Results Of Myocardial Revascularization Research Articles

Results of myocardial revascularization in patients with acute coronary syndrome and COVID-19: experience of the urban multidisciplinary hospital

Background. The 2019 novel coronavirus pandemic has had a significant impact on the prognosis and outcomes of patients with acute coronary syndrome (ACS).Objective. Study of the impact of a new coronavirus infection (NCI) on the nature of the course and outcomes of the disease in patients with ACS.Materials and methods. The study included patients with ACS and a positive test for COVID-19 upon admission to the hospital in the period from April 2020 to August 2021.Results. The study included 107 patients. Among patients with and without ST elevation with more than 50 % lesions (n = 10; n = 10), 8 patients died, which was 80 % in each group. In the group with and without ST elevation with less than 50 % involvement (n = 20; n = 67), 5 and 8 patients died, accounting for 25 % and 11.9 %, respectively. The role of the influence of the levels of Il-6 (interleukin-6), troponin T and creatinine on the course and outcomes of the patients’ disease was analyzed.Conclusion. COVID-19 infection, namely the degree of damage to the lung tissue, significantly worsens the course and outcomes in patients with both NSTE-ACS and STE-ACS. Further accumulation of clinical experience in endovascular treatment of ACS and the development of algorithms for providing medical care to patients with ACS in the context of COVID-19 is required.

Viddalena efektyvnist revaskuliaryzatsii miokarda u khvorykh pislia perenesenoho hostroho koronarnoho syndromu (literaturnyi ohliad; rezultaty vlasnykh doslidzhen)

Introduction. Acute coronary syndrome (ACS) is an urgent problem in the world. The vast majority of publications indicate the effectiveness of myocardial revascularization in this pathology. However, the effectiveness of this method of treatment in the remote period of GIMeST has not been sufficiently studied. The aim of the study. Analyze the long-term effectiveness of myocardial revascularization in patients after ACS based on literature publications and own results of conducted research. Materials and methods. 42 sources of published literature were used and the results of our own research on increasing the clinical effectiveness of coronary artery stenting by combining it with medical treatment in patients with post-STEMI with cardiovascular events were presented. Results. It has been proven that the 30-month survival rate of a patient with a hemodynamically significant lesion of the coronary artery trunk with drug therapy was 6.4 %, and with CABG – 80.0 %. The best results of myocardial revascularization were observed with CA p-value more than 70.0 % stenosis. It was found that primary coronary intervention in comparison with thrombolytic therapy contributes to a more complete restoration of epicardial impact (III degree according to the TIMI scale). Successful endovascular recanalization of infarct-induced KA helps to limit the area of necrosis and restore the reduced inotropic function of the hibernating myocardium up to 2 hours after the start of ACS. In the later periods of restoration of anterograde blood flow, the beneficial effect is manifested within a year. On the basis of our own research, positive dynamics of improvement in late LV remodeling and reduction of cardiac arrhythmias (SHE, AF, LVPH, and HF) are observed in patients with post-GIMeST after medical treatment. Conclusions. On the basis of the cited literary sources and our own research, it should be noted that in patients who underwent STEMI with cardiovascular events compared to those without cardiovascular events and underwent myocardial revascularization and outpatient drug treatment for two years, there was an increase in LVEF by 12.6 %, respectively, and a decrease in angina attacks by 6.6 %, CHF III and II FC – by 11.9 %, reduces SHE, AF and BLPNH and improves the quality of life. However, mortality 2 years after myocardial revascularization compared with medical treatment did not change significantly, and according to the literature, it decreased after CABG.

Results of myocardial revascularization using two thoracic internal arteries under general anesthesia

Objective. To evaluate the efficiency and safety of using two thoracic internal arteries during myocardial revascularization.Materials and methods. The study included 32 patients over 18 years of age who were operated on for coronary artery diseases using two internal arteries as an auto-graft. The incidence of postoperative complications was assessed taking into account the proposed criteria for selecting patients.Results. No increase in the number of postoperative complications in the early postoperative period was detected during bilateral internal thoracic artery coronary artery bypass graft.Conclusion. Coronary bypass grafting using two internal thoracic arteries under general multicomponent balanced anesthesia is an effective and safe method of myocardial revascularization. It does not increase the risk of complications in the postoperative period with proper selection of patients.

