Previous Coronary Artery Bypass Graft Surgery Research Articles

Complete revascularisation versus culprit lesion only PCI in patients with non-ST-elevation myocardial infarction and multivessel disease.

Abstract Background The incidence of non-ST-elevation myocardial infarction (NSTEMI) is escalating, with patients diagnosed with multivessel disease (MVD) facing more adverse clinical outcomes. Yet, optimal treatment strategies for NSTEMI patients with MVD remain uncertain. Objectives This study aimed to assess the clinical outcome of NSTEMI patients with MVD who underwent complete revascularization compared to those treated with the culprit lesion only. Methods Between 2014 and 2017, patients presenting with NSTEMI and MVD undergoing successful percutaneous coronary intervention (PCI) were retrospectively included. MVD was defined as patients having more than one lesion considered angiographically significant, exhibiting at least 50% stenosis of the vessel diameter on visual estimation, or having a Coronary Angiography-Derived Fractional Flow Reserve (caFFR) measurement of 0.80 or less. The main exclusion criteria were single vessel disease, and previous coronary-artery bypass grafting surgery. The primary endpoint of this study was major adverse cardiac events (MACE) at 3 years, defined as a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization. Results A total of 358 patients were included (mean age: 67.34±12.77; male: 70.1%), 155 and 203 patients were stratified into complete revascularisation group and culprit-lesion-only PCI group respectively. During 3-year follow-up, the culprit-lesion-only PCI group exhibited a significantly elevated risk of MACE compared to the complete revascularization group (17.7% vs 7.74%; hazard ratio [HR] 2.412, 95% confidence interval [CI] 1.255 - 4.636, P = 0.008). The increase 3-year MACE rate was mainly driven by the higher rate of ischaemia-driven revascularization in the culprit-lesion-only PCI group (11.3% vs 3.23%, HR 3.637, 95% CI 1.383 - 9.566, P = 0.009). Conclusion In NSTEMI patients with MVD, complete revascularization was superior to culprit-lesion-only PCI in mitigating the risk of future MACE at 3 years, which is predominantly attributed by a reduced incidence of repeat revascularisations.

Clinical predictors of coronary artery bypass graft surgery in patients hospitalized for Non-ST acute coronary syndrome - Buenos Aires I and ReSCAR22 registries.

To identify predictors of coronary artery bypass graft surgery (CABG) requirement as a revascularization method in in real-world non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients. . An individual pre-specified analysis of patients with NSTE-ACS was performed from two prospective Argentine registries between 2017 and 2022. We analyzed the difference in baseline characteristics between patients who required CABG and those who did not require this intervention. Then, a logistic regression analysis was performed to determine independent predictors in patients who received CABG as a method of revascularization. A total of 1848 patients with a median age of 54.8 (interquartile range [IQR]: 53.7-56) years and an ejection fraction of 42.1% (IQR: 41.2-43.1) were included. A total of 233 patients required CABG (12.6%). Baseline characteristics between the two groups were similar, except in patients requiring CABG, who were younger (51.5 vs. 55.7 years; p=0.010), more frequently diabetic (38.2% vs. 25.7%; p=0.001) and male (90.1% vs. 73.7%; p=0.001). In addition, they had, to a lesser extent, previous cardiac surgery (2.1% vs. 11.2%; p=0.011). After multivariable analysis, the following were independently associated with CABG: age (Odds Ratio [OR]: 0.99, 95% confidence interval [CI]: 0.98-0.99; p=0.008), male sex (OR: 3.08, 95% CI: 1.87-5.1; p=0.001), history of previous CABG (OR: 0.14, 95% CI: 0.05-0.30; p=0.001) and diabetes (OR: 1.84, 95% CI: 1.31- 2.57; p=0.001). In this analysis of two NSTEACS registries, younger age, male sex, a diagnosis of diabetes and the absence of previous surgery were independent predictors of the requirement for inpatient CABG.

