Percutaneous coronary intervention versus coronary artery surgery for left main disease according to lesion site: A meta-analysis

Filippo, Ovidio De; Boretto, Paolo; Bruno, Francesco; Cusenza, Vincenzo; Desalvo, Paolo; Demetres, Michelle; Saglietto, Andrea; Franchin, Luca; Piroli, Francesco; Marengo, Giorgio; Elia, Edoardo; Falk, Volkmar; Conrotto, Federico; Doenst, Torsten; Rinaldi, Mauro; Ferrari, Gaetano Maria De; Gaudino, Mario

doi:10.1016/j.jtcvs.2021.08.040

Cited by 16 publications

(14 citation statements)

References 31 publications

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“…Improvements in medical treatments, increased endovascular, and transcatheter treatments have led to a greater proportion of coronary, valvular heart disease, and aneurysmal disease being treated without surgery. [51][52][53][54] Of the cases which get surgically treated, the patients are older, have higher comorbidities, and increasingly require concomitant procedures entailing high surgical risk. 55,56 In a quest to deliver ever lower mortality and morbidity in an increasingly comorbid patient population, demanding technically more complex operations, there is no room for error.…”

Section: Discussionmentioning

confidence: 99%

“…There are numerous pressures that exert a strong influence on training programs. Improvements in medical treatments, increased endovascular, and transcatheter treatments have led to a greater proportion of coronary, valvular heart disease, and aneurysmal disease being treated without surgery 51–54 . Of the cases which get surgically treated, the patients are older, have higher comorbidities, and increasingly require concomitant procedures entailing high surgical risk 55,56 …”

Section: Discussionmentioning

confidence: 99%

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Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Comanici

Salmasi

Schulte

et al. 2022

Journal of Cardiac Surgery

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Objectives We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons. Methods EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. Eight hundred and ninety‐two results were obtained, 27 represented best evidence (2‐meta‐analyses, 1‐RCT, and 24 retrospective cohort studies). Results In all 474,160 operative outcomes were assessed for 434,535 coronary artery bypass grafting (CABG) (431,329 on‐pump vs. 3206 off‐pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital, and 4797 thoracic procedures. In all 398,058 cases were performed by trainees and 75,943 by consultants. One hundred fifty‐nine cases were indeterminate. There were no statistically significant differences in the patients' preoperative risk scores. All studies excluded extreme high‐risk patients in emergency setting, patients with poor left ventricular function, and reoperation cases that were undertaken by consultants. There were no differences in cardiopulmonary bypass and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the postoperative outcomes including perioperative myocardial infarction, resternotomy for bleeding, stroke, renal failure, intensive therapy unit length of stay, and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in‐hospital or midterm mortality out to 5‐years. Discussion Trainees can perform cardiothoracic surgery in dedicated high‐volume units with outcomes comparable to those of fully trained surgeons.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Comanici

Salmasi

Schulte

et al. 2022

Journal of Cardiac Surgery

View full text Add to dashboard Cite

show abstract

“…However, if only a shaft lesion was present, PCI and CABG were equal. 15 Randomized trials often exclude subgroups of patients with specific comorbidities. Thus, registry analyses are the only source of information for these patients.…”

Section: Surgical Treatment Of Coronary Artery Diseasementioning

confidence: 99%

Cardiac Surgery 2021 Reviewed

Doenst

Schneider

Can

et al. 2022

Thorac Cardiovasc Surg

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PubMed displayed more than 35,000 hits for the search term “cardiac surgery AND 2021.” We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term “myocardial revascularization” is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

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“…In the case of lesions located in the ostium/shaft, both treatment methods provided similar results in terms of primary composite outcomes and repeat revascularization rates [ 72 ]. Recent findings of a meta-analysis performed by De Filippo et al supported the superiority of CABG in distal but not in ostial/shaft LMCAD [ 73 ]. In summary, contemporary evidence suggests that heterogeneity related to the location of atherosclerotic plaques in LMCA is an important factor that should influence the decision regarding revascularization method.…”

Section: Evidence Supporting Lmca Revascularizationmentioning

confidence: 99%

Left Main Coronary Artery Disease—Current Management and Future Perspectives

Dąbrowski

Kożuch

Dobrzycki

2022

JCM

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Due to its anatomical features, patients with an obstruction of the left main coronary artery (LMCA) have an increased risk of death. For years, coronary artery bypass grafting (CABG) has been considered as a gold standard for revascularization. However, notable advancements in the field of percutaneous coronary intervention (PCI) led to its acknowledgement as an important treatment alternative, especially in patients with low and intermediate anatomical complexity. Although recent years brought several random clinical trials that investigated the safety and efficacy of the percutaneous approach in LMCA, there are still uncertainties regarding optimal revascularization strategies. In this paper, we provide a comprehensive review of state-of-the-art diagnostic and treatment methods of LMCA disease, focusing on percutaneous methods.

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Percutaneous coronary intervention versus coronary artery surgery for left main disease according to lesion site: A meta-analysis

Cited by 16 publications

References 31 publications

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Cardiac Surgery 2021 Reviewed

Left Main Coronary Artery Disease—Current Management and Future Perspectives

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