Long-term Outcome after Percutaneous Coronary Intervention Compared with Minimally Invasive Coronary Artery Bypass Surgery in the Elderly

Barsoum, Emad; Azab, Basem; Patel, Nileshkumar; Spagnola, Jonathan; Shariff, Masood A.; Kaleem, Umar; Morcus, Rewais; Asti, Deepak; McGinn, Joseph T.; Lafferty, James; McCord, Donald

doi:10.2174/1874192401610010011

Cited by 17 publications

(7 citation statements)

References 29 publications

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“…In this study, the mean number of disease vessels is 2.05, and the average age of patients is 65.64years. It is reported that long-term all-cause mortality is similar between PCI and CABG managed patients, but PCI treatment related to higher rate of repeat revascularization [ 16 ]. When a coronary intervention is performed in a patient who is being considered for surgery soon after coronary intervention, efforts should be made to avoid stent placement if possible.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and efficacy of simultaneous off-pump coronary artery bypass grafting and esophagectomy in elderly patients

Liu

Wang

et al. 2017

Oncotarget

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IntroductionTo analyze the outcomes of off-pump coronary artery bypass grafting (OPCABG) and esophagectomy simultaneously for patients with coronary artery disease (CAD) and coexisting esophageal cancer.MethodsTwenty-two patients with CAD and coexisting esophageal cancer underwent combined surgical interventions were subjected to the study. OPCABG was performed first, followed by esophagectomy. All the corresponding data including clinicopathological characteristics and postoperative outcomes were all investigated.ResultsAll the combined procedures were performed successfully. The average number of grafts was 2.36. Tumors were located at the middle third of the esophagus in 5 patients, at the lower third of the esophagus in 8 patients, at the esophageal gastric junction (EGJ) in 9 patients, respectively. The operations were carried out through a left lateral thoracotomy approach in 21 patients while a median sternotomy and left lateral thoracotomy approach was used in 1 patient for his condition rapidly worsened. Postoperatively, pneumonia occurred in 4 patients (18.2%). During the follow-up, three patients died of cancer metastasis /recurrence (6, 18, 37 months) and one died of pneumonia (1 month). The cumulative 5 years survival rate is 52.9%.ConclusionsThe combined procedure of OPCABG and esophagectomy is a safe and effective treatment option for patients with severe CAD and esophageal cancer.

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Section: Discussionmentioning

confidence: 99%

Feasibility and efficacy of simultaneous off-pump coronary artery bypass grafting and esophagectomy in elderly patients

Liu

Wang

et al. 2017

Oncotarget

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“…12 Our eventual 2% per year RR rates are comparable with that reported for CABG through median sternotomy as well as through minimally invasive direct CABG, which mostly uses LITA-LAD through a small left thoracotomy. [19][20][21][22][23] More advanced procedures such as endoscopic atraumatic CABG have varying results, with some centers manifesting with excellent outcomes, and others show the expectedly higher RR rates associated with the increased complexity of the surgery. [24][25][26][27] Even the latest approach of hybrid coronary revascularization, which aims to merge the advantages of the surgical and percutaneous approach, shows a persistent increase in RR, which is associated with the percutaneous intervention arm.…”

Section: Discussionmentioning

confidence: 99%

Repeat Revascularization after Minimally Invasive Coronary Artery Bypass Grafting

Rodriguez

Lapierre

Sohmer

et al. 2017

Innovations�(Phila)

