المؤلفون: An, Kevin R^1,2 (AUTHOR), Sandner, Sigrid³ (AUTHOR), Redfors, Björn^4,5,6 (AUTHOR), Alexander, John H⁷ (AUTHOR), Alzghari, Talal¹ (AUTHOR), Caldonazo, Tulio¹ (AUTHOR), Cancelli, Gianmarco¹ (AUTHOR), Dell'Aquila, Michele¹ (AUTHOR), Dimagli, Arnaldo¹ (AUTHOR), Gibson, C Michael⁸ (AUTHOR), Harik, Lamia¹ (AUTHOR), Heise, Rachel⁴ (AUTHOR), Kulik, Alexander⁹ (AUTHOR), Lamy, Andre¹⁰ (AUTHOR), Leith, Jordan¹ (AUTHOR), Peper, Joyce¹¹ (AUTHOR), Perezgrovas-Olaria, Roberto¹ (AUTHOR), Rossi, Camilla S¹ (AUTHOR), Ruel, Marc¹² (AUTHOR), Soletti, Giovanni Jr¹ (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Jun2024, Vol. 65 Issue 6, p1-10. 10p.

مصطلحات موضوعية: *CORONARY artery bypass, *GASTRIC bypass, *OBESITY, *DATA analysis, *CLINICAL trials, *BODY mass index

مستخلص: OBJECTIVES The association between obesity and graft failure after coronary artery bypass grafting has not been previously investigated. METHODS We pooled individual patient data from randomized clinical trials with systematic postoperative coronary imaging to evaluate the association between obesity and graft failure at the individual graft and patient levels. Penalized cubic regression splines and mixed-effects multivariable logistic regression models were performed. RESULTS Six trials comprising 3928 patients and 12 048 grafts were included. The median time to imaging was 1.03 (interquartile range 1.00–1.09) years. By body mass index (BMI) category, 800 (20.4%) patients were normal weight (BMI 18.5–24.9), 1668 (42.5%) were overweight (BMI 25–29.9), 983 (25.0%) were obesity class 1 (BMI 30–34.9), 344 (8.8%) were obesity class 2 (BMI 35–39.9) and 116 (2.9%) were obesity class 3 (BMI 40+). As a continuous variable, BMI was associated with reduced graft failure [adjusted odds ratio (aOR) 0.98 (95% confidence interval (CI) 0.97–0.99)] at the individual graft level. Compared to normal weight patients, graft failure at the individual graft level was reduced in overweight [aOR 0.79 (95% CI 0.64–0.96)], obesity class 1 [aOR 0.81 (95% CI 0.64–1.01)] and obesity class 2 [aOR 0.61 (95% CI 0.45–0.83)] patients, but not different compared to obesity class 3 [aOR 0.94 (95% CI 0.62–1.42)] patients. Findings were similar, but did not reach significance, at the patient level. CONCLUSIONS In a pooled individual patient data analysis of randomized clinical trials, BMI and obesity appear to be associated with reduced graft failure at 1 year after coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

المؤلفون: Gaudino, Mario, Lemma, Massimo, Sandner, Sigrid, Boening, Andreas, Harik, Lamia, Albert, Marc, Martin, Jose Albors, Alcocer, Jorge, Alexander, John H, Bhatt, Deepak L, Bonaros, Nikolaos, Borger, Michael, Danner, Bernhard C, Davierwala, Piroze, Deja, Marek A, Paulis, Ruggero De, Deutsch, Marcus-Andre, Flather, Marcus, Kappetein, Pieter, Kurlansky, Paul

المصدر: European Journal of Cardio-Thoracic Surgery; May2024, Vol. 65 Issue 5, p1-7, 7p

مصطلحات موضوعية: ARTERIAL grafts, MYOCARDIAL infarction, CORONARY artery bypass, COVID-19 pandemic

