The Eternal Debate With a Consistent Answer: CABG vs PCI

Farina, Piero; Gaudino, Mario; Taggart, David P.

doi:10.1053/j.semtcvs.2019.08.009

Cited by 19 publications

(20 citation statements)

References 26 publications

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“…Cardiovascular disease, mostly represented by coronary artery disease (CAD) and stroke, is the major cause of death in the United States 5 . The management of CAD, and the choices between medical therapy, percutaneous coronary intervention (PCI) and CABG, remains an intensely debated topic 6,7 …”

Section: Neurologic Injury and Coronary Revascularization Strategiesmentioning

confidence: 99%

Toward stroke‐free coronary surgery: The role of the anaortic off‐pump bypass technique

et al. 2021

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Surgical coronary revascularization remains the preferred strategy in a significant portion of patients with coronary artery disease due to superior long‐term outcomes. However, there is a significant risk of perioperative neurologic injury that has influenced guideline recommendations. These complications occur in 1%–5% of patients, ranging from overt neurologic deficits with permanent disability, to subtle cerebral defects noted on neuroimaging that may result in slow cognitive and functional decline. The primary mechanism by which these events occur is thromboembolism from manipulation of the ascending aorta. This occurs during cardiopulmonary bypass, aortic cross‐clamping, and partial occlusion clamping (side clamp). Elderly patients and patients with aortic atheroma are, therefore, at significantly increased risk. Initial surgical techniques addressed this by aggressively debriding or replacing the ascending aorta during coronary artery bypass grafting (CABG). Strategies then moved toward minimizing aortic manipulation through pump‐assisted beating heart surgery and off‐pump surgery with partial occlusion clamping or proximal anastomosis devices. Finally, anaortic off‐pump CABG aims to avoid all manipulation of the ascending aorta through advanced off‐pump grafting techniques combined with in situ and composite grafts. This has been demonstrated to result in the greatest reduction in risk. Establishing successful anaortic off‐pump CABG programs requires subspecialization and focused interest groups dedicated to advancing CABG outcomes.

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Section: Neurologic Injury and Coronary Revascularization Strategiesmentioning

confidence: 99%

Toward stroke‐free coronary surgery: The role of the anaortic off‐pump bypass technique

et al. 2021

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show abstract

“…Cardiovascular disease, mostly represented by coronary artery disease (CAD) and stroke, is the major cause of death in the United States (27). The management of CAD, and the choices between medical therapy, percutaneous coronary intervention (PCI) and CABG, remains an intensely debated topic (28,29).…”

Section: Neurologic Injury and Coronary Revascularization Strategiesmentioning

confidence: 99%

Towards stroke-free coronary surgery: the role of the anaortic off-pump bypass technique

Ramponi¹,

Seco²,

Brereton³

et al. 2020

Preprint

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Coronary artery and cerebrovascular disease represent a major cause of cardiovascular morbidity and mortality worldwide. Despite technological advancements in percutaneous interventions, surgical revascularization remains the preferred strategy in patients with left main or multivessel disease and in those with complex lesions with high SYNTAX score. As a result, an increasing number of older patients with diffuse atherosclerotic extracoronary disease are referred for coronary artery bypass grafting (CABG). Cerebrovascular complications after isolated coronary surgery occurs in 1-5% of patients; the magnitude of injury ranges from overt neurologic lesions with varying degree of permanent disability to “asymptomatic” cerebral events detected by dedicated neuro-imaging, nevertheless associated with significant long term cognitive and functional decline. Thromboembolic events due to manipulation of an atherosclerotic aorta are universally recognized as the leading etiology of early postoperative stroke following CABG. Coronary bypass surgery performed on an arrested heart relies on considerable aortic instrumentation associated with significant atheroembolic risk especially in older patients presenting with diffuse aortic calcifications. Surgical techniques to deal with a calcified ascending aorta during isolated coronary surgery have evolved over the last forty years. Moving away from aggressive aortic debridement or replacement, surgeons have developed strategies aimed to minimize aortic manipulation: from pump-assisted beating heart surgery with the use of composite grafts to complete avoidance of aortic manipulation with “anaortic” off-pump coronary artery bypass grafting, a safe and effective approach in significantly reducing the risk of intraoperative stroke.

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“…Coronary artery bypass grafting (CABG) remains the most common cardiac surgical procedure performed worldwide, representing an annual volume of approximately 200 000 isolated cases in the US and an average incidence rate of 62 per 100 000 inhabitants in Western European countries 1 . In the last 20 years, more than a dozen randomized controlled trials have compared CABG and percutaneous coronary intervention (PCI) in what may be seen as an eternal scientific debate 2 …”

Section: Introductionmentioning

confidence: 99%

“…1 In the last 20 years, more than a dozen randomized controlled trials have compared CABG and percutaneous coronary intervention (PCI) in what may be seen as an eternal scientific debate. 2 The selection between these two approaches relies on several factors, including coronary anatomy, clinical presentation, and comorbidities of each patient. 3 Despite achieving some definitive evidence regarding the superiority of either modality (provided certain conditions are met), some subgroups of patients still remain in a gray zone, and the indication for either approach remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Multi‐arterial and total‐arterial coronary revascularization: Past, present, and future perspective

et al. 2020

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Background and Aim of the Study: Although abundant biological, clinical, and scientific evidence exists on the superiority of multi-arterial (MAR) and total-arterial revascularization (TAR) over the conventional strategy with a single internal thoracic artery, only 10% of patients undergoing coronary artery bypass grafting (CABG) in the United States receives a second arterial conduit, and only 5% of patients receives TAR. Methods and Results: In January 2020, the authors performed comprehensive search to identify studies that evaluated MAR and TAR strategies through the MEDLINE database. Conclusions: In this paper, the authors reviewed the literature on the historical and current evidence in favor of MAR and TAR, thus underlying why current CABG practice needs qualitative improvement. K E Y W O R D S CABG, coronary artery bypass grafting, coronary artery disease, multiarterial revascularization, total arterial revascularization

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The Eternal Debate With a Consistent Answer: CABG vs PCI

Cited by 19 publications

References 26 publications

Toward stroke‐free coronary surgery: The role of the anaortic off‐pump bypass technique

Toward stroke‐free coronary surgery: The role of the anaortic off‐pump bypass technique

Towards stroke-free coronary surgery: the role of the anaortic off-pump bypass technique

Multi‐arterial and total‐arterial coronary revascularization: Past, present, and future perspective

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