In-hospital Outcomes of Patients With and Without Previous Coronary Artery Bypass Graft Surgery Who Present With a Non-ST-Segment Elevation Myocardial Infarction

The clinical course of patients with a previous coronary artery bypass graft surgery (CABG) presenting with non-ST-elevation myocardial infarction (NSTEMI) is not well defined. We aimed to compare the management and outcomes of patients with and without previous CABG who present with an NSTEMI. Patients hospitalized with an NSTEMI between 2002 and 2018 were identified from the National Inpatient Sample. The baseline characteristics and outcomes of patients with and without a previous CABG were compared. The outcomes included the rates of invasive procedures (defined as coronary angiography, percutaneous coronary intervention [PCI], or CABG), and its individual components, and in-hospital mortality. A total of 1,445,545 cases of NSTEMI were found, of which 133,691 (9.3%) had a previous CABG. Patients with a previous CABG were older (72.4 vs 68.6years, p <0.001), more likely men (68.8% vs 56.9%, p <0.001), and of White race (79.7% vs 74.8%, p <0.001). The previous CABG cohort had lower rates of invasive procedures (50.4% vs 65.6%, p <0.001), PCI (23.7% vs 32.0%, p <0.001), or CABG (1.2% vs 10.6%; p <0.001) in the unmatched analysis. The results were consistent in the propensity score-matched analysis with the previous CABG group less likely to receive any invasive procedures (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.47 to 0.49), including coronary angiography (OR 0.54, 95% CI 0.53 to 0.55), PCI (OR 0.66, 95% CI 0.64 to 0.67), or repeat CABG (OR 0.11, 95% CI 0.10 to 0.12). Moreover, the risk of in-hospital mortality was higher in the previous CABG group (OR 1.15, 95% CI 1.10 to 1.21). In the subset of patients who were revascularized in both groups, this excess mortality was no longer observed (OR 0.82, 95% CI 0.66 to 1.03). In conclusion, a previous CABG in patients who present with NSTEMI is associated with lower rates of invasive procedures and revascularization and higher in-hospital mortality than patients without a previous CABG.

Pretreatment with a P2Y12 receptor inhibitor and delay to coronary artery bypass surgery in patients with non-ST segment elevation acute coronary syndrome.

2020 ESC guidelines for non-ST elevation acute coronary syndromes (NSTE-ACS) recommend against the pretreatment with P2Y12 receptor inhibitors (P2Y12i) in patients undergoing early invasive management (<24 h). The rationale is, in part, to prevent bleeding complications and the delay of coronary artery bypass graft surgery (CABG) in patients with suitable coronary anatomy. This study aimed to analyze the theoretical impact of pretreatment with a P2Y12i on delay to CABG surgery in a real-world population with NSTE-ACS. Single-center retrospective cohort of consecutive patients with NSTE-ACS undergoing invasive evaluation in 2019. Those with previous CABG or nonobstructive coronary disease were excluded. The total cohort included 262 patients (mean age 68±12 years, 69% male, 15% with unstable angina and mean GRACE score 134±35). Median time from FMC to angiography was 2 (1-4) days. Overall, 168 (64%) patients underwent percutaneous coronary intervention, 47 (18%) were proposed for CABG and the remainder received conservative management. All patients considered for CABG received pretreatment with P2Y12i (clopidogrel or ticagrelor). The median time from angiography to CABG was 12 (7-15) days. Six patients experienced recurrent angina (13%) and 2 (4%) died before surgery due to refractory ventricular fibrillation. Those who underwent CABG under P2Y12i effect were more likely to receive blood and platelets transfusions (64.7% vs. 28.6%, P=0.017 and 82.4% vs. 21.4%, P<0.001, respectively), although there were no differences regarding major bleeding. Pretreatment with P2Y12i was a potential but not the sole driver of CABG delay in our cohort. Adopting the new recommendations of withholding pretreatment might decrease this delay, but other factors must be considered.

Outcomes of Patients Undergoing Closed Traction CoronaryEndarterectomy: A Long-Term Single Center Study.

