The journey of surgery for coronary artery disease in India: adoption, customization and innovation

Sajja, Lokeswara Rao

doi:10.1007/s12055-014-0282-0

Cited by 7 publications

(3 citation statements)

References 45 publications

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“…Graft occlusion is one of the major determinants of clinical prognosis after CABG and is measured by re-intervention rates and survival. In countries like India, Japan, and Brazil with an off-pump CABG adoption rate in excess of 50% [ 2 , 7 ], it is prudent to query the non-inferiority of this technique as compared with on-pump CABG. Angiographic evaluation was performed at 3 months considering that edema at the site of anastomosis would resolve by that time and it would be too early to have graft attrition.…”

Section: Discussionmentioning

confidence: 99%

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Graft patency at 3 months after off- and on-pump coronary bypass surgery: a randomized trial

Sajja¹,

Sarkar

Mannam

et al. 2019

Indian J Thorac Cardiovasc Surg

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Purpose Coronary artery bypass grafting (CABG) is performed either with the aid of cardiopulmonary bypass (on-pump) or without cardiopulmonary bypass (off-pump). There is a scarcity of angiographic data to support the non-inferiority of off-pump technique to on-pump technique. The objective of this study is to ascertain the non-inferiority of off-pump CABG when compared to on-pump CABG in terms of angiographically assessed graft patency at 3 months. Methods A total of 320 patients with multivessel coronary artery disease were enrolled in a multicenter prospective randomized trial either to on-pump CABG (n = 162) or off-pump CABG (n = 158) between March 2016 through March 2017. Graft patency was evaluated by using either multidetector computerized tomographic angiography or conventional coronary angiography at 3 months. The major adverse cardiac and cardiovascular events (MACCE) were also analyzed at 3 months. Results The median number of grafts per patient in off-pump was 3.00 (Q1:3.00 and Q3:4.00) vs on-pump 4.00 (Q1:3.00 to Q3:4.00), and the mean number of grafts per patient was lower in the off-pump CABG at 3.45 ± 0.75 vs 3.64 ± 0.70 in the onpump CABG (p = 0.01). There was no significant difference in mortality at 3 months between the off-pump (0.63%) and onpump groups (1.85%) with p value of 0.62. The cumulative combined MACCE showed significant difference between off-pump group (0.63%) and on-pump group (5.55%), p = 0.01. Follow-up angiograms were done in 239 (75%) patients with 120 offpump and 119 in the on-pump group. The analysis was also done regarding graft patency in a graded manner-when analysis of A (excellent) grafts vs B (stenosed) grafts and O (occluded) grafts were made, there was no statistically significant difference in overall graft patency at 3 months between on-pump [376 /429 grafts (87.6%)] and off-pump [366 /420 grafts (87.1%)] groups (p = 0.82). The patency rates were similar among bypass conduits (left internal thoracic artery (ITA) in off-pump (91.4%) vs onpump (92.9%) p = 0.66, right ITA in off-pump (82.1%) vs on-pump (81.8%) p = 0.97, radial artery in off-pump (84.4%) vs onpump (82.6%) p = 0.81; saphenous vein in off-pump (85.8%) vs on-pump (86.3%), p = 0.86 and among 3 coronary territories.

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Section: Discussionmentioning

confidence: 99%

“…Off-pump CABG is adopted in over 50% of the patients in India [7], whereas it is on decline in the Western world. In India, several surgeons adopt an on-pump strategy only when the patient is ineligible for off-pump because of hemodynamic instability or diffuse CAD with small caliber vessels.…”

Section: Introductionmentioning

confidence: 99%

Graft patency at 3 months after off- and on-pump coronary bypass surgery: a randomized trial

Sajja¹,

Sarkar

Mannam

et al. 2019

Indian J Thorac Cardiovasc Surg

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“…The unique features of coronary artery disease in Indians are young age at presentation, higher incidence of multi-vessel CAD, diffuse disease, distal disease and significant left ventricular (LV) dysfunction at presentation. 26 , 27 Although a large number of coronary bypass surgical procedures are done, the national cardiac surgical database in India is still in its infancy. Hence, the present survey was conducted to know the trends and concerns in the BITA grafting, a promising strategy for long term palliation of multivessel coronary artery disease.…”

Section: Introductionmentioning

confidence: 99%

Bilateral internal thoracic artery grafting in India—Time to raise the bar

Sajja

Beri²

2017

Indian Heart Journal

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ObjectivesBilateral internal thoracic artery (BITA) grafting strategy is the current trend in coronary artery bypass grafting for multivessel coronary artery disease. Although better long-term outcomes have been shown, BITA grafting is underutilized as a main strategy for revascularization by most of the surgeons. The survey was conducted to ascertain the current usage and concerns of BITA grafting in India.MethodsDatabase of 856 Indian cardiac surgeons currently with predominantly adult practice was prepared and a questionnaire was sent about use of single and bilateral ITA grafts and BITA grafting strategy in different clinical scenarios.ResultsA total of 112 surgeons (13.08%) from 75 institutions responded and 92 surgeons (10.7%) completed the survey. Single ITA is used by 79% of surgeons in more than 90% of their patients. 31% and 29% of surgeons use BITA grafting in 5–10% and 11–98% of their patients respectively. 53% of surgeons avoided the usage of BITA grafting in patients with smoking, 35% of surgeons in chronic obstructive pulmonary disease, 58% of surgeons in obesity and 62% of surgeons in acute coronary syndrome, 36% of surgeons in patients with left ventricular dysfunction and 61% of surgeons in patients with poor coronary anatomy. The concerns for BITA usage are risk of deep sternal wound infection (DSWI) (40%), increased operative time (27%), unknown superiority (12%) and limited length of right ITA (5%).ConclusionsThe usage of BITA grafting is restricted to 10% in India and main concerns are DSWI and increased operative time.

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