each) were established. After matching, procedure times were significantly longer and incidences of re-exploration for bleeding (5.9 vs. 3.9%, P < 0.0001) or spinal cord injury (4.8 vs. 3.3%, P = 0.0003) were significantly higher in the TAR group than AAR group. In-hospital mortality rate was significantly higher in the TAR group than AAR group (9.5 vs. 7.0%, P < 0.0001). When FET was used, the incidences of some of morbidities improved and the difference in in-hospital mortality between TAR and AAR groups disappeared (8.3 vs. 7.7%, P = 0.6583). However, the incidence of re-exploration for bleeding was still high (5.7 vs. 3.0%, P = 0.0066) and the incidence of spinal cord injury became pronounced (6.7 vs. 2.9%, P = 0.0002). TAR was associated with longer procedure time and higher incidences of postoperative morbidities and mortality. FET holds promise for improving outcomes of TAR. However, spinal cord injury has emerged as another serious concern and its clinical role remains unclear.

Minimally invasive cardiac surgery (MICS) coronary artery bypass grafting (CABG), first established two decades ago, offers multivessel revascularization via a small left anterior thoracotomy and without the need for cardiopulmonary bypass, potentially leading to lower complication rates and faster recovery. However, adoption of MICS CABG has been slow, in part due to lack of randomized trial data. Here, we review important retrospective studies, as well as ongoing and completed MICS CABG trials. The majority of studies remain single-center observational studies demonstrating that MICS CABG yields comparable perioperative morbidity and mortality to conventional CABG, with excellent angiographic graft patency, comparable long-term outcomes and faster recovery times. There are two ongoing randomized controlled trials, the MIST and MICS-CABG PRPP trials, both comparing quality of life and recovery in the early postoperative period between patients undergoing MICS CABG versus sternotomy CABG. The MIST and MICS-CABG PRPP trials will for the first time provide prospective, randomized data on the benefits of MICS CABG. However, both trials involve highly experienced MICS CABG surgeons. As such, the findings will likely not be generalizable to the general cardiac surgery community and MICS CABG will remain a boutique operation offered in highly specialized centers.

The comorbidity of myocardial ischemia reperfusion injury (MIRI) and depression (DEP) may worsen the prognosis of coronary heart disease surgery. Currently, research on medications and therapeutic mechanisms for MIRI combined with DEP is still insufficient. This study aims to explore the relationship between DEP and MIRI, and the therapeutic effects and mechanisms of Baihe Dihuang Danshen decoction (BDDSD) on DEP combined with MIRI. SD rats were assigned to a final experimental framework of six groups (Sham, MIRI, DEP+MIRI, BDDSD, DEP drug control, MIRI drug control). DEP was induced via 6-week chronic unpredictable mild stress (CUMS), with BDDSD administered during the final 2 weeks. MIRI was then induced by 30-minute coronary artery ligation and 2-hour reperfusion. DEP severity was assessed using behavioral tests (open field, elevated plus maze, sucrose preference, forced swimming). MIRI outcomes were evaluated via infarct size, histopathology, serum markers (LDH, IL-6, IL-1β), myocardial oxidative stress (MDA, GSH, SOD, Fe²⁺), and NADPH/FSP1/CoQ10 pathway proteins (FSP1, CoQ10, FTL, NOX2, NOX4, COX2). Compared with the MIRI group, DEP significantly exacerbated MIRI, manifested by increased serum IL-6 and IL-1β levels, enlarged infarction area, and aggravated oxidative damage (elevated MDA/Fe²⁺, decreased SOD/GSH). Compared with the DEP+MIRI group, BDDSD intervention relieved DEP of rats, and subsequently reduced infarction area; decreased serum LDH, IL-6, and IL-1β; lowered myocardial MDA and Fe²⁺ while increasing SOD and GSH; upregulated FSP1/CoQ10/FTL; and downregulated NOX2/NOX4/COX2 expression. DEP can aggravate inflammation and oxidative stress, promoting cardiac ferroptosis, thereby exacerbating MIRI. Our results demonstrate that BDDSD alleviates MIRI-DEP comorbidity through a dual mechanism, mitigating depressive symptoms and inhibiting myocardial ferroptosis via modulation of the NADPH/FSP1/CoQ10 pathway. Although the efficacy of BDDSD is encouraging, its dose-effect relationship and long-term safety require further study. BDDSD effectively treats DEP-MIRI comorbidity through its dual mechanism, mitigating DEP and protecting against myocardial ferroptosis. Our study not only offers a novel therapeutic strategy for patients with DEP requiring coronary heart disease surgery but also provides new targets for developing drugs to treat MIRI combined with DEP.