Background-Coronary endarterectomy (CEA) is an option for treating severely diffused coronary artery diseases; however, many surgeons avoid performing it due to its complexity and reported controversial results. Therefore, we aimed to review the results of patients undergoing CEA within coronary artery bypass grafting (CABG). Methods-This is a retrospective observational study evaluating the results of patients undergoing CEA within CABG surgery between March 2003 and February 2018. Follow-up via active personal and/or telephone interviews was performed to evaluate long-term clinical outcomes. The study endpoints included early postoperative incidence of myocardial infarction or cardiac mortality, long-term survival, and freedom from major adverse cardiac and cerebrovascular events (MACCE). Results-A total of 326 patients were included in this study for evaluation. The patients' mean age was 67 years; 88% were male, and most presented with three-vessel disease, reporting a mean SYNTAX score of 33.1 ± 12. Approximately 5.5% (n = 18) of the patients had undergone previous CABG surgery. A total of 394 CEAs within a mean of 4.3 ± 1.1 grafts per patient were performed. The indication for CEA was either totally (n = 111, 28.2%) or sub-totally (n = 283, 71.8%) occluded coronary arteries. Early results included perioperative myocardial infarction in eight (2.4%), stroke in eight (2.4%), and in-hospital mortality in thirteen (4.0%) patients. Long-term clinical follow-up reported mortality in 27.6% and overall incidence of MACCE in 41.4% of the patients at the ten-year follow-up. Conclusions-Patients with severe and diffuse CAD are difficult candidates for surgical revascularization. CEA offers an option to allow complete revascularization, even in the case of chronic occlusion, when the myocardium is still viable. The closed traction CEA technique presented here is our preferred method; it achieves satisfactory short- and long-term results.

Contemporary coronary artery bypass graft surgery and subsequent percutaneous revascularization.

Patients who have undergone coronary artery bypass graft (CABG) surgery are susceptible to bypass graft failure and progression of native coronary artery disease. Although the saphenous vein graft (SVG) was traditionally the most-used conduit, arterial grafts (including the left and right internal thoracic arteries and the radial artery) have improved patency rates. However, the need for secondary revascularization remains common, and percutaneous coronary intervention (PCI) has become the most common modality of secondary revascularization after CABG surgery. Procedural characteristics and clinical outcomes differ considerably from those associated with PCI in patients without previous CABG surgery, owing to altered coronary anatomy and differences in conduit pathophysiology. In particular, SVG PCI carries an increased risk of complications, and operators are shifting their focus towards embolic protection strategies and complex native-vessel interventions, increasingly using SVGs as conduits to facilitate native-vessel PCI rather than pursuing SVG PCI. In this Review, we discuss the differences in conduit pathophysiology, changes in CABG surgery techniques, and the latest evidence in terms of PCI in patients with previous CABG surgery, with a particular emphasis on safety and long-term efficacy. We explore the subject of contemporary CABG surgery and subsequent percutaneous revascularization in this complex patient population.

OUTCOMES AMONG PATIENTS WITH CORONARY ARTERY BYPASS GRAFTS PRESENTING WITH ACUTE CORONARY SYNDROME: ROLE OF PERCUTANEOUS CORONARY INTERVENTION

<h3>BACKGROUND</h3> Patients with complex coronary artery disease (CAD) are treated with coronary artery bypass graft surgery (CABG). Due to progressive atherosclerotic CAD, patients with previous CABG can present with an acute coronary syndrome (ACS). Robust data demonstrating prognostic benefit for revascularization over medical management in this patient population is lacking. Therefore, we evaluated patients with previous CABG presenting with ACS, to identify the long-term outcomes of repeat revascularization vs. medical management. <h3>METHODS AND RESULTS</h3> Using the Manitoba Center for Health Policy repository, we identified patients treated with CABG, who subsequently presented with ACS from January 1, 2000 to March 31, 2018. Patients were divided into 3 groups: 1) not investigated by cardiac catheterization and managed medically; investigated by cardiac catheterization and 2a) treated medically, and 2b) treated with percutaneous coronary intervention (PCI). An inverse probability treatment weighted survival in a propensity-matched cohort was calculated, 90 days post-discharge from hospital. A total of 20297 CABG patients were included. Nearly 25% of patients with previous CABG presented with an ACS at a median of 7.2 years (3.4-11.5 years) post-CABG. In propensity-matched cohorts, treatment with PCI [N=741, median age 70 years (62-77 years); 581/741 (78.4%) male] was associated with improved survival in comparison to those investigated by catheterization but treated medically [N=546, median age 71 years (62-78 years); 418/546 (76.6%) male] at 10-years of follow-up; adjusted hazard ratio HR: 0.87 (95% CI 0.77 - 0.97); p=0.02 (Table 1, Figure 1). Patients treated medically and not referred for cardiac catheterization [N=742, median age 78 years (71-84 years); 518/742 (69.8%) male] were older and had significantly higher mortality in comparison to those treated with PCI. Mortality benefit associated with PCI may be secondary to underlying coronary anatomy and severity of disease, however, we do not have individual patient level angiographic data. <h3>CONCLUSION</h3> ACS is not uncommon following CABG. Suitable patients should be revascularized given the association with improved outcomes; however, this may be accounted for by inherent differences in the patient populations and coronary anatomy. Further individual patient level data is required to identify observed mortality differences.