مستخلص: The ROMA trial is a large randomized clinical trial comparing single arterial grafting (SAG) and multiple arterial grafting (MAG) in coronary artery bypass surgery (CABG). The trial began in 2017 and is expected to conclude in 2023. It was initiated due to the inconclusive results of a previous trial. Challenges faced by the ROMA trial include high crossover rates and the impact of the COVID-19 pandemic. The trial's results are still pending but are anticipated to provide valuable insights into the effectiveness of MAG in CABG procedures. The success of the ROMA trial has led to the establishment of the ROMA network, which conducts other cardiac surgery trials. The trial involves multiple participating centers across different continents, including hospitals in Asia such as Jilin Heart Hospital, Fuwai Hospital, Teda Hospital, National Taiwan University Hospital, and Ruijin Hospital Shanghai Jiao Tong USM. The document also provides a list of hospitals and medical institutions from various countries involved in the trial. The ROMA trial is funded by the National Institutes of Health and the Canadian Institutes of Health and Research. [Extracted from the article]

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المؤلفون: Gaudino, Mario, Bakaeen, Faisal G, Sandner, Sigrid, Aldea, Gabriel S, Arai, Hirokuni, Chikwe, Joanna, Firestone, Scott, Fremes, Stephen E, Gomes, Walter J, Bong-Kim, Ki, Kisson, Kalie, Kurlansky, Paul, Lawton, Jennifer, Navia, Daniel, Puskas, John D, Ruel, Marc, Sabik, Joseph F, Schwann, Thomas A, Taggart, David P, Tatoulis, James

المصدر: European Journal of Cardio-Thoracic Surgery; Aug2023, Vol. 64 Issue 2, p1-15, 15p

مصطلحات موضوعية: CORONARY artery bypass, THORACIC surgery, CARDIOVASCULAR surgery, SURGERY, SURGEONS

مستخلص: Open in new tab Download slide Preamble The finalized document was endorsed by the EACTS Council and STS Executive Committee before being simultaneously published in the European Journal of Cardio-thoracic Surgery (EJCTS) and The Annals of Thoracic Surgery (The Annals) and the Journal of Thoracic and Cardiovascular Surgery (JTCVS). [ABSTRACT FROM AUTHOR]

: Copyright of European Journal of Cardio-Thoracic Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Caliskan, Etem, Misfeld, Martin, Sandner, Sigrid, Böning, Andreas, Aramendi, Jose, Salzberg, Sacha P, Choi, Yeong-Hoon, Perrault, Louis P, Tekin, Ilker, Cuerpo, Gregorio P, Lopez-Menendez, Jose, Weltert, Luca P, Böhm, Johannes, Krane, Markus, González-Santos, José M, Tellez, Juan-Carlos, Holubec, Tomas, Ferrari, Enrico, Emmert, Maximilian Y, investigators, European DuraGraft Registry

المصدر: European Journal of Cardio-Thoracic Surgery; Oct2022, Vol. 62 Issue 4, p1-9, 9p

مصطلحات موضوعية: CORONARY artery bypass, MYOCARDIAL infarction, MAJOR adverse cardiovascular events, PROPENSITY score matching, CORONARY artery disease

مستخلص: Open in new tab Download slide OBJECTIVES Left main coronary artery disease (LMCAD) is considered an independent risk factor for clinical events after coronary artery bypass grafting (CABG). We have conducted a subgroup analysis of the multicentre European DuraGraft Registry to investigate clinical event rates at 1 year in patients with and without LMCAD undergoing isolated CABG in contemporary practice. METHODS Patients undergoing isolated CABG were selected. The primary end point was the incidence of a major adverse cardiac event (MACE) defined as the composite of death, myocardial infarction (MI) or repeat revascularization (RR) at 1 year. The secondary end point was major adverse cardiac and cerebrovascular events (MACCE) defined as MACE plus stroke. Propensity score matching was performed to balance for differences in baseline characteristics. RESULTS LMCAD was present in 1033 (41.2%) and absent in 1477 (58.8%) patients. At 1 year, the MACE rate was higher for LMCAD patients (8.2% vs 5.1%, P  = 0.002) driven by higher rates of death (5.4% vs 3.4%, P  = 0.016), MI (3.0% vs 1.3%, P  = 0.002) and numerically higher rates of RR (2.8% vs 1.8%, P  = 0.13). The incidence of MACCE was 8.8% vs 6.6%, P  = 0.043, with a stroke rate of 1.0% and 2.4%, P  = 0.011, for the LMCAD and non-LMCAD groups, respectively. After propensity score matching, the MACE rate was 8.0% vs 5.2%, P  = 0.015. The incidence of death was 5.1% vs 3.7%, P  = 0.10, MI 3.0% vs 1.4%, P  = 0.020, and RR was 2.7% vs 1.6%, P  = 0.090, for the LMCAD and non-LMCAD groups, respectively. Less strokes occurred in LMCAD patients (1.0% vs 2.4%, P  = 0.017). The MACCE rate was not different, 8.5% vs 6.7%, P  = 0.12. CONCLUSIONS In this large registry, LMCAD was demonstrated to be an independent risk factor for MACE after isolated CABG. Conversely, the risk of stroke was lower in LMCAD patients. Clinical trial registration number ClinicalTrials.gov NCT02922088. [ABSTRACT FROM AUTHOR]