Surgical neuromodulation therapies to prevent postoperative atrial fibrillation: A meta-analysis, meta-regression, and trial sequential analysis of randomized controlled trials.

This study evaluated the safety and feasibility of minimally invasive coronary surgery (MICS) for patients with multivessel disease. Patients with multivessel coronary artery disease (CAD) undergoing isolated off-pump coronary artery bypass grafting surgery (OPCAB) in our center between January 2017 and December 2020 were included in this study. Patients were divided into the MICS group or the conventional OPCAB group. Clinical characteristics, surgical data, postoperative outcomes and graft patency were analyzed between the two groups. Propensity score matching (PSM) was performed to reduce the potential effects of a selection bias. A total of 476 patients were included in this study, with 103 patients in the MICS group and 373 patients in the OPCAB group. Before matching, patients in the MICS group showed a higher left ventricular ejection fraction (LVEF) and a lower left ventricular end-diastolic dimension (LVEDD), and the proportion of patients with 3 target vessels or more was significantly lower in the MICS group. Following the PSM, bilateral internal thoracic arteries (ITAs), sequential grafting and composite conduits were more frequently used in the MICS group, and the proportion of patients with 2 anastomoses or more on the ascending aorta was significantly lower in the MICS group. The postoperative length of stay was significantly shorter in the MICS group, and the rate of wound dehiscence was lower in the MICS group. There was no difference in the rate of postoperative MI, stroke, repeated revascularization, or in-hospital death between the two groups. The short-term graft patency was similar between the two groups. MICS can achieve comparable clinical outcomes and graft patency to conventional OPCAB. Cardiac function and the number of target vessels are two factors that surgeons take in consideration when deciding to proceed with a MICS. Sequential grafts and composite conduits are more frequently used in MICS patients, which is in accordance with the reduction in the number of proximal anastomoses performed on the ascending aorta.

Focusing on exercise rehabilitation for elderly patients with coronary artery disease after coronary angiography, this paper systematically analyzes the multifaceted significance of exercise rehabilitation in restoring physical function, improving mental health, and enhancing quality of life. The paper explores the mechanisms and clinical effects of rehabilitation modalities, including aerobic exercise to promote collateral circulation and cardiac function, resistance training to improve lipid profile by increasing muscle mass, flexibility training to prevent joint stiffness, and balance training to reduce the risk of falls. Key findings emphasize that exercise rehabilitation can promote the aerobic metabolism of myocardium, increase myocardial oxygen uptake, enhance myocardial contractility, improve cardiac pumping function, improve cardiac function, significantly reduce cardiovascular events and postoperative complications, and improve patients' quality of life. Meanwhile, early exercise rehabilitation has a positive impact on patients' psychological state through neurobiological mechanisms, improves psychological comfort, reduces anxiety and depression, and improves the negative psychological state of patients after coronary heart disease surgery. The study provides both theoretical frameworks and practical guidance for integrating scientific exercise programs into post-PCI rehabilitation, emphasizing its role in achieving comprehensive physical and psychological recovery for elderly patients.

Commentator Discussion: Surgical approach and outcomes in adults with anomalous aortic origin of coronary arteries at a reference center: Outcomes of proximal coronary surgery

Coronary artery bypass grafting (CABG) remains a cornerstone in the management of coronary artery disease (CAD), evolving with advancements in surgical techniques, personalized medicine, and artificial intelligence-driven decision-making. This narrative review examines the historical progression of CABG, highlighting key milestones that have shaped modern practices. Epidemiological trends underscore the global burden of CAD, with variations in CABG utilization influenced by regional healthcare infrastructure, demographic factors, and socioeconomic disparities. A comparative analysis of CABG practices across North America, Europe, Asia–Pacific, Latin America, and the Middle East and Africa reveals differences in patient selection, procedural approaches, and healthcare system support. Market dynamics, including technological innovations, cost-effectiveness, and reimbursement policies, impact CABG accessibility and growth trends. Additionally, the environmental footprint of CABG is explored, emphasizing strategies to minimize carbon emissions and promote sustainability in cardiac surgery. Future directions in CABG focus on integrating artificial intelligence and machine learning for improved surgical planning and risk prediction, alongside advancements in personalized medicine and tailored treatment strategies. Potential research areas include optimizing graft longevity, refining perioperative risk assessment, and exploring hybrid coronary revascularization techniques. By analyzing global trends, this review aims to provide insights into evolving CABG practices while identifying opportunities for innovation to enhance patient outcomes and healthcare sustainability. Continued multidisciplinary collaboration and evidence-based approaches will be essential in shaping the future landscape of coronary surgery.