Reasonable Incomplete Myocardial Revascularization in Patients with Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction

The aim. To evaluate the results of incomplete myocardial revascularization with percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy and heart failure with reduced left ventricular ejection fraction based on the residual SYNTAX Score (rSS) scale.
 Materials and methods. This prospective observational one-center study was conducted at the Ukrainian Children’s Cardiac Center, Clinic for Adults and included 192 patients whounderwent coronary angiography and myocardial re-vascularization using PCI. Baseline demographic and clinical parameters, including gender, age, presence of comorbid pathology were obtained from the medical history of each patient retrospectively. The results of revascularization were evaluated over a period of 2 years (from March 2020 to March 2022). To assess the completeness of revascularization, the rSS scale was used, and coronary angiography was repeated.
 Results and discussion. The most significant adverse events during 24 months of follow-up, associated with the severity of coronary artery damage according to the SYNTAX scale ≥23 points, were: death from any cause with odds ratio (OR) 6.9 (95% CI, p = 0.05); myocardial infarction (MI) with OR 5.5 (95% CI, p = 0.001); the combined endpoint was OR 2.4 (95% CI, p = 0.005). Over a 2-year follow-up period,results of myocardial revascularization according to the rSS scale were evaluated the effect of coronary artery stenting with minimal residual atherosclerotic narrowing (rSS ≤8) and significant arterial lesions (rSS ≥9) on indicators such as all-cause mortality, myocardial revascularization, re-hospitalization, recurrent acute MI and stroke were analyzed. Data analysis showed statistically significant difference in all indicators in favor of the group with a score of rSS ≤8 (р <0.05).
 Conclusions. The rSS scale in patients with coronary artery disease and heart failure with reduced left ventricular ejection fraction after PCI is a statistically significant criterion for the impact on the combined endpoint. In addition, an rSS score ≥9 was associated with a significantly higher riskof all-cause mortality, recurrent acute MI, and recurrent revascularization. A stratified rSS score ≥9 in ischemic cardiomyopathy with left ventricular ejection fraction ≤40% was more often observed in patients with existing comorbid pathology, such as hypertension, diabetes mellitus, stroke, peripheral artery disease.

What is better for a patient with stable coronary artery disease — bypass surgery or percutaneous coronary intervention?

Background: The main methods of treating patients with stable coronary artery disease (CAD) are myocardial revascularization with coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI). These are two fundamentally different in technique and volume of surgical interventions; PCI is associated with rapid rehabilitation of the patient, and only CABG demonstrated effective in survival benefit.
 Aims: Comparison of the long-term results of myocardial revascularization with CABG and PCI in patients with stable CAD.
 Methods: The results of a prospective one-center cohort study of 369 patients with stable CAD are presented, the average age is 60.1 5.4 years. Patients were randomized into 2 groups by the Heart Team: CABG (n = 196) and PCI (n = 173). In each group, subgroups were identified depending on the severity of the coronary lesion, and the CABG group was also separately studied in according to CABG technique ― beating-heart (off-pump) and with cardiopulmonary bypass (on-pump). The average follow-up was 54.3 7 months. The main outcomes of the study were major adverse cardiac and cerebral events (MACCE): death from all causes, cardiac mortality, nonfatal myocardial infarction (MI), nonfatal stroke and repeated coronary revascularization.
 Results: Over the 5-year follow-up period, no differences were found between the CABG and PCI groups with a low complexity of coronary artery lesions (SYNTAX Score 14.2 4.8) in terms of survival, cardiac mortality, nonfatal MI and stroke, and the need for repeated myocardial revascularization. Patients with stenosis of the left main coronary artery (LMCA) and/or multivascular CA disease (SYNTAX Score 25.8 5.0) in the long-term follow-up after CABG and PCI did not differ in MACCE, but the CABG group demonstrated a significant advantage in repeated myocardial revascularization. No significant differences were found in any study endpoint in patients after CABG on-pump versus off-pump.
 Conclusions: Our study demonstrates the advantage of CABG in patients with stable CAD with stenosis of the LMCA and/or multivascular CA disease, and which CABG technique should depends on the comorbidity of the patient, the experience of the surgeon and the surgical center.

