CABG - update. Sahar Gideon MD
|
|
- Esmond Burns
- 5 years ago
- Views:
Transcription
1 CABG - update Sahar Gideon MD מ נהל המ חלקה לני ת ו ח י לב המרכז הרפואי סורוק ה השתלמו ת לבוגרי התמ ח ו ת בקרדיו לוגיה 2010
2 Percutaneous Coronary Interventions 1977: 1 st Coronary angioplasty by Gruntzig Limitation: restenosis (PCI)
3 Open Heart Surgery - Israel year Total CABG
4
5 META-ANALYSIS ANALYSIS of 13 RCT CABG vs PCI Hoffman SN et al: JACC 2003 opatients: 2/3 had 2VD (41% prox LAD disease) and 100% had normal LV function Excluded patients (L L main, severe/complex 3VD, occlusions, poor LV) 5 yr RESULTS All trials PCI vs CABG FREEDOM FROM nos % RD (95% CI) favouring CABG ALL DEATH ( ) Cardiac Death ( ) REINTERVENTION (31-44) < Repeat CABG (16-27) < Repeat PCI (16-30) < Death/MI MI/Revasc (21-41) < Angina ( ) A small survival advantage (p=0.02, NNT=53) A marked reduction in the need for reintervention (p<0.001, NNT=4) p NNT
6 Adjusted Survival Curves : 2CAD without LAD 2CAD +Prox LAD 3CAD +Prox LAD
7 CABG is associated with lower rates of death or MI and repeat revascularization for 2 and 3 vessel disease Multivessel disease DES(N = 9963) CABG(N = 7437) in New York State
8 6033 pt s s treated with DES 13,738 pt s s treated with BMS DES were associated with increased rate of death, as compared with BMS after six months N Engl J Med 2007;356:
9 Circulation, Mar 2005; 111:
10
11 Appropriate : Score 7 to 9 Uncertain : Score 4 to 6 Inappropriate: Score 1 to 3
12 Medical treatment
13 Probability of survival free of overall mortality 611 pt s CABG 203 PCI 205 MT 203 (P = 0.631) Survival (P =0.0026) Conclusions : Long-term events and rate of additional revascularization MT similar to PCI. Event free CABG was superior to MT in terms of the primary end points, reaching a significant 44% reduction The primary end points were total mortality, Q-wave myocardial infarction, or refractory angina requiring revascularization. Circulation. 2007;115:
14 Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial Randomized trial 2287 pt s F/U median- 4.6yr
15 3,675 - PCI 3,838 medical J Am Coll Cardiol 2008;52:
16 Diabetes Mellitus
17
18 SIRIUS Reduced Efficacy in IDDM In-Segment Restenosis P<0.001 P=NS 50.7% 50.0% % P< % 35.0% 6.1% 12.3% Non-diabetic DM-Oral Agent DM- Insulin Sirolimus Control
19
20
21 Pedicled IMA harvesting was related to a higher incidence of sternal complications, both in the LIMA and in the BIMA group Ann Thorac Surg 2005;80:888 95
22
23 LV Dysfunction
24 3,088 pt s 80% reduction in mortality for pt s with viability treated by revascularization When 25% to 30% of the LV is viable by noninvasive testing, revascularization might be considered
25 יש ל י תו ר לנ יתו ח י "ח זה"...
26 Prospective randomized trial 282 pt s ;mean age- 80 yr 14 centers in Switzerland Time to Death or Nonfatal MI Rates of Major Adverse Clinical Events (MACE) INV - symptom relief cost intervention MT - 50%late nonfatal events
27 Left Main Disease
28 Left main stenosis PCI vs. CAVG LM is a potentially attractive target for PCI because of its large diameter and proximal position Two important pathophysiological features may mitigate against the success of PCI: (i) bifurcation Up to 80% of LM disease involves the bifurcation known to be at particularly high risk of restenosis multivessel (ii) Up to 80% of LM patients also have multivessel CAD where CABG, as already discussed, may already offer a survival advantage.
