Off-pump versus on-pump redo coronary artery bypass grafting: A propensity score analysis of long-term follow-up

Rufa, Magdalena; Ursulescu, Adrian; Nagib, Ragi; Shanmuganathan, Selvaraj; Albert, Marc; Reichert, Stefan; Franke, Ulrich

doi:10.1016/j.jtcvs.2019.03.122

Cited by 13 publications

(24 citation statements)

References 26 publications

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“…Usually a maximum standardized mean difference of 0.1 or even 0.15 is considered acceptable. 19 For the time-to-event analysis, the primary outcome of interest was mortality, and freedom from mortality was estimated using the Kaplan-Meier survival method and differences in survival curves were analyzed Inclusion criteria: acute uncomplicated TBAD without rupture, refractory pain, or rapid aortic expansion. Exclusion criteria: younger than 18 years; aortic dissection secondary to trauma; iatrogenic injury or intramural hematoma; Marfan syndrome or Ehlers-Danlos syndrome.…”

Section: Discussionmentioning

confidence: 99%

Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection

Xiang¹,

Kan²,

Liang³

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: To further assess the early and mid-term outcomes of thoracic endovascular aortic repair (TEVAR) in patients with acute uncomplicated type B aortic dissection (TBAD) compared with those receiving best medical treatment (BMT). Methods: Between February 2008 and March 2018, 357 consecutive patients with acute uncomplicated TBAD were retrospectively analyzed. Among them, 191 patients underwent TEVAR, and 166 received BMT. After propensity score matching, we obtained 145 matched pairs for analysis. Results: In the matched population, the 30-day mortality between the TEVAR group and the BMT group showed no statistically significant difference, whereas the early adverse events rates in the TEVAR group were significantly greater than that of the BMT group (P ¼ .003). Freedom from all-cause mortality in the TEVAR group was significantly greater than that of the BMT group (TEVAR: 91.9% at 5 years, BMT: 82.2% at 5 years, P ¼ .028). Freedom from aortic-related mortality in the TEVAR group was significantly greater than that of the BMT group (TEVAR: 94.1% at 5 years, BMT: 86.1% at 5 years, P ¼ .044). Multivariable Cox-hazard regression analysis demonstrated that the older age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.01-1.08, P ¼ .013), BMT (HR, 2.33; 95% CI, 1.08-5.05, P ¼ .032), and the distance between the primary entry tear and the left subclavian artery<2.0 cm (HR, 2.30; 95% CI, 1.06-4.99, P ¼ .035) were the significant risk factors for all-cause death. Given death as a competing factor, the cumulative incidence of rupture in the BMT group was significantly greater than that of the TEVAR group (BMT: 13.7% at 5 years, TEVAR: 5.1% at 5 years, P ¼ .024). Conclusions: Despite more complications in the early stage, TEVAR was associated with decreased risk of late death and had fewer late aortic ruptures compared with BMT in patients with acute uncomplicated TBAD. Therefore, TEVAR may be considered as the first option to improve the late outcomes in these patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection

Xiang¹,

Kan²,

Liang³

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Este dado pode estar diretamente relacionado com a menor resposta inflamatória gerada quando o procedimento é realizado sem o suporte da CEC, pois, dessa forma, o sangue não é colocado em contato com as superfícies não endoteliais do sistema de circulação extracorpórea. Da mesma forma, o menor tempo cirúrgico, menor necessidade de hemodiluição, culminando na em menor necessidade de transfusões sanguíneas, igualmente pode influenciar na recuperação destes pacientes (1,10,11,12,18,21,22,24,27,29,30,38,41). A insuficiência renal (IR) ocorre em 30% dos pacientes que são submetidos a CRM e continua sendo uma grave complicação pós-operatória associada com significativos aumentos da morbimortalidade, sendo que o uso da circulação extracorpórea é um fator de risco para o desenvolvimento de IR (42,43).…”

Section: Discussionunclassified

“…Nos quatro estudos presentes nessa revisão, realizados com pacientes acima de 60 anos, os resultados foram semelhantes para os dois grupos, não evidenciando vantagens entre as técnicas (10,20,28,40). Esses resultados se tornam controversos se analisarmos o desfecho da recuperação pós-operatória dos pacientes que realizaram o procedimento sem CEC, onde os mesmos possuem uma melhor recuperação pós cirurgia tendo como base os tempos de permanência na UTI e de manutenção da ventilação mecânica após os procedimentos (1,10,12,18,21,24,30,37,41). Por outro lado, Soylu et al (36), comparando os resultados quanto à incidência de isquemia mesentérica pós revascularização do miocárdio, evidenciou que pacientes submetidos a CRM sem CEC possuem melhores desfechos comparados com os indivíduos operados com circulação extracorpórea (36).…”

Section: Discussionunclassified

Cirurgia de revascularização do miocárdio com e sem circulação extracorpórea. O que os novos estudos evidenciam?