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Objective Minimally invasive coronary artery bypass grafting (MICS CABG) via a small left thoracotomy is a novel technique for coronary revascularization that is increasingly used around the world. However, multivessel MICS CABG is difficult, and concerns about repeat revascularization (RR) have been raised. This longitudinal study describes the rates of RR among patients who have undergone MICS CABG and identifies targets for improvement. Methods A prospective observational study was performed on the 306 MICS CABG patients operated on by a single surgeon from 2005 to 2015. Minimally invasive coronary artery bypass grafting was performed through a small left thoracotomy, using the in situ left internal mammary artery, ± a radial artery, and 1 to 3 saphenous veins anastomosed proximally to the aorta. Patients were followed annually. We examined the difference between the first half and second half of the series to ascertain the effects of a learning curve. Results Eighty percent of the procedures were performed off-pump. The median number of grafts performed were 2, and the left anterior descending, diagonals, obtuse marginals, and posterior interventricular artery were the distal targets in 94%, 12%, 44%, and 26%, respectively. The graftability index (#grafts/#diseased vessels) was 0.93. Revascularization of targets smaller than 1.5 mm decreased from 69% to 50% ( P = 0.002) between the series’ first and second halves. Overall, RR was needed in 21 patients (6.9%) and was performed at a mean ± SD of 1.7 ± 1.6 years postoperatively. The culprit lesion was attributed to the index surgical procedure (“graft-associated”) in 52%, to a stent stenosis or progression of native disease in 43%, and was unidentified in 5%. Patients with graft-associated RR had a lower graftability index at operation (0.73 vs 0.94) and more frequent involvement of the circumflex system (0.8 vs 0.3). The overall rate of RR at 3 years decreased from 11% in the first half to 2.6% in the second half ( P = 0.001). Conclusions The need for RR is part of the learning curve with MICS CABG, involves a graft in half of the cases, is more common in patients who had a lower graftability index at operation, and markedly improves with experience.

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“…MICS CABG may also be considered in high-risk older patients in view of the benefits conferred by the minimally invasive approach. 34 As reported by McGinn and colleagues 6 in their initial series of MICS CABG, absolute contraindications include emergency surgery with hemodynamic compromise, severe chest wall deformity such as pectus excavatum, and severe lung disease precluding single-lung ventilation. In addition, MICS CABG should be avoided in patients with severely low ejection fractions (with possible need for emergency CPB), cardiomegaly (difficult conduit anastomosis), diffuse multivessel disease (difficult target identification), and history of chest radiation that raises the risk of significant adhesions (complicating BITA harvesting).…”

Section: Indications For Minimally Invasive Multi-arterial Bita Revasmentioning

confidence: 99%

“…32,33 In addition, MICS CABG may confer a pronounced benefit in patients aged 75 years and older. 34…”

Section: Indications For Minimally Invasive Multi-arterial Bita Revasmentioning

confidence: 99%

Minimally invasive coronary artery bypass grafting: a systematic review

Kikuchi

Mori

2017

Asian Cardiovasc Thorac Ann

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To minimize surgical morbidity in coronary artery bypass grafting, minimally invasive cardiac surgery has gained popularity. Minimally invasive coronary artery bypass grafting offers unique advantages compared to conventional off-pump coronary artery bypass or minimally invasive direct coronary artery bypass in that it enables the surgeon to harvest and graft bilateral internal thoracic arteries via a small thoracotomy while being conducted completely off-pump. This review focuses on current evidence behind off-pump coronary artery bypass, multi-arterial revascularization, patient populations that would most benefit from bilateral internal thoracic artery minimally invasive coronary artery bypass grafting, the surgical technique, and early outcomes. By overcoming the perceived inability to utilize bilateral internal thoracic arteries in minimally invasive coronary artery bypass grafting, the new technique further expands the armamentarium of surgeons and cardiologists. Hybrid coronary revascularization with bilateral internal thoracic artery minimally invasive coronary artery bypass grafting further augments the appeal of the next generation of minimally invasive cardiac surgery.

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Long-term Outcome after Percutaneous Coronary Intervention Compared with Minimally Invasive Coronary Artery Bypass Surgery in the Elderly

Cited by 17 publications

References 29 publications

Feasibility and efficacy of simultaneous off-pump coronary artery bypass grafting and esophagectomy in elderly patients

Feasibility and efficacy of simultaneous off-pump coronary artery bypass grafting and esophagectomy in elderly patients

Repeat Revascularization after Minimally Invasive Coronary Artery Bypass Grafting

Minimally invasive coronary artery bypass grafting: a systematic review

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