29
30 Drug eluting stents (DES) vs BMS in Left Main Chieffo/Colombo Circ BMS 85DES Valgimigli/Serruys Circ BMS 95 DES 30 day % Mortality 7 11 % Repeat Revascularization 2 0 % MACE months % Mortality 9 4 % Repeat Revascularization % MACE months % Mortality % Repeat Revascularization 23 6 % MACE 45 24
31
32
33 10.3 Early post-operative operative risk The survival outcome for all CABG operations performed in the UK in the period showed : 1.1% hospital mortality in 78,367 elective patients. 2.6% in 32,990 urgent patients. In all pt s s without and 30,218 pt s s with LM stenosis,, the respective mortalities were 1.5% and 2.5% (respective predicted elective mortalities 0.9% and 1.5%). In all pt s s without or 26, 020 pt s s with DM, the respective mortalities were 1.6% and 2.6% (respective predicted elective mortalities 1.0% and 1.6%).
34
35 Do you prefer a reintervention or a CVA?
36
37 STS
38
39
40
41 RESULTS OF AORTIC NO-TOUCH MYOCARDIAL REVASCULARISATION: A COMPARATIVE ANALYSIS IN 1713 PATIENTS M. Albert, Germany Group A :Complete no aortic touch technique - OFFPUMP (n=679) Group B :ON/OPCAB + partial clamping of the aorta (n=1034) RESULTS : Group A Group B P Mortality (30d) 4 (0.6%) 24(2.3%) <0.05 CVA 1(0.1%) 7(0.7%) <0.05 Conclusions Total arterial revascularisation with bilateral ITA graft using the aortic no touch technique allow the reduction of cerebrovascular event after CABG to zero
42
43
44
45
46
47
48
49
50
51
52 1005 pt s
53
54 Eur. Heart J. October 2, 2010
55 Heart Team Heart Team - cardiac surgeon, and an interventional cardiologist. Myocardial revascularization should in general not be performed at the time of diagnostic angiography, thereby allowing the Heart Team sufficient time to assess all available information, reach a consensus, and clearly explain and discuss the findings with the patient.
56 6.7 Recommendations
57
58
59 CABG CABG DEALS WITH THE CULPRIT LESION AND ANY FUTURE CULPRIT LESION (because graft is to mid vessel) BUT PCI only deals with suitable culprit lesion CABG COMPLETE revascularization
60
61
62
63 Controversial Definition 1: Traditional revascularization was defined as all diseased arterial systems receiving at least one graft insertion. Definition 2: Functional revascularization was defined as bypassing all diseased primary coronary segments (LAD,LCX,RCA) Nondiseased vessel : <1.5 mm in diameter regardless of the degree of stenosis, or with a stenosis of <50%.
64 1034pt s
65 Arterial Re vascularization
66 Effect of LIMA SVG compared to LIMA to LAD: X 1.61 risk of death in 10 y X 1.41 risk of late MI X 2.00 risk of re-operation Loop et al, N Engl J Medicine 1986
67 LIMA + RIMA Resistance to atherosclerosis. Production of vasodilators nitric oxide and prostacyclin - "downstream" effect Response to : vasodilators (milrinone( + nitroglycerin) No Response to Norepinephrine. Remodeling - adapting to demand
68 Effect of Bilateral IMA 10 y outcomes: 76% survival compared with 85% with bilateral IMA Pick et al Ann Thoracic Surg y outcomes: Bilat IMA had improved survival and reduced re-interventions Lytle et al, Ann Thorac Surg 2004
69 Comparison of the bilateral ITA (BITA) and single ITA (SITA) groups in terms of survival (A) and reoperationfreesurvival (B).
70 Single (SIMA) IMA grafts were used in 490 Multiple (MIMA) IMA grafts in 377,, along with concomitant saphenous veins. BIMA BIMA BIMA 59% BIMA
71 One year gained
72 Pedicled Skeletonized
73 Flow of ITA harvested as pedicled or skeletonized conduit.
74 pain Lt skeletonized and a Rt nonskeletonized Circulation. 2006;114:
75 T garft
76 40 pt s 6 months - angiography
77 Radial artery : 5-year patency : 83-95% Very susceptible to competitive flow. The graft failure rate is higher if : 1. The target vessel stenosis is less than severe 2. On the right coronary system.