With the development of the social economy and the continuous improvement of people’s living standards, the number of coronary heart disease patients is on the rise, even affecting some younger groups. When a patient’s coronary artery stenosis endangers their life, doctors usually recommend coronary artery stent surgery to effectively improve myocardial ischemia and prevent sudden death. After a successful operation, it is necessary to clarify the key points of clinical nursing and prevent complications. Starting from the situation after coronary heart disease stent implantation, this article analyzes the key points of clinical nursing and proposes specific strategies for preventing complications, aiming to improve the surgical effect and provide a reference for complication prevention activities.

This study explores the impact of left ventricular mass and geometry on the prognosis of patients undergoing coronary artery bypass grafting. Left ventricular hypertrophy is a known risk factor for cardiovascular complications, yet its role in surgical outcomes remains underexplored.A retrospective cohort of 494 elective coronary artery bypass grafting patients treated between 2013 and 2018 was analyzed. Left ventricular mass was calculated using the Devereux formula, and patients were divided into normal and increased left ventricular mass index groups. Mortality rates, postoperative complications, and echocardiographic parameters were evaluated.Patients with increased left ventricular mass exhibited significantly higher 5-year mortality rates (27.2 vs. 11.5%, p < 0.001), postoperative atrial fibrillation (24.8 vs. 16.0%, p = 0.018), and carotid stenosis (21.8 vs. 12.5%, p = 0.006). Elevated preoperative biomarkers, including creatinine and C-reactive protein, were observed in this group, with sustained impairment in postoperative kidney function. However, no significant differences in 30-day, 1-year, or 3-year mortality rates were detected.Left ventricular mass and geometry independently predict long-term outcomes in coronary artery bypass grafting patients. Targeted strategies to mitigate left ventricular remodeling may enhance postoperative outcomes. Future research should focus on therapeutic interventions to reverse adverse left ventricular changes and optimize patient survival and quality of life.

Background: Patients diagnosed with coronary artery disease (CAD) have been seen to exhibit increases in health-related quality of life (HRQoL) following percutaneous coronary interventions (PCIs). This study thus aimed to assess the impact of PCI on health outcomes among Jordanian patients three months post-procedure. Methods: This prospective descriptive study evaluated health outcomes three months post-PCI among Jordanian patients who had been originally diagnosed with Chronic Coronary Syndrome (CCS) before being scheduled for PCIs. Quantitative data was collected using the updated version of the Coronary Revascularization Outcome Questionnaire (CROQ v2) across a non-probability sample, based on accessibility, of Jordanian patients who had received the procedure at any of several hospitals in Jordan. Multivariate analysis of covariance (MANCOVA) was employed to examine the mean scores of patient-reported outcomes following revascularization, while partial correlations were employed to investigate associations among patients' age, weight, gender, and the reported results. Results: A total of 101 patients participated in the study, with a predominance of males (n = 85, 84.2%) relative to females (n = 16, 15.8%). The results indicated a statistically significant improvement across all measures assessed across these patients. Furthermore, the results demonstrated that males showed higher physical function, psychological functioning, and cognitive performance relative to females following coronary revascularization surgery. Nevertheless, the results also revealed varied levels of adverse effects following coronary revascularization, with the most commonly reported being discomfort around the groin or arm wound, followed by pain in the same areas. Conversely, the least significant concerns pertained to the emergence of bruises and similar issues in the groin or arm areas where the catheter was inserted. Conclusions: This study shows that PCI improves CAD patients' quality of life over the initial three-month period post-procedure. Understanding the positive associations of this and the negative consequences that it entails may help healthcare practitioners better identify those patients likely to benefit or suffer from PCI, enabling more appropriate interventions. To understand how PCI affects HRQoL in CAD patients over time, more research based on rigorous study designs and validated metrics is required, however.

Surgical approach and outcomes in adults with anomalous aortic origin of coronary arteries at a reference center: Outcomes of proximal coronary surgery