Effects of previous coronary artery bypass graft surgery on in-hospital mortality in ST-segment elevation myocardial infarction: National dataset analysis

Association of history of coronary artery bypass graft surgery (CABG) with clinical outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI) is unclear from current data.Using Nationwide Inpatient Sample (NIS) data from 2003 to 2014, adult patients hospitalized with principal diagnosis of STEMI were extracted. The cohort was divided into patients with a history of CABG and those without a history of CABG. The primary outcome measure was in-hospital mortality (IHM).2,710,375 STEMI patients were included in final analysis of which 110,066 had history of CABG. Patients with history of CABG had higher unadjusted (12.2% vs. 8.8%, P < 0.001) and adjusted (odds ratio [OR]1.16; 95% confidence interval [CI] 1.14 to1.19, P < 0.001) IHM compared to those without previous CABG. Compared to a trend of decreasing IHM in STEMI patients without previous CABG, a trend of increasing IHM was observed over the study period in those with a history of previous CABG. Although patients with previous CABG when treated with primary PCI (PPCI) had a higher unadjusted IHM compared to those without previous CABG, (4.8% vs 4.3%, P < 0.001), after adjusting for comorbidities and in-hospital complications no significant increase in IHM was observed in patients with previous CABG treated with PPCI.STEMI patients with previous CABG have a significantly higher IHM compared to those without previous CABG. PPCI improves IHM with no independent mortality disadvantage attributable to previous CABG.

Abstract 15630: Gender-related Differences in the Management of Chronic Coronary Syndrome: Registry Data of a Tertiary Center in Brazil

Introduction: There is scarce data on sex-related differences in chronic coronary syndrome (CCS) management in low-and-middle-income countries. We aimed to describe those in CCS patients in a tertiary center in Brazil. Hypothesis: Multiple gender-related differences may affect management of CCS and, subsequently, influence outcome in developing countries - improvement in tertiary care is justified. Methods: Patients from an outpatient clinic with known history of myocardial infarction (MI), coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), or stable angina with documented coronary artery lesions &gt; 50% were evaluated for differences regarding prescription, laboratory data, symptoms and other clinical variables. Patients were deemed to have optimal goal-directed therapy if blood pressure (BP) was &lt; 140/90 mmHg, LDL-cholesterol &lt; 70 mg/dL and were in use of antithrombotics. We also assessed incidence of MI, stroke or death. Results: 625 patients, 208 (33.3%) women and 417 men, were included. We found no sex-related differences in mean age (65 years, SD 9.6 for the cohort) or in prevalence of previous MI, CABG or PCI. Women had higher systolic BP (134 vs 128 mmHg, p &lt; 0.001), higher left ventricular ejection fraction (56 vs 51%, p &lt; 0.001), lower creatinine clearance (69 vs 73 mL/min, p= 0.04), and higher LDL (103 vs 87 mg/dL, p &lt; 0.001). We found no differences regarding glucose levels, BMI or symptoms. Women were less likely to be prescribed calcium-channel blockers (p = 0.04), but equally likely to be prescribed statins. Gender-related differences in LDL and BP were present even after adjustments. Women were less likely to have optimized goal-directed therapy (14.9% vs 28.3%, p &lt; 0.001), even after adjustments. Gender was not associated with event-free survival on one-year follow-up (97% vs 98%). Conclusions: In this setting, women had higher LDL-cholesterol, higher SBP, and lower proportion of optimized goal-directed therapy than men, but gender was not related to worse one-year prognosis.

Association between proprotein convertase subtilisin/kexin type 9 and late saphenous vein graft disease after coronary artery bypass grafting: a cross-sectional study

ObjectiveThe study aims to explore the association between serum proprotein convertase subtilisin/kexin type 9 (PCSK9) level and saphenous vein grafts disease (SVGD) after coronary artery bypass grafting (CABG).DesignA cross-sectional study.SettingA...