78 231 radial artery anastomoses Angiography -109 patients Mean 27.1 mo postop for symptoms of ischemia. Cumulative patency for RA anastomotic locations. Cumulative RA patency associated withproximal target stenosis: P <.001). The relative risks for the targets of the RCA were statistically significant versus those of the LAD (P =.01) and bordered on significance versusthose of the circumflex artery J Thorac Cardiovasc Surg 2002;123:45-52
79
80 Gstroepiploic J Thorac Cardiovasc Surg 120: ;2000 Ann Thorac Surg 2004;78:2033 6
81 Radial LIMA RIMA At 10 ; 15 yrs LITA - 95 and 88% SVG - 61 and 32% SVG
82
83 Coronary Artery Reoperations 21,568 pt s who underwent bypass surgery from showed a steady decrease in the number of patients undergoing redo coronary artery operations.
84 RESULTS OF CORONARY ARTERY REOPERATIONS STS database - in-hospital mortality rate of 6.95% ( ). 1993). Recent mortality rates from other large series range from 4.2 to 11.4%, most being around 7% times higher than the risk of primary CABG.
85 CORONARY ARTERY REOPERATIONS Axial CT image : Preoperative assessment for aortic valve replacement in a 67-year-old man who had undergone CABG.
86
87 Factors favoring PTCA Early (<5 years) stenoses Single stenotic vein graft Focal graft lesions Patent ITA-LAD graft Normal left ventricular function
88 9.6 Crossed revascularization procedures
89 Off Pump Coronary Bypass
90 C.P.B חס רו נ ות פגי ע ה במ ער כ ת קרי ש ת הדם ש פ ע ול ה מנגנון הדל ק ת י בגוף response ריאות הרקמ ת יי- בזי לו ח הפרעה נזקי ם נוירולוג ים הפרע ו ת קוגניטיב יו ת inflamatory כליו ת,
91 Off PUMP Revascularization without the potential complications of extracorporeal support % of all procedures performed in the United States. Completeness of Revascularization and Graft Patency? Technically demanding Learning curve
92 Off Pump Coronary Bypass Only 1 randomized study 200 patients: Similar graft patency,, similar cardiac outcomes, lower cost.. Puskas et al, JAMA 2004 Off-pump coronary artery bypass surgery may be superior to conventional CABG in many patients, especially those who are considered high-risk 1 Reduced transfusions and bleeding 2,4 Reduced inotropes 2,4 Reduced arrhythmias 2-4 Reduced sternal wound infection 2-4 Reduced cerebral emboli and cognitive dysfunction 3 Reduced postoperative hospital length of stay 2
93 12,812 consecutive pt s Ten-year survival data Four groups: OPCABG 1-3 grafts (n = 3,946) OPCABG 4-7 grafts (n = 1,721) On-pump CABG 1-3 grafts (n = 3,380) On-pump CABG 4-7 grafts (n = 3,765) ICOR - Index of Completeness of Revascularization
94 Patients Most Likely to Benefit from OPCAB Atheromatous calcified aorta Patients with significant comorbidities: Cerebral vascular disease Peripheral vascular disease Hepatic disease Bleeding disorders COPD Renal dysfunction Reoperative surgery Patients who refuse blood products
95 Minimally Invasive Myocardial MINIMALLYINVASIVEDIRECT CORONARY ARTERY BYPASS (MIDCAB) Revascularization TOTAL ENDOSCOPIC CORONARY ARTERY BYPASS GRAFTING (TECAB)
96
97 Endoscopic Surgery
98 Endoscopic Saphenous Vein Harvesting Complications (wound infection) was reduced significantly by 69% Follow-up angiography of all vein grafts - 6 months after the operation. Cheng D, Allen K, Cohn W, et al: Endoscopic vascular harvest in coronary artery bypass grafting surgery : A meta-analysis analysis of randomized trials and controlled trials. Innovations (in press).
