المؤلفون: Sandner, Sigrid^1,2 (AUTHOR), Redfors, Björn^3,4,5 (AUTHOR), An, Kevin R.^1,6 (AUTHOR), Harik, Lamia¹ (AUTHOR), Heise, Rachel¹ (AUTHOR), Di Franco, Antonino¹ (AUTHOR), Fremes, Stephen E.⁷ (AUTHOR), Hare, David L.⁸ (AUTHOR), Kulik, Alexander⁹ (AUTHOR), Lamy, Andre¹⁰ (AUTHOR), Peper, Joyce¹¹ (AUTHOR), Ruel, Marc¹² (AUTHOR), ten Berg, Jurrien M.¹¹ (AUTHOR), Willemsen, Laura M.¹¹ (AUTHOR), Zhao, Qiang¹³ (AUTHOR), Zhu, Yunpeng¹³ (AUTHOR), Wojdyla, Daniel M.¹⁴ (AUTHOR), Bhatt, Deepak L.¹⁵ (AUTHOR), Alexander, John H.¹⁶ (AUTHOR), Gaudino, Mario¹ (AUTHOR) mfg9004@med.cornell.edu

المصدر: Journal of the American College of Cardiology (JACC). Jul2024, Vol. 84 Issue 2, p182-191. 10p.

مصطلحات موضوعية: *MYOCARDIAL infarction, *CORONARY artery bypass, *CORONARY artery surgery, *CLINICAL trials, *DRUG-eluting stents

مستخلص: Women have worse outcomes after coronary artery bypass surgery (CABG) than men. This study aimed to determine the incidence of CABG graft failure in women, its association with cardiac events, and whether it contributes to sex-related differences in outcomes. A pooled analysis of individual patient data from randomized clinical trials with systematic imaging follow-up was performed. Multivariable logistic regression models were used to assess the association of graft failure with myocardial infarction and repeat revascularization between CABG and imaging (primary outcome) and death after imaging (secondary outcome). Mediation analysis was performed to evaluate the effect of graft failure on the association between female sex and risk of death. Seven randomized clinical trials (N = 4,413, 777 women) were included. At a median imaging follow-up of 1.03 years, graft failure was significantly more frequent among women than men (37.3% vs 32.9% at the patient-level and 20.5% vs 15.8% at the graft level; P = 0.02 and P < 0.001, respectively). In women, graft failure was associated with an increased risk of myocardial infarction and repeat revascularization (OR: 3.94; 95% CI: 1.79-8.67) and death (OR: 3.18; 95% CI: 1.73-5.85). Female sex was independently associated with the risk of death (direct effect, HR: 1.84; 95% CI: 1.35-2.50) but the association was not mediated by graft failure (indirect effect, HR: 1.04; 95% CI: 0.86-1.26). Graft failure is more frequent in women and is associated with adverse cardiac events. The excess mortality risk associated with female sex among CABG patients is not mediated by graft failure. [ABSTRACT FROM AUTHOR]

المؤلفون: Alzghari, Talal¹ (AUTHOR), Sandner, Sigrid² (AUTHOR), Di Franco, Antonino¹ (AUTHOR), Harik, Lamia¹ (AUTHOR), Perezgorvas-Olaria, Roberto¹ (AUTHOR), Soletti, Giovanni¹ (AUTHOR), Dimagli, Arnaldo¹ (AUTHOR), Cancelli, Gianmarco¹ (AUTHOR), Demetres, Michelle³ (AUTHOR), Lau, Christopher¹ (AUTHOR), Girardi, Leonard N.¹ (AUTHOR), Gaudino, Mario¹ (AUTHOR) mfg9004@med.cornell.edu

المصدر: Heart, Lung & Circulation. Dec2023, Vol. 32 Issue 12, p1500-1511. 12p.

مصطلحات موضوعية: *CORONARY artery surgery, *CORONARY arteries, *CORONARY artery bypass, *INTERNAL thoracic artery, *RADIAL artery, *ILEAL conduit surgery

مستخلص: To review the available literature on the use of coronary artery bypass grafting (CABG) as a treatment option for anomalous origin of coronary artery in adults. A systematic literature search was performed in March 2023 (including Ovid MEDLINE, Ovid Embase, and the Cochrane Library databases) to identify studies reporting the use of CABG in adult patients with anomalous origin of coronary artery. A total of 31 studies and 62 patients were included, 32 patients (52%) were women, and the mean age was 45.1±16.1 years. The most common coronary anomaly was the right coronary artery arising from the left coronary sinus in 26 patients (42%), followed by an anomalous left coronary artery from the pulmonary artery in 23 patients (37%). A total of 65 conduits were used in 61 patients, and 1 case report did not report conduit type. Reported grafts included saphenous vein (23 of 65 [35.4%]), left internal thoracic artery (15 of 65 [23.1%]), right internal thoracic artery (23 of 65 [35.4%]), and radial artery (2 of 65 [3.1%]); right gastroepiploic artery and basilic vein were used once (1.5%) each. Ligation of the native coronary artery was performed in 42 (67.7%) patients. Patient follow-up was available in 19 studies with a mean of 31.2 months. Only 1 operative mortality was reported. Based on the limited available data, CABG can be performed with good early results. Use of arterial conduits and ligation of the native coronary artery may improve long-term graft patency. [Display omitted] [ABSTRACT FROM AUTHOR]

