Long-term survival of more than 2,000 patients after coronary artery bypass grafting

“…2) In contrast, authors advocating mitral valve repair at the time of CABG suggest that CABG alone will not correct moderate MR in patients with scarring from myocardial infarction and ventricular dilation and residual MR often leads to late heart failure symptoms and reduced long-term survival. 3,4) In addition, a recent case series has reported improved outcomes of mitral valve repair with mortality rates less than 5%. 5) At our institution, the primary strategy for coronary artery bypass surgery is off-pump CABG (OPCAB), and for mitral valve repair, posterior mitral annuloplasty (MAP) with a vascular strip has been performed.…”

Section: Introductionmentioning

confidence: 99%

Off Pump Coronary Artery Bypass versus Mitral Annuloplasty in Moderate Ischemic Mitral Regurgitation

Jeong

Lee

Kim

et al. 2012

ATCS

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Results: Freedom from cardiac-related death at eight years was similar between groups (78.4 ± 5.5%, the OPCAB group versus 81.5 ± 5.9%, the MAP group, p = 0.297). In patients with left ventricular ejection fraction (LVEF) >40%, the MAP group were similar to the OPCAB group in freedom from recurrent MR at eight years (85.7± 10.0% versus 84.9 ± 8.3%, p = 0.738), but a significant difference was found in patients with LVEF ≤40% (93.5± 4.5%, the MAP group versus 36.9 ± 18.4%, the OPCAB group, p = 0.013). On multivariate analysis, emergency operation and low LVEF were predictive of recurrent MR. Conclusion: Concomitant MAP was more effective against recurrent MR than was OPCAB alone, in patients with LVEF ≤40%. We suggest that MAP should be considered in moderate ischemic MR with low LVEF.

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“…In the surgical group diabetes was not associated with MACCE, which is in contrast to previous observational studies which have shown diabetes to be an independent predictor of mortality. [31][32][33] The relative safety and efficacy of CABG decreases with increasing age, and this is independent of a patient's diabetic status. This data therefore suggests that young patients with diabetes benefit the most from surgery, and conversely, elderly patients without diabetes have a better outcome following SES PCI, compared to CABG.…”

mentioning

confidence: 99%

Influence of age on the clinical outcomes of coronary revascularisation for the treatment of patients with multivessel de novo coronary artery lesions: sirolimus-eluting stent vs. coronary artery bypass surgery and bare metal stent, insight from the multicentre randomised Arterial Revascularisation Therapy Study Part I (ARTS-I) and Part II (ARTS-II)

et al. 2011

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Aims: We sought to evaluate the prognostic impact of age on the procedural results and subsequent clinical outcomes in patients with multivessel disease (MVD) treated either by coronary artery bypass surgery (CABG) or by percutaneous coronary intervention (PCI) with or without drug eluting stents, based on data of the Arterial Revascularisation Therapies Study (ARTS) part I and part II. The potential influence of age in determining the most appropriate revascularisation strategy for patients with MVD is largely unknown. Methods and results: Three year clinical outcome of ARTS I patients randomised to PCI with bare metal stent (BMS) (n= 600) or CABG (n= 605), and matched patients treated by PCI with sirolimus-eluting stents (SES) in ARTS II (n= 607) were reviewed according to four age quartiles. Endpoints were measured in terms of major adverse cardiac and cerebrovascular events MACCE) during hospital stay and up to three years. The frequency of female, diabetes, hypertension, peripheral vascular disease, pulmonary disease, as well as lesion complexity increased with age. At three years, MACCE free survival was comparable between patients treated by CABG or SES PCI, regardless of age quartile. The incidence of MACCE was higher among ARTS I BMS treated patients in all but the second age quartile. This was primarily related to a higher need for repeat revascularisation among BMS treated patients. However, age, which emerged as a strong independent predictor of MACCE following CABG (p<0.005), was not predictive of adverse events following PCI. Conversely, diabetes was the strongest independent predictor of MACCE among PCI treated patients (p<0.02), but didn't affect three-year outcomes following CABG. Conclusions: Age seems to influence the CABG outcome in-hospital but not PCI. PCI-SES could offer lower immediate risk in patients with MVD and comparable long-term outcome as CABG especially in older patients. The worst outcome of PCI-BMS group is primarily related to the need for repeat revascularisation. Diabetes is the most important predictor of MACCE following PCI.

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Long-term survival of more than 2,000 patients after coronary artery bypass grafting

Cited by 117 publications

References 27 publications

Surgical Management of Ischemic Mitral Regurgitation

Surgical Management of Ischemic Mitral Regurgitation

Off Pump Coronary Artery Bypass versus Mitral Annuloplasty in Moderate Ischemic Mitral Regurgitation

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