28 Complication rate of coronary angiography in patients with prior coronary artery bypass grafting

Background When consenting patients for elective coronary angiography, a risk of major complications such as death, stroke or myocardial infarction is quoted at 1–2 in 1000. However, what is the risk for patients who have had a prior coronary artery bypass graft surgery (CABG)? It is believed to be higher than the basic complication rate due to a lengthier, more complex procedure. We aim to estimate the complication rate in this cohort of patients, and identify factors that increase this risk. Methods Between April 2008 and August 2016, a cohort of 681 consecutive patients undergoing elective coronary angiography with a history of CABG was collected retrospectively from a district general hospital in London. The primary outcome was Major Adverse Cardiac or Cerebrovascular Events (MACCE-death, stroke, myocardial infarction). Our secondary outcome was vascular complications (pseudoaneurysm, ischaemic limb, retroperitoneal bleed, significant haematoma requiring transfusion). The complication rates were calculated and then a backward logistic regression model constructed to identify the strongest predictor variables. Results The 681 patient cohort consisted of 566 (83%) male patients and the mean age was 72 years (±9). The majority of cases (626, 92%) were performed transfemorally. The median procedural time was 45mins (IQR: 40–55). The overall MACCE rate was 23 per 1000. Vascular complications were observed at 5.9 per 1000. Using the regression model the single strongest predictor of MACE and vascular complications is procedural time. For every additional 10 min there is a 1.261 fold increase in risk of MACE (95% CI: 1.111–1.596, p=0.042), and a 1.826 fold increase in risk of vascular complications (95% CI: 1.309–2.137, p=0.001). Conclusion The findings of this study estimates the MACE and vascular complication rates in patients with a previous CABG at 23 per 1000 and 5.9 per 1000 respectively. It demonstrates that procedural time is a strongest predictor of either of these complications.

62 Angiography after cabg surgery; solving the problem of missing surgical records with a sternal wire code

Background The recommendation that surgical records (graft notes) are obtained before coronary angiography in patients with previous coronary artery bypass graft (CABG) surgery is not always followed. Lack of prior information on the number and origin of grafts increases procedure time, complexity and risk to patients. Here, we determine the proportion of angiograms undertaken without graft notes, and propose a code to permanently provide this information. Methods For patients undergoing angiography at the Barts Heart Centre, London (September 2015-September 2016), records of patients with previous CABG were retrieved. From the procedure reports, we identified patients without graft notes and the indication for the angiogram. Results Of 6483 patients undergoing angiography, 559 had undergone previous CABG surgery; graft notes were unavailable in 91/559 patients (16%). In 88/91 patients (97%), angiography was an unplanned emergency procedure; 84 acute coronary syndromes and 4 out-of-hospital arrests. Three patients had planned angiograms for stable angina. In 20/91 patients additional imaging investigations were required because of uncertainty over whether all grafts had been identified and one patient consequently developed pulmonary oedema due to a large contrast load. Conclusion About 1 in 6 patients with previous CABG surgery, who require coronary angiography, undergo this procedure without graft notes, almost all in the emergency setting. A clinical code, based on the orientation of the wires used to close the sternum after CABG, could provide a permanent record of the number and origin of the surgical grafts (see Table). We propose that this code, which requires no new technology or technique, be adopted routinely in CABG surgery.

Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry

BackgroundHigh patient radiation dose during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) might lead to procedural failure and radiation skin injury. MethodsWe examined the association between several clinical and angiographic variables on patient air kerma (AK) radiation dose among 748 consecutive CTO PCIs performed at 9 experienced US centres between May 2012 and May 2015. ResultsThe mean age was 65 ± 10 years, 87% of patients were men, and 35% had previous coronary artery bypass graft surgery (CABG). Technical and procedural success was 92% and 90%, respectively. The median patient AK dose was 3.40 (interquartile range, 2.00-5.40) Gy and 34% of the patients received > 4.8 Gy (high radiation exposure). In univariable analysis male sex (P = 0.016), high body mass index (P < 0.001), history of hyperlipidemia (P = 0.023), previous CABG (P < 0.001), moderate or severe calcification (P < 0.001), tortuosity (P < 0.001), proximal cap ambiguity (P = 0.001), distal cap at a bifurcation (P = 0.006), longer CTO occlusion length (P < 0.001), blunt/no blunt stump (P < 0.001), and centre (P < 0.001) were associated with higher patient AK dose. In multivariable analysis high body mass index (P < 0.001), previous CABG (P = 0.005), moderate or severe calcification (P = 0.005), longer CTO occlusion length (P < 0.001), and centre (P < 0.001) were independently associated with higher patient AK dose. ConclusionsApproximately 1 in 3 patients who undergo CTO PCI receive high AK radiation dose (> 4.8 Gy). Several baseline clinical and angiographic characteristics can help predict the likelihood of high radiation dose and assist with intensifying efforts to reduce radiation exposure for the patient and the operator.