Features of coronary artery bypass grafting in young patients with acute coronary syndrome

Aim: Purpose of the study was retrospective analysis of hospital and early (up to six monthes after operation) results of the surgical myocardial revascularization in patients, third and fourth decates of life, with acute coronary syndrome. Material and Methods: Since 2012 year up to November, 2018 year in CCH by the same brigade, performed 500 coronary artery bypass grafting operations in the patients with acute coronary syndrome, at the age of 30-83 years old, including 15 operations in patients ≤ 40 years old (3%). Clinical manifestation of acute coronary syndrome was presented: unstable angina in 13 (86.7%) patients, 6 (40%) of them with pass myocardial infarction in anamnesis; acute myocardial infarction, accompanied by S-T segment elevation (STEMI) in 2 (13.3%) patients. In coronarography: multivessel lesion of coronary arteries was revealed in 10 (66.7%) patients, 3 of them with lesion of trunk of the left coronary artery; bivascular lesion in 4 (26.7%) patients, single vessel lesion in 1 (6.6%). In 13 (86.7%) patients were performed coronary artery bypass grafting under the cardiopulmonary bypass (CPB). Average duration of the CPB= 127±9.66 min. Mean aortic clamp time = 68±6.91 min. Number of shunts for the whole group of 15 operated were from 1 to 5, at the average (3.28±0.31). In 6 patients (40%) performed three-branches CPB, in 5 patients (33.3%) fourth-branches, in 1 patient (6.7%) fifth-branches, in 2 patients (13.3%) double-branches and in 1 patient (6.7%) single branch CPB. Used conduits: left internal mammary artery in all 15 patients (100%), autovein in 12 (80%), radial artery in 10 (66.7%) patients. In last group with using radial artery, average amount of shunts was 1.5±0.1. Results: The structure of postoperative complications consist: low cardiac output syndrome in two patients; bleeding in 2 patients. In analyzed series, no lethal outcomes watched in duration up to 30 days after operation. All patients were watched during 6 monthes after discharge. It was not watches necessity for reinterventions and lethal outcomes. Conclusion: Hospital and immediate results of myocardial revascularization in young people with acute coronary syndrome very encouraging, while long-term results are not so optimistic and unsatisfactory. Therefor, considering the long life expectancy and higher functional and social demands of the patients at age ≤ 40 years, preference is given to hybrid interventions or isolated shunting using arterial conduits in both variants of revascularization.

Пятилетние результаты реваскуляризации миокарда больных стабильной ишемической болезнью сердца со стенозом ствола левой коронарной артерии и/или многососудистым поражением коронарного русла

Пятилетние результаты реваскуляризации миокарда больных стабильной ишемической болезнью сердца со стенозом ствола левой коронарной артерии и/или многососудистым поражением коронарного русла

Analysis of the immediate results of myocardial revascularization in patients with stable coronary artery disease

Analysis of the immediate results of myocardial revascularization in patients with stable coronary artery disease

Electrocardiographic biomarkers of metabolic cardiomyopathy and their association with long-term results of myocardial revascularization in men with coronary atherosclerosis

Electrocardiographic biomarkers of metabolic cardiomyopathy and their association with long-term results of myocardial revascularization in men with coronary atherosclerosis