99 Endoscopic -1,753 ; Open 1,247 Angiography months
100
101 Robotics The Da Vinci System Console Visualization Stereo Visualization: Direct connection of surgeon hands to tool tips Registration is both visual and spatial Eye-hand coordination is restored One image per eye
102 Addition of a 3 DOF wrist at the tip (total of 7 DOF)
103
104 Hybrid Procedure
105 Hybrid Revascularization Lima to LAD followed by PCI to other targets- problem if PCI does not succeed PCI to CX and/or RCA territory followed by Minimally invasive LIMA to LAD- problem anti- platelets during surgery and PCI with significant LAD lesion
106 Simultaneous integrated coronary artery revascularization with long-term angiographic follow-up 58 pt s s underwent simultaneous, integrated coronary artery revascularization in an operating theater equipped with angiographic equipment. CONCLUSION: For multivessel coronary artery disease, simultaneous integrated coronary artery revascularization with bivalirudin is safe and feasible. J Thorac Cardiovasc Surg Sep;136(3):702-8
107
108
Implications of the New ESC/EACTS Guidelines for Myocardial Revascularization in 2011
Implications of the New ESC/EACTS Guidelines for Myocardial Revascularization in 2011 Prof. Dr. Volkmar Falk Klinik für Herz- und Gefäßchirurgie, Universitätsspital Zürich, Schweiz In 2004 headlines were
More informationDeclaration of conflict of interest NONE
Declaration of conflict of interest NONE Claudio Muneretto MD, PhD Director of Division of Cardiac Surgery University of Brescia Medical School Italy Hybrid Chymera Different features and potential advantages
More informationSurgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome
Surgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome Chris C. Cook, MD Associate Professor of Surgery Director, CT Residency Program, WVU ACOI 10/17/18 No Disclosures
More informationSURGICAL MYOCARDIAL REVASCULARIZATION: ARTERIAL VS VENOUS GRAFTS, SINGLE VS MULTIPLE GRAFTS?
SURGICAL MYOCARDIAL REVASCULARIZATION: ARTERIAL VS VENOUS GRAFTS, SINGLE VS MULTIPLE GRAFTS? Luigi Martinelli Chief, Dept. of Surgery Istituto Clinico Ligure di Alta Specialità RAPALLO During 1987 2006,
More informationImportance of the third arterial graft in multiple arterial grafting strategies
Research Highlight Importance of the third arterial graft in multiple arterial grafting strategies David Glineur Department of Cardiovascular Surgery, Cliniques St Luc, Bouge and the Department of Cardiovascular
More informationRobotic & Hybrid Coronary Revascularization
Robotic & Hybrid Coronary Revascularization Michael Chu, MD, FRCSC Associate Professor of Surgery Western University, London Health Sciences Centre, London, ON, Canada Saudi Heart Association 2017 Riyadh,
More informationWhat do the guidelines say?
Percutaneous coronary intervention in 3-vessel disease and main stem What do the guidelines say? Nothing to disclose Dariusz Dudek Institute of Cardiology, Jagiellonian University Krakow, Poland The European
More informationAbout OMICS International Conferences
About OMICS Group OMICS Group is an amalgamation of Open Access publications and worldwide international science conferences and events. Established in the year 2007 with the sole aim of making the information
More informationCan Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO!
Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO! Young-Hak Kim, MD, PhD Heart Institute, University of Ulsan College of Medicine Asan Medical Center,
More informationROBOTIC CARDIAC SURGERY
ROBOTIC CARDIAC SURGERY N. Bonaros Department of Cardiac Surgery Innsbruck Medical University NEGATIVE PROPHECIES GOOD OMENS N Bonaros ESCVS Regensburg 2013 ROBOTIC CORONARY ARTERY BYPASS HAS SURVIVED
More informationCONTEMPORARY USE OF ARTERIAL GRAFTS DURING CORONARY ARTERY BYPASS SURGERY: PARADIGM SHIFT? OR A LITTLE (MORE) TALK THAT NEEDS A LOT MORE ACTION
CONTEMPORARY USE OF ARTERIAL GRAFTS DURING CORONARY ARTERY BYPASS SURGERY: PARADIGM SHIFT? OR A LITTLE (MORE) TALK THAT NEEDS A LOT MORE ACTION JAMES L ZELLNER MD I have no financial disclosures. 1897
More informationThe Second Best Arterial Graft:
The Second Best Arterial Graft: A Propensity Analysis of the Radial Artery Versus the Right Internal Thoracic Artery to Bypass the Circumflex Coronary Artery American Association for Thoracic Surgery,
More informationEmergency surgery in acute coronary syndrome
Emergency surgery in acute coronary syndrome Teerawoot Jantarawan Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