Outcomes Following Primary Percutaneous Coronary Intervention in Patients With Previous Coronary Artery Bypass Surgery.

There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting with ST-segment-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). We report outcomes in patients with STEMI undergoing PPCI with or without previous CABG surgery in a large real-world, all-comer population. Clinical, demographic, procedural, and outcomes data were collected for all patients undergoing PPCI in England and Wales from January 2007 to December 2012. All-cause mortality at 30 days and 1 year were evaluated in the whole and a propensity-matched cohort. Of 79 295 patients with STEMI studied, 2658 (3.4%) patients had prior CABG, of whom 44% (n=1168) underwent PPCI to native vessels and 56% (n=1490) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. Patients with prior CABG (with primary PCI to native artery or graft) had higher mortality at 30 days (6.2% with PPCI to native artery, 6.1% with PPCI to bypass graft) than patients with no prior CABG (4.5%; P<0.001). However, after risk factor adjustments, there was no significant difference in outcomes. There were also no significant differences in 30-day mortality, in-hospital major adverse cardiovascular events, in-hospital stroke, and in-hospital bleeding in the propensity-matched population. A prior history of CABG in patients presenting with STEMI and undergoing PPCI does not independently confer additional risk of mortality, although it is a marker of other high-risk features.

Echocardiographic evaluation of cardiac function response to removal of aortic stenosis: Surgical and trans-catheter aortic valve implantation (TAVI)

&lt;p&gt;Aortic stenosis (AS) is the commonest valve disease in the&lt;/p&gt;&lt;p&gt;West, with a prevalence varying between 0.02% in adults&lt;/p&gt;&lt;p&gt;under 44 years and 3-9% in those over 80 years of age &lt;span&gt;1, 2&lt;/span&gt;. The&lt;/p&gt;&lt;p&gt;disease may remain “silent” and hence unnoticed for years,&lt;/p&gt;&lt;p&gt;particularly in the elderly with naturally limited exercise. With the&lt;/p&gt;&lt;p&gt;development of symptoms, patients may carry a mortality of&lt;/p&gt;&lt;p&gt;36-52%, 52-80% and 80-90% at 3, 5 and 10 years, respectively&lt;/p&gt;&lt;p&gt;if left untreated, with a potential high risk of sudden death &lt;span&gt;3&lt;/span&gt;.&lt;/p&gt;&lt;p&gt;Surgical aortic valve replacement (SAVR) used to be the only&lt;/p&gt;&lt;p&gt;effective treatment for severe AS, being the second indication&lt;/p&gt;&lt;p&gt;for open heart surgery after coronary artery bypass grafting&lt;/p&gt;&lt;p&gt;(CABG) &lt;span&gt;4&lt;/span&gt;. Trans-catheter aortic valve implantation (TAVI) is a&lt;/p&gt;&lt;p&gt;recently developed procedure which aims at non-surgical AVR&lt;/p&gt;&lt;p&gt;in patients with severe, symptomatic and calcified AS who&lt;/p&gt;&lt;p&gt;are at high surgical risk because of either poor left ventricular&lt;/p&gt;&lt;p&gt;(LV) function, ejection fraction (EF) &amp;lt;50%, or other significant&lt;/p&gt;&lt;p&gt;co-morbidities e.g. age &amp;gt;80 years, previous CABG surgery and/&lt;/p&gt;&lt;p&gt;or aorta or other heart valve surgery, impaired kidney function,&lt;/p&gt;&lt;p&gt;chronic obstructive pulmonary disease (COPD) or pulmonary&lt;/p&gt;&lt;p&gt;hypertension &lt;span&gt;5&lt;/span&gt;. Currently, this technique is not recommended&lt;/p&gt;&lt;p&gt;in bicuspid AS patients due to the risk of incomplete and&lt;/p&gt;&lt;p&gt;suboptimal deployment of the aortic prosthesis [6]. TAVI&lt;/p&gt;&lt;p&gt;avoids open heart surgery and hence is likely to protect&lt;/p&gt;&lt;p&gt;myocardial function. The purpose of this paper is to review the&lt;/p&gt;&lt;p&gt;echocardiographic evaluation of LV, right ventricular (RV), and&lt;/p&gt;&lt;p&gt;left atrial (LA) function response to SAVR and TAVI for AS.&lt;/p&gt;

