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Circulation Dec 2018This article reviews the context and evidence of recent myocardial revascularization trials that compared percutaneous coronary intervention with coronary artery bypass... (Comparative Study)
Comparative Study Review
This article reviews the context and evidence of recent myocardial revascularization trials that compared percutaneous coronary intervention with coronary artery bypass grafting for the treatment of left main and multivessel coronary artery disease. We develop the rationale that some of the knowledge synthesis resulting from these trials, particularly with regard to the claimed noninferiority of percutaneous coronary intervention beyond nondiabetic patients with low anatomic complexity, may have been affected by trial design, patient selection based on suitability for percutaneous coronary intervention, and end point optimization favoring percutaneous coronary intervention over coronary artery bypass grafting. We provide recommendations that include holding a circumspect interpretation of the currently available evidence, as well as suggestions for the collaborative design and conduct of future clinical trials in this and other fields.
Topics: Bias; Clinical Trials as Topic; Coronary Artery Bypass; Coronary Artery Disease; Humans; Myocardial Revascularization; Patient Selection; Percutaneous Coronary Intervention
PubMed: 30566019
DOI: 10.1161/CIRCULATIONAHA.118.035970 -
Annals of the Royal College of Surgeons... Sep 2018A summary of its uses in mitral valve surgery and coronary artery revascularisation. (Review)
Review
A summary of its uses in mitral valve surgery and coronary artery revascularisation.
Topics: Cardiac Surgical Procedures; Heart Valve Diseases; Humans; Minimally Invasive Surgical Procedures; Mitral Valve; Myocardial Revascularization; Robotic Surgical Procedures
PubMed: 30179050
DOI: 10.1308/rcsann.supp2.22 -
The Journals of Gerontology. Series A,... Jul 2021Little is known on the incidence and postoperative outcomes of revascularizations according to electivity in persons with Alzheimer's disease (AD).
BACKGROUND
Little is known on the incidence and postoperative outcomes of revascularizations according to electivity in persons with Alzheimer's disease (AD).
METHODS
The Medication Use and Alzheimer's disease (MEDALZ) cohort includes 70 718 community dwellers diagnosed with incident AD during 2005-2011 in Finland. For each person with AD, 1-4 age-, sex-, and hospital district-matched comparison persons without AD were identified. Altogether 448 persons with AD and 5909 without AD underwent revascularization during the follow-up. The outcomes were 30-day and 90-day re-admission rate after discharge, and all-cause 1-year and 3-year mortality. Risk of outcomes in persons with AD were compared to those without AD using Cox proportional hazard models adjusted with age, sex, comorbidities, statin use, revascularization type, length of stay, and support at discharge.
RESULT
People with AD had less revascularizations (adjusted hazard ratio 0.24, 95% confidence interval 0.22-0.27). Emergency procedures were more common (42.6% vs 33.1%) than elective procedures (34.2% vs 48.6%) among people with AD. There was no difference in 30-day readmissions (0.97, 0.80-1.17) or 1-year mortality (1.04, 0.75-1.42) and 90 days readmission risk was lower in persons with AD (0.85, 0.74-0.98). People with AD had higher 3-year mortality (1.42, 1.15-1.74), but the risk increase was observed only for emergency (1.71, 1.27-2.31), not for elective procedures (0.96, 0.63-1.46).
CONCLUSION
People with AD did not have worse readmission and mortality outcomes following elective revascularization. These findings in conjunction with lower revascularization rate especially for elective procedures raise questions on the threshold for elective procedures in people with AD.
Topics: Aged; Alzheimer Disease; Comorbidity; Coronary Disease; Elective Surgical Procedures; Emergency Treatment; Female; Finland; Humans; Independent Living; Male; Myocardial Revascularization; Outcome Assessment, Health Care; Patient Readmission; Risk Assessment; Survival Analysis
PubMed: 33420783
DOI: 10.1093/gerona/glab006 -
American Family Physician Dec 2010Aspirin is recommended as a lifelong therapy that should never be interrupted for patients with cardiovascular dis- ease. Clopidogrel therapy is mandatory for six weeks... (Review)
Review
Aspirin is recommended as a lifelong therapy that should never be interrupted for patients with cardiovascular dis- ease. Clopidogrel therapy is mandatory for six weeks after placement of bare-metal stents, three to six months after myocardial infarction, and at least 12 months after placement of drug-eluting stents. Because of the hypercoagulable state induced by surgery, early withdrawal of antiplatelet therapy for secondary prevention of cardiovascular disease increases the risk of postoperative myocardial infarction and death five- to 10-fold in stented patients who are on continuous dual antiplatelet therapy. The shorter the time between revascularization and surgery, the higher the risk of adverse cardiac events. Elective surgery should be postponed beyond these periods, whereas vital, semiurgent, or urgent operations should be performed under continued dual antiplatelet therapy. The risk of surgical hemorrhage is increased approximately 20 percent by aspirin or clopidogrel alone, and 50 percent by dual antiplatelet therapy. The present clinical data suggest that the risk of a cardiovascular event when stopping antiplatelet agents preoperatively is higher than the risk of surgical bleeding when continuing these drugs, except during surgery in a closed space (e.g., intracranial, posterior eye chamber) or surgeries associated with massive bleeding and difficult hemostasis.