: Copyright of European Journal of Cardio-Thoracic Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Sandner, Sigrid E¹ (AUTHOR) sigrid.sandner@meduniwien.ac.at, Donovan, Terrence John² (AUTHOR), Edelstein, Stav³ (AUTHOR), Puskas, John D⁴ (AUTHOR), Angleitner, Philipp¹ (AUTHOR), Krasopoulos, George⁵ (AUTHOR), Channon, Keith⁶ (AUTHOR), Gehrig, Thomas² (AUTHOR), Rajakaruna, Cha⁷ (AUTHOR), Ladyshenskij, Leonid⁸ (AUTHOR), Silva, Ravi De⁹ (AUTHOR), Bonaros, Nikolaos¹⁰ (AUTHOR), Bolotin, Gil¹¹ (AUTHOR), Jacobs, Stephan¹² (AUTHOR), Thielmann, Matthias¹³ (AUTHOR), Choi, Yeong-Hoon¹⁴ (AUTHOR), Ohri, Sunil¹⁵ (AUTHOR), Lipey, Alexander¹⁶ (AUTHOR), Friedrich, Ivar² (AUTHOR), Taggart, David P⁵ (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Jul2022, Vol. 62 Issue 1, p1-9. 9p.

مصطلحات موضوعية: *CORONARY artery bypass, *VEIN diseases, *INTRAVASCULAR ultrasonography, *CORONARY angiography, *HARVESTING, *SAPHENOUS vein

مستخلص: Open in new tab Download slide OBJECTIVES In a post hoc analysis of the VEST III trial, we investigated the effect of the harvesting technique on saphenous vein graft (SVG) patency and disease progression after coronary artery bypass grafting. METHODS Angiographic outcomes were assessed in 183 patients undergoing open (126 patients, 252 SVG) or endoscopic harvesting (57 patients, 114 SVG). Overall SVG patency was assessed by computed tomography angiography at 6 months and by coronary angiography at 2 years. Fitzgibbon patency (FP I, II and III) and intimal hyperplasia (IH) in a patient subset were assessed by coronary angiography and intravascular ultrasound, respectively, at 2 years. RESULTS Baseline characteristics were similar between patients who underwent open and those who underwent endoscopic harvesting. Open compared with endoscopic harvesting was associated with higher overall SVG patency rates at 6 months (92.9% vs 80.4%, P = 0.04) and 2 years (90.8% vs 73.9%, P = 0.01), improved FP I, II and III rates (65.2% vs 49.2%; 25.3% vs 45.9%, and 9.5% vs 4.9%, respectively; odds ratio 2.81, P = 0.09) and reduced IH area (-31.8%; P = 0.04) and thickness (-28.9%; P = 0.04). External stenting was associated with improved FP I, II and III rates (odds ratio 2.84, P = 0.01), reduced IH area (-19.5%; P < 0.001) and thickness (-25.0%; P < 0.001) in the open-harvest group and reduced IH area (-12.7%; P = 0.01) and thickness (-9.5%; P = 0.21) in the endoscopic-harvest group. CONCLUSIONS A post-hoc analysis of the VEST III trial showed that open harvesting is associated with improved overall SVG patency and reduced IH. External stenting reduces SVG disease progression, particularly with open harvesting. [ABSTRACT FROM AUTHOR]

المؤلفون: Schaefer, Andreas, Conradi, Lenard, Schneeberger, Yvonne, Reichenspurner, Hermann, Sandner, Sigrid, Tebbe, Ulrich, Nowak, Bernd, Stritzke, Jan, Kastrati, Adnan, Schunkert, Heribert, Scheidt, Moritz von, investigators, for the TiCAB

المصدر: European Journal of Cardio-Thoracic Surgery; Feb2021, Vol. 59 Issue 2, p417-425, 9p