Retraction note: Meta-analysis of the effect of percutaneous coronary intervention on chronic total coronary occlusions.

Coronary chronic total occlusion (CTO) is the last stage of coronary artery atherosclerosis. Percutaneous coronary intervention (PCI) is a therapeutic procedure used to recanalize vessels with total occlusion. However, successful recanalization of CTO is still not optimal, and the key influence factors are still uncertainty. Therefore, a scientific evaluation on the effective of PCI for CTO treatment is necessary. Relevant studies of PCI treatment for CTO were examined. Data were extracted and assessed by two independent clinical experts. Embase, PubMed and Medline et al. were used as database. The main research key words include “CTO”, “PCI”, “Stent”, “Reopen”, “long-term”, “follow-up” and “outcome”. Quality assessment was carried out according to the Cochrane Handbook. The selected data were pooled and analyzed using fixed-effect model and random-effect model. Heterogeneity was assessed using the I 2 test, Q test, L’abbe and Galbraith. Comprehensive Meta -Analysis 2.0 and Metanalysis 1.0 were used for statistics analysis in this research. A total of 16 articles involving 6695 cases in successful CTO recanalization (CTO success group) and 2370 cases in failed CTO recanalization(CTO failure group) were included in this research. Low CTO success was associated with elder age, previous coronary artery bypass graft surgery (CABG) history, multi-vessel diseases and right coronary artery disease lesion. Six follow-up variables including major adverse cardiac events (MACE), recurrent myocardial infarction (MI), all-cause death, incidence of angina, subsequent CABG and cumulative survival rate were found significantly reduced associated with CTO success. Clinical baseline characteristics such as age, previous CABG history and lesion baseline characteristics such as lesion length, multi-vessel diseases might be important factors influencing the successful rate of CTO recanalization. Compared to CTO failure patients, all six follow-up variables showed advantage for CTO success patients.

Application of the “Hybrid Approach” to Chronic Total Occlusions in Patients With Previous Coronary Artery Bypass Graft Surgery (from a Contemporary Multicenter US Registry)

Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been traditionally associated with lower success rates in patients with previous coronary artery bypass graft surgery (CABG). We sought to examine the success and complication rates of CTO PCI using the "hybrid" crossing algorithm among patients with a history of previous CABG. The procedural outcomes of 496 consecutive CTO PCIs performed at 5 high-volume PCI centers in the United States from January 2012 to August 2013 were assessed. The outcomes of patients with previous CABG were compared with those of patients without previous CABG. Compared with patients without previous CABG (n = 320), patients with previous CABG (n = 176, 35%) were older, had more coronary artery disease risk factors, and had less favorable baseline angiographic CTO characteristics. Technical and procedural success was slightly lower among patients with previous CABG (88.1% vs 93.4%, p = 0.044 and 87.5 vs 92.5%, p = 0.07, respectively). Patients with previous CABG more commonly underwent CTO PCI using the retrograde approach (39% vs 24%, respectively, p <0.001) and received higher air kerma radiation exposure (4.8 [interquartile range 3.0 to 6.4] vs 3.1 [1.9 to 5.3] Gray, p <0.001) and fluoroscopy time (59 [38 to 77] vs 34 [21 to 55] minutes, p <0.001). Major procedural complications were similar in the 2 groups: 2 of 176 (1.1%) patients with previous CABG versus 7 of 320 (2.1%) patients without previous CABG (p = 0.40). In conclusion, with application of the "hybrid" approach to CTO PCI, success was slightly lower, and complication rates were similar between patients with and without previous CABG.