Topics: Humans; Platelet Aggregation Inhibitors; Postoperative Complications; Preoperative Care; Surgical Procedures, Operative; Thrombosis
PubMed: 21166368
DOI: No ID Found -
The Journal of Cardiovascular Surgery Apr 2021Owing to the ageing of the population and rising rates of diabetes, more patients suffering from chronic limb threatening ischemia (CLTI) need revascularization for... (Review)
Review
INTRODUCTION
Owing to the ageing of the population and rising rates of diabetes, more patients suffering from chronic limb threatening ischemia (CLTI) need revascularization for often complex, multilevel peripheral arterial occlusive disease. Below the knee (BTK) lesions are common in CLTI and short-term outcomes of BTK endovascular revascularizations have improved substantially over the last decade as a consequence of improved techniques and dedicated low profile devices.
EVIDENCE ACQUISITION
The manuscript summarized the information identified through a limited literature review conducted on key resources including MEDLINE and EMBASE databases as well as conference proceedings. The keywords were "angioplasty," "endovascular intervention," "infrapopliteal," "tibial arteries" and "below the knee." The search was limited to contemporary English-language documents published between 2000 and 2020.
EVIDENCE SYNTHESIS
Rates of re-stenosis and re-occlusion are high after infrapopliteal interventions limiting long-term success and necessitating frequent repeat procedures.
CONCLUSIONS
In this article we aimed to summarize current knowledge regarding the need, options and outcome of repeat BTK interventions through a limited literature review and presentation of own data.
Topics: Arterial Occlusive Diseases; Endovascular Procedures; Humans; Ischemia; Limb Salvage; Lower Extremity; Peripheral Arterial Disease; Recurrence
PubMed: 33635043
DOI: 10.23736/S0021-9509.21.11679-9 -
World Neurosurgery Oct 2023Moyamoya vasculopathy is a rare steno-occlusive cerebrovascular disorder presenting with ischemia or hemorrhage. There are racial and geographic differences in...
BACKGROUND
Moyamoya vasculopathy is a rare steno-occlusive cerebrovascular disorder presenting with ischemia or hemorrhage. There are racial and geographic differences in presentation and outcome. There is little information regarding moyamoya in Australia.
METHODS
Moyamoya patients undergoing surgery from 2001 to 2022 were studied retrospectively. The outcomes of revascularization surgery in adult and pediatric patients, with ischemic and hemorrhagic disease were analyzed, including functional outcomes, postoperative complications, bypass patency, and long-term rates of ischemic and hemorrhagic events.
RESULTS
A total of 68 patients with 122 revascularized hemispheres and 8 posterior circulation revascularizations were included in this study. Eighteen patients were of Asian descent and 46 were of Caucasian origin. Presentation was with ischemia in 124 hemispheres and hemorrhage in six hemispheres. There were 92 direct, 34 indirect, and 4 combined revascularization surgeries performed. Early postoperative complications occurred in 3.1% (n = 4) of operations and delayed complications (infection, subdural hematoma) occurred after 4.6% (n = 6) of operations. Mean follow-up was 6.5 years (3-252 months). There was 100% patency of direct grafts at last follow-up. There were no hemorrhagic events following surgery and 1 new ischemic event 2 years after surgery. There was significant improvement in physical health functional outcomes at most recent follow-up (P < 0.05); mental health outcomes were not different between preoperative and postoperative assessments.
CONCLUSIONS
The majority of Australian moyamoya patients are Caucasian and the most common clinical presentation is ischemia. Revascularization surgery had excellent outcomes with very low rates of ischemia and hemorrhage, comparing favorably to the natural history of moyamoya vasculopathy.