مصطلحات موضوعية: CORONARY artery bypass, TREATMENT effectiveness, CEREBRAL revascularization, PERCUTANEOUS coronary intervention, ANGINA pectoris, CARDIOVASCULAR disease related mortality

مستخلص: Open in new tab Download slide Open in new tab Download slide OBJECTIVES In this post hoc analysis of the Ticagrelor in coronary artery bypass grafting (CABG) trial, we aimed to analyse patients treated with CABG receiving either complete revascularization (CR) or incomplete revascularization (ICR) independent from random allocation to either ticagrelor or aspirin. METHODS Of 1859 patients enrolled in the Ticagrelor in CABG trial, 1550 patients (83.4%) received CR and 309 patients (16.6%) ICR. Outcomes were evaluated regarding all-cause mortality, cardiovascular death, myocardial infarction (MI), repeat revascularization, stroke and bleeding within 12 months after CABG. RESULTS Baseline parameters revealed significant differences regarding clinical presentation (stable angina pectoris: CR 68.9% vs ICR 71.2%, instable angina pectoris: 14.1% vs 7.8%, non-ST elevation MI: 17.0% vs 21.0%, P ˂ 0.01), lesion characteristics (chronic total occlusion: CR 91.3% vs ICR 96.8%, P ˂ 0.01), operative technique [off-pump coronary artery bypass surgery (OPCAB): CR 3.0% vs ICR 6.1%, P ˂ 0.01] and number of utilized grafts (total number of grafts: 2.69/patient vs 2.49/patient, P ˂ 0.001). ICR patients displayed a significantly increased risk of repeat revascularization [hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.16–3.16; P  < 0.01] and percutaneous coronary intervention (HR 1.95, 95% CI 1.13–3.35; P  < 0.05) within 12 months after CABG. Higher risk for repeat revascularization in ICR patients was independent from random allocation to either ticagrelor or aspirin and persisted after adjustment for baseline imbalances. CONCLUSIONS Patients with ICR presented more stable at the time of admission, but received less grafts, highly likely due to a higher rate of chronic total occlusion lesions and performed OPCAB. Although mortality presented no difference between groups, our results suggest that patients benefit from CR with regard to prevention of repeat revascularization. [ABSTRACT FROM AUTHOR]

: Copyright of European Journal of Cardio-Thoracic Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Gaudino, Mario F L¹ (AUTHOR) mfg9004@med.cornell.edu, Sandner, Sigrid² (AUTHOR), Bonalumi, Giorgia³ (AUTHOR), Lawton, Jennifer S⁴ (AUTHOR), Fremes, Stephen E⁵ (AUTHOR), Surgery, in collaboration with the Coronary Task Force of the European Association for Cardio-Thoracic (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Dec2020, Vol. 58 Issue 6, p1111-1117. 7p.

مصطلحات موضوعية: *CORONARY artery bypass, *ARTERIAL grafts, *INTERNAL thoracic artery, *RADIAL artery, *MYOCARDIAL revascularization, SURGERY practice

الشركة/الكيان: EUROPEAN Society of Cardiology

مستخلص: Open in new tab Download slide Open in new tab Download slide Observational evidence shows that the use of multiple arterial grafts (MAG) is associated with longer postoperative survival and improved clinical outcomes. The current European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines on myocardial revascularization recommend the use of MAG in appropriate patients. However, a significant volume-to-outcome relationship exists for MAG, and lack of sufficient experience is associated with increased operative risk. A stepwise approach to building experience with MAG allows successful implementation of this technique into routine coronary surgery practice. [ABSTRACT FROM AUTHOR]

المؤلفون: Sandner, Sigrid E¹ (AUTHOR) sigrid.sandner@meduniwien.ac.at, Schunkert, Heribert^1,2 (AUTHOR), Kastrati, Adnan^2,3 (AUTHOR), Wiedemann, Dominik¹ (AUTHOR), Misfeld, Martin⁴ (AUTHOR), Böning, Andreas⁵ (AUTHOR), Tebbe, Ulrich⁶ (AUTHOR), Nowak, Bernd⁷ (AUTHOR), Stritzke, Jan⁸ (AUTHOR), Laufer, Günther¹ (AUTHOR), Scheidt, Moritz von^2,3 (AUTHOR), Investigators, for the TiCAB (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Apr2020, Vol. 57 Issue 4, p732-739. 8p.