Computed tomography angiography of coronary artery bypass grafts: robustness in emergency and clinical routine settings

There is a high probability for presence of irregular heart rates and artifacts in patients with previous coronary artery bypass graft (CABG) surgery. Previously reported diagnostic performance of ECG-gated 64-slice dual-source computer tomography angiography (CTA) in this patient group is based on pre-selection for normal heart rate and routine clinical setting. To investigate image quality and diagnostic performance of CTA in patients with previous CABG surgery in various clinical settings. Fifty-six non-selected, consecutive patients (110 grafts, 44 arterial, 66 venous) with previous CABG surgery were prospectively examined using a dual-source 64-slice CT (Siemens Definition, Forchheim, Germany) without utilization of CT-related pharmaceutical heart rate control. Patients were stratified according to the clinical setting: planned redo-cardiac surgery; emergency CTA within 30 days after CABG surgery; routine follow-up after CABG surgery. A reference standard was available for 30 patients (53.6%; 67/110 grafts). Image quality, artifacts, and graft patency were independently assessed by two observers. All CTAs were diagnostic despite the presence of irregular heart rhythm (25% of cases) and artifacts (72.7% of grafts). CTA was accurate in all patient groups in assessing graft patency (97.9% sensitivity; 100% specificity; 98.5% accuracy) but artifacts decreased diagnostic performance for stenosis detection (60% sensitivity; 88.6% specificity; 84.1% accuracy). Arterial grafts exhibited more surgical clip artifacts compared to venous grafts, which predominantly showed motion artifacts. Overall diagnostic quality was rated excellent in 70.9%/56.4%, good in 23.4%/39.1%, and sufficient in 5.5%/4.5% by each observer, respectively. CTA detected acute findings in 10 cases (graft bleeding, graft occlusion, pericardial hematoma, sternal instability with retrosternal abscess formation, pericardial effusion, left ventricle thrombus) in the emergency group; seven cases required surgical revision. Dual-source CTA is a robust and accurate method for assessment of graft patency and detection of relevant extra-cardiac pathologies in a non-selected patient population after CABG surgery in routine as well as emergency clinical settings. Artifacts caused by irregular heart rhythm or surgical clips do not impair graft patency evaluation but limit stenosis assessment.

RETRACTED ARTICLE: Meta-analysis of the effect of percutaneous coronary intervention on chronic total coronary occlusions

Background and purposeCoronary chronic total occlusion (CTO) is the last stage of coronary artery atherosclerosis. Percutaneous coronary intervention (PCI) is a therapeutic procedure used to recanalize vessels with total occlusion. However, successful recanalization of CTO is still not optimal, and the key influence factors are still uncertainty. Therefore, a scientific evaluation on the effective of PCI for CTO treatment is necessary.MethodsRelevant studies of PCI treatment for CTO were examined. Data were extracted and assessed by two independent clinical experts. Embase, PubMed and Medline et al. were used as database. The main research key words include “CTO”, “PCI”, “Stent”, “Reopen”, “long-term”, “follow-up” and “outcome”. Quality assessment was carried out according to the Cochrane Handbook. The selected data were pooled and analyzed using fixed-effect model and random-effect model. Heterogeneity was assessed using the I2 test, Q test, L’abbe and Galbraith. Comprehensive Meta -Analysis 2.0 and Metanalysis 1.0 were used for statistics analysis in this research.ResultsA total of 16 articles involving 6695 cases in successful CTO recanalization (CTO success group) and 2370 cases in failed CTO recanalization(CTO failure group) were included in this research. Low CTO success was associated with elder age, previous coronary artery bypass graft surgery (CABG) history, multi-vessel diseases and right coronary artery disease lesion. Six follow-up variables including major adverse cardiac events (MACE), recurrent myocardial infarction (MI), all-cause death, incidence of angina, subsequent CABG and cumulative survival rate were found significantly reduced associated with CTO success.ConclusionsClinical baseline characteristics such as age, previous CABG history and lesion baseline characteristics such as lesion length, multi-vessel diseases might be important factors influencing the successful rate of CTO recanalization. Compared to CTO failure patients, all six follow-up variables showed advantage for CTO success patients.

Coronary artery bypass graft surgery during heart transplantation

We report the case of a patient who was submitted to coronary artery bypass graft surgery (CABG) during heart transplant as, during bench exploration, the donor heart presented a palpable atherosclerotic lesion in the anterior descending artery, not detected before harvesting. The patent internal thoracic artery from a previous CABG was used.