المؤلفون: Gaudino, Mario¹ mfg9004@med.cornell.edu, Sandner, Sigrid², Di Giammarco, Gabriele³, Di Franco, Antonino¹, Hirokuni Arai⁴, Tohru Asai⁵, Bakaeen, Faisal⁶, Doenst, Torsten⁷, Fremes, Stephen E.⁸, Glineur, David⁹, Kieser, Teresa M.¹⁰, Lawton, Jennifer S.¹¹, Lorusso, Roberto¹², Patel, Nirav¹³, Puskas, John D.¹⁴, Tatoulis, James¹⁵, Taggart, David P.¹⁶, Vallely, Michael¹⁷, Ruel, Marc¹⁸, Arai, Hirokuni¹⁹ (AUTHOR)

المصدر: Circulation. 10/5/2021, Vol. 144 Issue 14, p1160-1171. 12p.

مصطلحات موضوعية: *CORONARY artery surgery, *CORONARY artery bypass, *ARTERIAL grafts, *FLOW measurement, *TIME measurements, *EXPERT evidence, *SURGICAL therapeutics, *SYSTEMATIC reviews, *ROUTINE diagnostic tests, *CARDIOVASCULAR disease diagnosis

مستخلص: Transit time flow measurement (TTFM) allows quality control in coronary artery bypass grafting but remains largely underused, probably because of limited information and the lack of standardization. We performed a systematic review of the evidence on TTFM and other methods for quality control in coronary artery bypass grafting following PRISMA standards and elaborated expert recommendations by using a structured process. A panel of 19 experts took part in the consensus process using a 3-step modified Delphi method that consisted of 2 rounds of electronic voting and a final face-to-face virtual meeting. Eighty percent agreement was required for acceptance of the statements. A 2-level scale (strong, moderate) was used to grade the statements based on the perceived likelihood of a clinical benefit. The existing evidence supports an association between TTFM readings and graft patency and postoperative clinical outcomes, although there is high methodological heterogeneity among the published series. The evidence is more robust for arterial, rather than venous, grafts and for grafts to the left anterior descending artery. Although TTFM use increases the duration and the cost of surgery, there are no data to quantify this effect. Based on the systematic review, 10 expert statements for TTFM use in clinical practice were formulated. Six were approved at the first round of voting, 3 at the second round, and 1 at the virtual meeting. In conclusion, although TTFM use may increase the costs and duration of the procedure and requires a learning curve, its cost/benefit ratio seems largely favorable, in view of the potential clinical consequences of graft dysfunction. These consensus statements will help to standardize the use of TTFM in clinical practice and provide guidance in clinical decision-making. [ABSTRACT FROM AUTHOR]

المؤلفون: Gaudino, Mario¹ (AUTHOR) mfg9004@med.cornell.edu, Di Franco, Antonino¹ (AUTHOR), Cao, Davide² (AUTHOR), Giustino, Gennaro² (AUTHOR), Bairey Merz, C. Noel³ (AUTHOR), Fremes, Stephen E.⁴ (AUTHOR), Kirtane, Ajay J.⁵ (AUTHOR), Kunadian, Vijay⁶ (AUTHOR), Lawton, Jennifer S.⁷ (AUTHOR), Masterson Creber, Ruth Marie⁸ (AUTHOR), Sandner, Sigrid⁹ (AUTHOR), Vogel, Birgit² (AUTHOR), Zwischenberger, Brittany A.¹⁰ (AUTHOR), Dangas, George D.² (AUTHOR), Mehran, Roxana² (AUTHOR)

المصدر: Journal of the American College of Cardiology (JACC). Apr2022, Vol. 79 Issue 14, p1407-1425. 19p.

مصطلحات موضوعية: *CORONARY artery disease, *CORONARY artery bypass, *CORONARY artery surgery, *PERCUTANEOUS coronary intervention, *DRUG-eluting stents, *TREATMENT effectiveness, *CARDIOVASCULAR surgery, *MEDICAL care, *CARDIOVASCULAR system, *SEX distribution

مستخلص: Biological and sociocultural differences between men and women are complex and likely account for most of the variations in the epidemiology and treatment outcomes of coronary artery disease (CAD) between the 2 sexes. Worse outcomes in women have been described following both conservative and invasive treatments of CAD. For example, increased levels of residual platelet reactivity during treatment with antiplatelet drugs, higher rates of adverse cardiovascular outcomes following percutaneous coronary revascularization, and higher operative and long-term mortality after coronary bypass surgery have been reported in women compared with in men. Despite the growing recognition of sex-specific determinants of outcomes, representation of women in clinical studies remains low and sex-specific management strategies are generally not provided in guidelines. This review summarizes the current evidence on sex-related differences in patients with CAD, focusing on the differential outcomes following medical therapy, percutaneous coronary interventions, and coronary artery bypass surgery. [ABSTRACT FROM AUTHOR]