مصطلحات موضوعية: *CORONARY artery bypass, *ASPIRIN, *ARTERIAL grafts, *MYOCARDIAL infarction, *CEREBRAL revascularization, *TICAGRELOR

مستخلص: Open in new tab Download slide Open in new tab Download slide OBJECTIVES We evaluated the effect of ticagrelor monotherapy on outcomes after multiple arterial grafting (MAG) or single arterial grafting (SAG) in coronary artery bypass grafting (CABG). METHODS In a post hoc , non-randomized analysis of the TiCAB (Ticagrelor in CABG; ClinicalTrials.gov NCT01755520) trial, we compared event rates for ticagrelor versus aspirin in patients undergoing MAG and SAG. Primary outcome was the composite of cardiovascular death, non-fatal myocardial infarction (MI), stroke or repeat revascularization 1 year after CABG. Secondary outcomes included individual components of the primary end point, all-cause death and bleeding. RESULTS Among 1753 patients, 998 patients underwent MAG and 755 patients underwent SAG. There was no significant difference in the 1-year primary composite outcome for ticagrelor versus aspirin with MAG [7.2% vs 7.9%; hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.57–1.43; P  = 0.66] or SAG (12.3% vs 8.6%; HR 1.47, 95% CI 0.93–2.31; P  = 0.10). Event rates for cardiovascular death, MI, stroke, repeat revascularization and all-cause death were similar for both treatment groups with MAG and SAG. No significant difference in major bleeding was observed for ticagrelor versus aspirin with MAG (2.6% vs 2.7%; HR 0.95, 95% CI 0.44–2.05; P  = 0.90) or SAG (5.8% vs 4.0%; HR 1.49, 95% CI 0.77–2.89; P  = 0.24). CONCLUSIONS In patients undergoing either MAG or SAG in the TiCAB trial, ticagrelor monotherapy compared with aspirin did not affect the rate of cardiovascular death, non-fatal MI, stroke or repeat revascularization, or the rate of bleeding, at 1 year after CABG. [ABSTRACT FROM AUTHOR]

المؤلفون: Sandner, Sigrid E¹ (AUTHOR) sigrid.sandner@meduniwien.ac.at, Nolz, Richard² (AUTHOR), Loewe, Christian² (AUTHOR), Gregorich, Mariella³ (AUTHOR), Heinze, Georg³ (AUTHOR), Andreas, Martin¹ (AUTHOR), Kolh, Philippe⁴ (AUTHOR), Zimpfer, Daniel¹ (AUTHOR), Laufer, Guenther¹ (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Apr2020, Vol. 57 Issue 4, p684-690. 7p.

مصطلحات موضوعية: *CORONARY artery bypass, *COMPUTED tomography, *PROPENSITY score matching, *STROKE, *ANGIOGRAPHY

مستخلص: Open in new tab Download slide Open in new tab Download slide OBJECTIVES The aim of this study was to determine stroke rates in patients who did or did not undergo routine computed tomography angiography (CTA) aortic imaging before isolated coronary artery bypass grafting (CABG). METHODS We conducted a retrospective analysis of a prospectively maintained single-centre registry. Between 2009 and 2016, a total of 2320 consecutive patients who underwent isolated CABG at our institution were identified. Propensity score matching was used to create a paired cohort of patients with similar baseline characteristics who did (CTA cohort) or did not (non-CTA cohort) undergo preoperative aortic CTA. The primary end point of the analysis was in-hospital stroke. RESULTS In 435 propensity score-matched pairs, stroke occurred in 4 patients (0.92%) in the CTA cohort and in 14 patients (3.22%) in the non-CTA cohort (P  = 0.017). Routine preoperative aortic CTA was associated with a significantly reduced risk of in-hospital stroke [relative risk 0.29, 95% confidence interval (CI) 0.09–0.86; P  = 0.026; absolute risk reduction 2.3%, 95% CI 0.4–4.2; P  = 0.017; number needed to treat = 44, 95% CI 24–242]. CONCLUSIONS A preoperative screening for atheromatous aortic disease using CTA is associated with reduced risk of stroke after CABG. The routine use of preoperative aortic CTA could be applied so that surgical manipulation of the ascending aorta can be selectively reduced or avoided in patients with atheromatous aortic disease. [ABSTRACT FROM AUTHOR]