المؤلفون: Gaudino, Mario¹ mfg9004@med.cornell.edu, Sandner, Sigrid², An, Kevin R.^1,3, Dimagli, Arnaldo¹, Di Franco, Antonino¹, Audisio, Katia¹, Harik, Lamia¹, Perezgrovas-Olaria, Roberto¹, Soletti, Giovanni¹, Fremes, Stephen E.⁴, Hare, David L.⁵, Kulik, Alexander⁶, Lamy, Andre⁷, Peper, Joyce⁸, Ruel, Marc⁹, ten Berg, Jurrien M.⁸, Willemsen, Laura M.⁸, Qiang Zhao¹⁰, Wojdyla, Daniel M.¹¹, Bhatt, Deepak L.¹²

المصدر: Circulation. 10/24/2023, Vol. 148 Issue 17, p1305-1315. 11p.

مصطلحات موضوعية: *CORONARY artery bypass, *MYOCARDIAL infarction, *DIAGNOSTIC imaging, *CLINICAL trials, *DATA analysis, *ARTERIAL grafts

مستخلص: BACKGROUND: Graft patency is the postulated mechanism for the benefits of coronary artery bypass grafting (CABG). However, systematic graft imaging assessment after CABG is rare, and there is a lack of contemporary data on the factors associated with graft failure and on the association between graft failure and clinical events after CABG. METHODS: We pooled individual patient data from randomized clinical trials with systematic CABG graft imaging to assess the incidence of graft failure and its association with clinical risk factors. The primary outcome was the composite of myocardial infarction or repeat revascularization occurring after CABG and before imaging. A 2-stage meta-analytic approach was used to evaluate the association between graft failure and the primary outcome. We also assessed the association between graft failure and myocardial infarction, repeat revascularization, or all-cause death occurring after imaging. RESULTS: Seven trials were included comprising 4413 patients (mean age, 64.4±9.1 years; 777 [17.6%] women; 3636 [82.4%] men) and 13 163 grafts (8740 saphenous vein grafts and 4423 arterial grafts). The median time to imaging was 1.02 years (interquartile range [IQR], 1.00-1.03). Graft failure occurred in 1487 (33.7%) patients and in 2190 (16.6%) grafts. Age (adjusted odds ratio [aOR], 1.08 [per 10-year increment] [95% CI, 1.01-1.15]; P=0.03), female sex (aOR, 1.27 [95% CI, 1.08-1.50]; P=0.004), and smoking (aOR, 1.20 [95% CI, 1.04-1.38]; P=0.01) were independently associated with graft failure, whereas statins were associated with a protective effect (aOR, 0.74 [95% CI, 0.63-0.88]; P<0.001). Graft failure was associated with an increased risk of myocardial infarction or repeat revascularization occurring between CABG and imaging assessment (8.0% in patients with graft failure versus 1.7% in patients without graft failure; aOR, 3.98 [95% CI, 3.54-4.47]; P<0.001). Graft failure was also associated with an increased risk of myocardial infarction or repeat revascularization occurring after imaging (7.8% versus 2.0%; aOR, 2.59 [95% CI, 1.86-3.62]; P<0.001). All-cause death after imaging occurred more frequently in patients with graft failure compared with patients without graft failure (11.0% versus 2.1%; aOR, 2.79 [95% CI, 2.01-3.89]; P<0.001). CONCLUSIONS: In contemporary practice, graft failure remains common among patients undergoing CABG and is strongly associated with adverse cardiac events. [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, Mario (AUTHOR), Dangas, George D. (AUTHOR), Angiolillo, Dominick J. (AUTHOR), Brodt, Jessica (AUTHOR), Chikwe, Joanna (AUTHOR), DeAnda, Abe (AUTHOR), Hameed, Irbaz (AUTHOR), Rodgers, Mary L. (NURSE), Sandner, Sigrid (AUTHOR), Sun, Louise Y. (AUTHOR), Yong, Celina M. (AUTHOR)

المصدر: Circulation. 8/1/2023, Vol. 148 Issue 5, p442-454. 13p.

مصطلحات موضوعية: *CARDIAC surgery, *CORONARY artery bypass, *MYOCARDIAL infarction, *POSTOPERATIVE care, *PERCUTANEOUS coronary intervention, *MYOCARDIAL ischemia, *CARDIOPULMONARY bypass

الشركة/الكيان: AMERICAN Heart Association

مستخلص: Acute postoperative myocardial ischemia (PMI) after cardiac surgery is an infrequent event that can evolve rapidly and become a potentially life-threatening complication. Multiple factors are associated with acute PMI after cardiac surgery and may vary by the type of surgical procedure performed. Although the criteria defining nonprocedural myocardial ischemia are well established, there are no universally accepted criteria for the diagnosis of acute PMI. In addition, current evidence on the management of acute PMI after cardiac surgery is sparse and generally of low methodological quality. Once acute PMI is suspected, prompt diagnosis and treatment are imperative, and options range from conservative strategies to percutaneous coronary intervention and redo coronary artery bypass grafting. In this document, a multidisciplinary group including experts in cardiac surgery, cardiology, anesthesiology, and postoperative care summarizes the existing evidence on diagnosis and treatment of acute PMI and provides clinical guidance. [ABSTRACT FROM AUTHOR]