PubMed: 37419316
DOI: 10.1016/j.wneu.2023.06.129 -
Revista Espanola de Cardiologia 1998The technique of coronary endarterectomy, in coronary artery surgery, has been controversial and alternatively indicated or contraindicated by different authors. In this... (Review)
Review
The technique of coronary endarterectomy, in coronary artery surgery, has been controversial and alternatively indicated or contraindicated by different authors. In this paper coronary endarterectomy is reviewed, including its definition, history and development of different techniques. Early and late results of the main papers in the literature are commented on as well as our results. The surgical technique of endarterectomy in the different coronary artery territories is described with the primary indications and contraindications. Coronary endarterectomy is a valid and well established technique that can provide possibilities of revascularization in patients with extended and diffused coronary artery obstructions, which are unable to be treated with conventional coronary artery bypass grafts. Operative mortality and morbidity are slightly higher, but long-term results, as far as survival and functional class are concerned, are similar to standard coronary artery surgical procedures.
Topics: Contraindications; Coronary Disease; Coronary Vessels; Endarterectomy; History, 20th Century; Humans
PubMed: 9717404
DOI: No ID Found -
Annals of Saudi Medicine 2011Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic,... (Review)
Review
Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary osteoplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy.
Topics: Angioplasty; Humans; Saphenous Vein; Stents; Vascular Grafting
PubMed: 21245602
DOI: 10.4103/0256-4947.75781 -
American Family Physician Feb 2012Cardiovascular complications are the most common cause of perioperative morbidity and mortality. Noninvasive stress testing is rarely helpful in assessing risk, and for... (Review)
Review
Cardiovascular complications are the most common cause of perioperative morbidity and mortality. Noninvasive stress testing is rarely helpful in assessing risk, and for most patients there is no evidence that coronary revascularization provides more protection against perioperative cardiovascular events than optimal medical management. Patients likely to benefit from perioperative beta blockade include those with stable coronary artery disease and multiple cardiac risk factors. Perioperative beta blockers should be initiated weeks before surgery and titrated to heart rate and blood pressure targets. The balance of benefits and harms of perioperative beta-blocker therapy is much less favorable in patients with limited cardiac risk factors and when initiated in the acute preoperative period. Perioperative statin therapy is recommended for all patients undergoing vascular surgery. When prescribed for the secondary prevention of cardiovascular disease, aspirin should be continued in the perioperative period.
Topics: Adrenergic beta-Antagonists; Cardiovascular Diseases; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Morbidity; Perioperative Care; Platelet Aggregation Inhibitors; Prognosis; Risk Assessment; Surgical Procedures, Operative; Survival Rate; United States
PubMed: 22335263
DOI: No ID Found -
World Journal of Gastroenterology Jun 2015We undertook this meta-analysis to investigate the relationship between revascularization and outcomes after liver transplantation. (Meta-Analysis)
Meta-Analysis Review
AIM
We undertook this meta-analysis to investigate the relationship between revascularization and outcomes after liver transplantation.
METHODS
A literature search was performed using MeSH and key words. The quality of the included studies was assessed using the Jadad Score and the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the χ(2) and I (2) tests. The risk of publication bias was assessed using a funnel plot and Egger's test, and the risk of bias was assessed using a domain-based assessment tool. A sensitivity analysis was conducted by reanalyzing the data using different statistical approaches.
RESULTS
Six studies with a total of 467 patients were included. Ischemic-type biliary lesions were significantly reduced in the simultaneous revascularization group compared with the sequential revascularization group (OR = 4.97, 95%CI: 2.45-10.07; P < 0.00001), and intensive care unit (ICU) days were decreased (MD = 2.00, 95%CI: 0.55-3.45; P = 0.007) in the simultaneous revascularization group. Although warm ischemia time was prolonged in simultaneous revascularization group (MD = -25.84, 95%CI: -29.28-22.40; P < 0.00001), there were no significant differences in other outcomes between sequential and simultaneous revascularization groups. Assessment of the risk of bias showed that the methods of random sequence generation and blinding might have been a source of bias. The sensitivity analysis strengthened the reliability of the results of this meta-analysis.
CONCLUSION
The results of this study indicate that simultaneous revascularization in liver transplantation may reduce the incidence of ischemic-type biliary lesions and length of stay of patients in the ICU.
Topics: Biliary Tract Diseases; Chi-Square Distribution; Graft Survival; Humans; Intensive Care Units; Ischemia; Length of Stay; Liver Transplantation; Odds Ratio; Operative Time; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 26078582
DOI: 10.3748/wjg.v21.i22.7036