Invited Commentary

The population prevalence of patients receiving hemodialysis (HD) due to end stage renal disease is progressively increasing, and cardiovascular complications have been identified as the most common cause of death in these patients [1U.S. Renal Data System2011 Atlas of CKD and ESRD.http://www.usrds.org/atlas.aspxGoogle Scholar]. As a consequence, cardiac operations on HD patients are becoming more common. Traditionally, the results of myocardial revascularization in these patients have been poor because of advanced coronary disease and complications from the underlying condition. Indeed, guidelines from the European Society of Cardiology on myocardial revascularization suggest accounting for the general condition of the HD patient and life expectancy when considering a revascularization strategy [2Kolh P. Wijns W. Danchin N. et al.Guidelines on myocardial revascularization.Eur J Cardiothorac Surg. 2010; 38: S1-S52Crossref PubMed Scopus (316) Google Scholar]. The article by Takami and colleagues provides important new data on predictors of early and late outcomes after coronary artery bypass grafting (CABG) in HD patients [3Takami Y. Tajima K. Kato W. et al.Predictors for early and late outcomes after coronary artery bypass grafting in hemodialysis patients.Ann Thorac Surg. 2012; 94: 1940-1946Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar]. In their retrospective analysis of 152 HD patients, the authors found a significant reduction in hospital mortality with the introduction of an off-pump coronary artery bypass (OPCAB) in 2003. Early mortality decreased from 15.3% in the pre-OPCAB era to 6.3% afterward. Crude mortality in these patients is still significantly higher that in the general CABG population, but the improvement associated with the introduction of OPCAB in their experience was noteworthy. The effect of off-pump CABG on renal function in non-HD patients remains controversial [4Lamy A. Devereaux P.J. Prabhakaran D. et al.Off-pup or on-pump coronary artery bypass grafting at 30 days.N Eng J Med. 2012; 366: 1489-1497Crossref PubMed Scopus (530) Google Scholar, 5Elmistekawy E. Chan V. Bourke M.E. et al.Off-pump coronary artery bypass grafting does not preserve renal function better than on-pump coronary artery bypass grafting: results of a case-matched study.J Thorac Cardiovasc Surg. 2012; 143: 85-92Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar], but OPCAB may confer a clear benefit in the specific subgroup of HD patients. One may speculate as to the possible mechanisms leading to this association, with OPCAB potentially resulting in less manipulations of the aorta, a lower need for transfusion, volume replacement and hemodilution, and therefore fewer strokes, a shorter duration of mechanical ventilation, and a lower incidence of infections. Another important finding of this study was that the long-term survival of HD patients who underwent CABG appeared equivalent to that of HD patients who did not undergo myocardial revascularization. Thus, despite the high early mortality, CABG effectively returns HD patients to their life expectancy curve. Although indication bias in selecting patients was likely in Takami's study, this finding carries important implications for the patient and clinician when considering HD patients for coronary surgery. External validation by further studies will be needed to confirm whether OPCAB is indeed the optimal strategy for myocardial revascularization in HD patients. Moreover, future studies may consider the role of minimally invasive procedures such as minimally invasive cardiac surgery-CABG in further reducing surgical trauma [6McGinn Jr, J.T. Usman S. Lapierre H. Pothula V.R. Mesana T.G. Ruel M. Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients.Circulation. 2009; 120: S78-S84Crossref PubMed Scopus (139) Google Scholar], considering that mediastinitis is the most common fatal complication in HD patients after conventional surgery [7Liu J.Y. Birkmeyer J.O. Sanders J.H. et al.Risk of morbidity and mortality in dyalisis patients undergoing coronary artery bypass surgery.Circulation. 2000; 102: 2973-2977Crossref PubMed Scopus (192) Google Scholar]. Predictors for Early and Late Outcomes After Coronary Artery Bypass Grafting in Hemodialysis PatientsThe Annals of Thoracic SurgeryVol. 94Issue 6PreviewMarkedly higher hospital and long-term mortality after coronary artery bypass grafting (CABG) have been reported in hemodialysis (HD)-dependent patients. We tried to identify the predictors for short-term and long-term outcomes after CABG, which have not been well studied. Full-Text PDF

Physiological Evaluation of the Results of Myocardial Revascularization in Patients with Ischemic Heart Disease

Intraoperative assessment of the myocardial blood flow was performed in different heart areas in 94 patients with ischemic heart disease prior to and after myocardial revascularization. An ALF-21 laser–Doppler flowmeter (Transonic Systems Inc.) was used to measure the myocardial blood flow near the anterior and posterior surfaces of the left ventricle (LVasand LVps, respectively) and the anterior surface of the right ventricle (RVas). According to the results of revascularization, the patients were divided into four groups: group I with increased myocardial blood flow in all areas tested, group II and group III with blood flow redistributed along LV and RV, and group IV with moderately decreased myocardial blood flow in all test areas. All groups showed a postoperative decrease in blood flow differences between different myocardium areas and the leveling of blood flow in the whole myocardium. The efficiency of revascularization depended on a number of factors, including the initial level of myocardial blood flow, completeness of revascularization of ischemic areas, the number and quality of bypass grafts, and the patients' age. The most pronounced positive results were observed in patients under the age of 60 years.