Ortolan¹,

Marcos²,

Caetano³

et al. 2020

VITTALLE, ISSN 1413-3563, Rio Grande, Brasil

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A doença arterial coronariana (DAC) é uma das principais causas de óbitos no mundo. A cirurgia de revascularização do miocárdio (CRM) prolonga a sobrevida e reduz a mortalidade de pacientes com DAC. Inúmeros estudos comparam os resultados obtidos em CRM com e sem o suporte da circulação extracorpórea (CEC), contudo, não existe um consenso sobre a modalidade ideal para esta cirurgia. O presente estudo consiste em uma revisão da literatura em que foram incluídas publicações que abordassem os resultados da realização de revascularização do miocárdio com e sem a utilização de circulação extracorpórea. Um total de 2.175.226 pacientes foram estudados, destes, 1.594.036 realizaram o procedimento com CEC e 581.190 foram submetidos a cirurgia sem CEC. A média de internação na unidade de tratamento intensivo (UTI) nos procedimentos realizados com CEC foi de 82,44 horas e quando realizado sem CEC foi de 55,95 horas. A média da quantidade de horas que os pacientes permaneceram sob ventilação mecânica após procedimentos com CEC foi de 16,12 horas e sem CEC foi de 11,34 horas. A mortalidade total dos pacientes submetidos a CRM com CEC foi de 909 sobre 25.074 indivíduos envolvidos (3,62%). Quando o procedimento foi realizado sem CEC a mortalidade total foi de 771 pacientes de um total de 27.655 indivíduos operados (2,84%). O número médio de enxertos que os pacientes receberam durante os procedimentos cirúrgicos foi maior no grupo que realizou o procedimento com CEC. Ocorreu da mesma forma, com relação à necessidade de transfusão sanguínea. É necessário que os pacientes sejam avaliados caso a caso, pois ambos os procedimentos, com e sem CEC, possuem vantagens e desvantagens. Não se pode considerar que uma técnica seja uniformemente superior a outra neste tipo de cirurgia.

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“…25 In contrast, a German analysis suggests that off-pump surgery may be superior to on-pump surgery in patients with previous coronary bypass surgery. 26 Finally, the German GOPCABE trial compared off-and on-pumps in the elderly patients. The 5-year outcome showed no difference between groups but demonstrated that the long-term survival of the combined operative cohort was better than that of the age-matched German population (►Fig.…”

Section: Technical Aspects Of Cabg Conductmentioning

confidence: 99%

Cardiac Surgery 2019 Reviewed

Doenst

Bargenda

Kirov

et al. 2020

Thorac Cardiovasc Surg

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For the year 2019, almost 25,000 published references can be found in PubMed when entering the search term “cardiac surgery.” We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach for article selection and reviewed the main fields of adult cardiac surgery (i.e., coronary, valve, aortic, and heart failure surgery). The past decade has experienced an enormous development of interventional techniques that compete more and more with classic surgery. This contest was broadly visible in 2019. It peaked over the interpretation of the EXCEL trial data, where percutaneous coronary intervention and coronary artery bypass grafting (CABG) for left main disease were compared. A novel pathomechanism for CABG was proposed, potentially answering open questions in the field. In aortic valve surgery, two low-risk trials comparing transcatheter aortic valve implantation (TAVI) to classic aortic valve replacement (surgical aortic valve replacement) received attention for showing equal or superior short-term outcomes for TAVI. Longer follow-up information from recent trials became available presenting results emphasizing the need for joint decision making. While publications addressing surgery on the aorta and the mitral and tricuspid valves were less abundant, there was substantial activity regarding left ventricular assist device support and heart transplantation. This article attempts to summarize the most pertinent publications. It does not expect to be complete and cannot be free of individual interpretation. We aimed to provide a condensed summary of 2019s publications with a stimulus for in-depth reading and a basis supporting patient information.

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Off-pump versus on-pump redo coronary artery bypass grafting: A propensity score analysis of long-term follow-up

Cited by 13 publications

References 26 publications

Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection

Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection

Cirurgia de revascularização do miocárdio com e sem circulação extracorpórea. O que os novos estudos evidenciam?

Cardiac Surgery 2019 Reviewed

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