Revascularização do miocárdio em idosos

Com o objetivo de conhecer a população de idosos submetida a revascularização do miocárdio com uso de circulação extracorpórea e sua morbimortalidade, realizou-se estudo retrospectivo de 41 pacientes, com idade igual ou superior a 70 anos (média de 73,2 anos). Houve predomínio do sexo masculino (65,8%), triarteriais (70,7%) com angina instável (65,8%). Esses pacientes foram estudados segundo faixa etária, raça, sexo, clínica pré-operatória, achados eletrocardiográficos, radiológicos e cinecoronariográficos, evolução pós-operatória e suas complicações. Procedeu-se a análise estatística segundo teste T de Student, teste do Qui-quadrado e teste exato de Fischer. Ocorreram 19,2% de complicações menores. A mortalidade global foi de 9,8%, sendo maior em mulheres (21,4%). A alta hospitalar ocorreu em média no sétimo dia do pós-operatório. Os autores concluem que é possível realizar a revascularização do miocárdio com circulação extracorpórea em idosos com baixa morbimortalidade.

Initial Clinical Results of Myocardial Revascularization with the Internal Mammary Artery for Evolving Myocardial Infarction

In 25 patients undergoing emergency revascularization for an evolving myocardial infarction, the internal mammary artery (IMA) was used as graft. To bridge the time needed for harvesting the IMA, the left ventricle was totally decompressed by means of the extracorporeal circulation. Cardioplegia was delivered retrogradely, in order to achieve a good distribution in the jeopardized area. One patient died postoperatively, and eight patients showed a postoperative myocardial infarction. These initial results suggest that, with an adapted operative strategy, the IMA can be used as graft even in emergency revascularization.

Results of myocardial revascularization in black males

The impact of black-white differences in the prevalence of risk factors for coronary heart disease on the outcome of coronary bypass surgery has not been well defined. Preoperative status, coronary anatomy, and surgical results were reviewed in 54 black males operated on between December 1970 and August 1983. With the use of criteria established by the New York Heart Association, five patients were classified in class II, 34 were in class III, and 15 were in class IV. Five patients had unstable angina. The most common risk factor, cigarette smoking, occurred in 43 patients (80%). Thirty patients (56%) had hypertension, 10 (19%) were diabetic, 14 (26%) were obese, and 23 (43%) had a family history of coronary disease. Elevated cholesterol and triglyceride levels were present in 8 and 12 patients, respectively. An average of 2.9 grafts per patient was placed. Overall operative mortality was 5.6%. Prior to the use of cardioplegia in 1978, there were two deaths among 14 patients (mortality, 14%). Since 1978 there has been one death among 40 patients (mortality, 2.5%). Although immediate operative mortality appears not to be affected by black-white status, long-term prognosis may be influence significantly by the high prevalence of hypertension and diabetes and the lower prevalence of hyperlipidemia among black patients.

Influence of partial sympathetic denervation on the results of myocardial revascularization in variant angina

Poor results of the aortocoronary bypass graft operation in the treatment of variant angina have been ascribed to recurrent vasospastic activity due to autonomic imbalance. Cardiac sympathetic denervation (plexectomy) may represent a rational approach in the prevention of vasospasm. To test the value of plexectomy in the treatment of variant angina, 31 patients were studied, 17 of whom (Group 1) underwent conventional coronary artery grafting whereas the remaining 14 (Group 2) underwent cardiac sympathetic denervation also. The 2 groups were similar with respect to age (54 +/- 8 versus 50 +/- 7 years), sex distribution (male/female ratio 12/5 versus 9/5), prevalence of coexisting effort angina (10 versus 12 patients), previous myocardial infarction (7 versus 4 patients), and duration of variant angina (3.3 +/- 5.4 versus 2.4 +/- 2.7 months). The left ventricular ejection fraction was comparable in both groups (60 +/- 11 versus 60 +/- 4%) as were left ventricular end-diastolic pressure (15 +/- 4 versus 13 +/- 5 mm Hg) and extent of coronary artery disease (65 versus 71% prevalence of multivessel disease). The average duration of follow-up was 23 +/- 15 months in Group 1 and 22 +/- 18 months in Group 2 (p = not significant [NS]). There were no operative deaths. Four patients, 2 in each group, had a perioperative myocardial infarction. Seven patients in Group 1 and 1 patient in Group 2 had recurrent variant angina. There was sudden death and 2 infarcts in Group 1. Actuarial curves showed the cumulative probability of recurrent variant angina to be significantly lower (p less than 0.05 and p less than 0.001 at 6 and 10 months, respectively) in Group 2. This study suggests that cardiac sympathetic denervation may prevent recurrent vasospastic activity in variant angina.

Long-term results of myocardial revascularization

During 1970 to 1977, among 1,733 patients who underwent isolated coronary bypass grafting, the operative mortality was 2.5 percent. Actuarial 5 year survival is 88.1 percent. At an average follow-up of 46 months (range 13 to 108), 90 percent of patients remain angina-free or with symptomatic improvement. The 5 year survival rate of patients with single vessel coronary artery disease is 97.9 percent. In patients with multivessel disease, operative survival appears to be favorably influenced by the presence of normal preoperative ventricular function. Late survival is significantly better in patients with multivessel disease with normal preoperative ventricular function or with complete revascularization. Risk of perioperative myocardial infarction has been appreciably reduced by the introduction of cold potassium chloride cardioplegia. Late myocardial infarction has occurred at an average annual risk of 1.46 percent. These data show that long-term survival and a small incidence of late myocardial infarction after myocardial revascularization are more likely in patients who undergo complete revascularization before significant left ventricular myocardial damage has occurred.

Asymptomatic coronary artery disease managed by myocardial revascularization: results at 5 years.

A consecutive series of 17 patients surgically treated for asymptomatic coronary artery disease was surveyed for survival, clinical status, and graft patency after a mean follow-up of 75 months. Documented myocardial infarction (MI), 14 transmural and 3 subendocardial, was the major indication for catheterization. All patients were asymptomatic for at least 4 months prior to surgery. Six patients had greater than 70% obstruction in one vessel, seven in two vessels, and four in three vessels. The indication for revascularization was critical stenoses in vessels supplying large areas of viable myocardium. All patients received left internal mammary artery (LIMA) grafts to the left anterior descending coronary artery; seven patients also received saphenous vein grafts (SVG) to other vessels. There was no operative or late mortality. In 12 patients, postoperative angiography (mean interval, 12 1/2 months) showed 11/12 LIMA and all SVG patent. One incompletely revascularized patient with an occluded LIMA is symptomatic. All others are fully active without symptoms or interval MI after a minimum follow-up of 5 1/2 years. The safety and long-term results of myocardial revascularization warrant its consideration for selected asymptomatic postinfarction patients.

Late Results of Myocardial Revascularization

Data are presented on 1,400 consecutive patients who had myocardial revascularization at our institution. The patients ranged in age from 33 to 80 years. Coronary bypass was done with an associated noncardiac procedure in 70 patients and with an associated cardiac procedure in 73 patients. The hospital mortality was 2.0%. Left ventricular function was a primary determinant of hospital mortality. With a 98% follow-up, survival was 93.1% at a mean of three years (range, six months to seven years). Ventricular function was the prime determinant of the overall long-term survival. These data indicate that myocardial revascularization, either alone or with an associated cardiac or noncardiac procedure, can be done with a low operative mortality. Because of the excellent five-year survival in our group of patients followed up for this length of time, we believe these data support the hypothesis that myocardial revascularization extends the life expectancy of patients with coronary artery disease.