More informationThe MAIN-COMPARE Study
Long-Term Outcomes of Coronary Stent Implantation versus Bypass Surgery for the Treatment of Unprotected Left Main Coronary Artery Disease Revascularization for Unprotected Left MAIN Coronary Artery Stenosis:
More informationHybrid coronary revascularization for the treatment of multivessel coronary artery disease
Perspective Hybrid coronary revascularization for the treatment of multivessel coronary artery disease Michael O. Kayatta 1, Michael E. Halkos 1, John D. Puskas 2 1 Division of Cardiothoracic Surgery,
More informationImproved CABG for Complex CAD: A Perspective of Coming Back
Improved CABG for Complex CAD: A Perspective of Coming Back John D. Puskas, MD, MSc, FACS, FACC Professor of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai Chairman, Department of Cardiac
More informationHow to Perform Hybrid Myocardial Revascularisation: Interventional Perspective
How to Perform Hybrid Myocardial Revascularisation: Interventional Perspective Gerhard Schuler Herzzentrum Leipzig Nothing to disclose Hybrid An animal or a plant resulting from a cross between genetically
More informationFFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium
FFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium Conflict of Interest Institutional research grants and speaker s fee from St. Jude Medical and Boston Scientic to Cardiovascular
More informationOPCAB IS NOT BETTER THAN CONVENTIONAL CABG
OPCAB IS NOT BETTER THAN CONVENTIONAL CABG Harold L. Lazar, M.D. Harold L. Lazar, M.D. Professor of Cardiothoracic Surgery Boston Medical Center and the Boston University School of Medicine Boston, MA
More informationOn-Pump vs. Off-Pump CABG: The Controversy Continues. Miguel Sousa Uva Immediate Past President European Association for Cardiothoracic Surgery
On-Pump vs. Off-Pump CABG: The Controversy Continues Miguel Sousa Uva Immediate Past President European Association for Cardiothoracic Surgery On-pump vs. Off-Pump CABG: The Controversy Continues Conflict
More informationOPCABG for Full Myocardial Revascularisation How we do it
OPCABG for Full Myocardial Revascularisation How we do it 28 th SHA Conferance Dr.Farouk Oueida Head of Cardiac Surgery Dept. SBCC-Dammam KSA The Less Invasive CABG Full Revascularisation Full Sternotomy
More informationRevascularization after Drug-Eluting Stent Implantation or Coronary Artery Bypass Surgery for Multivessel Coronary Disease
Impact of Angiographic Complete Revascularization after Drug-Eluting Stent Implantation or Coronary Artery Bypass Surgery for Multivessel Coronary Disease Young-Hak Kim, Duk-Woo Park, Jong-Young Lee, Won-Jang
More informationRadial Artery Grafting: Why Do It? (Evidence Basis)
Advanced Techniques for State of the Art CABG Session AATS 2015 Radial Artery Grafting: Why Do It? (Evidence Basis) David P Taggart MD PhD FRCS FESC Professor of Cardiovascular Surgery, University of Oxford
More informationMinimally invasive direct coronary artery bypass for left anterior descending artery revascularization analysis of 300 cases
Original paper Videosurgery Minimally invasive direct coronary artery bypass for left anterior descending artery revascularization analysis of 300 cases Lufeng Zhang, Zhongqi Cui, Zhiming Song, Hang Yang,
More informationSotirios N. Prapas, M.D., Ph.D, F.E.C.T.S.
CORONARY ARTERY REVASCULARIZATION WITH MILD AORTIC STENOSIS: STRATEGIES OF TREATMENT 9 th ANNUAL MEETING OF THE EAB SOCIETY, Pravets, Bulgaria, 2012 Sotirios N. Prapas, M.D., Ph.D, F.E.C.T.S. Director
More informationUnprotected LM intervention
Unprotected LM intervention Guideline for COMBAT Seung-Jung Park, MD, PhD Professor of Internal Medicine, Seoul, Korea Current Recommendation for unprotected LMCA Stenosis Class IIb C in ESC guideline
More informationMandatory knowledge about natural history of coronary grafts. P.Sergeant P. Maureira K.U.Leuven, Belgium
Mandatory knowledge about natural history of coronary grafts P.Sergeant P. Maureira K.U.Leuven, Belgium Types of grafts Arterial ITA/IMA (internal thoracic/mammary artery) Radial artery Gastro-epiploïc
More informationLM stenting - Cypher
LM stenting - Cypher Left main stenting with BMS Since 1995 Issues in BMS era AMC Restenosis and TLR (%) 3 27 TLR P=.282 Restenosis P=.71 28 2 1 15 12 Ostium 5 4 Shaft Bifurcation Left main stenting with
More informationCoronary Artery Bypass Grafting in Diabetics: All Arterial or Hybrid?
Coronary Artery Bypass Grafting in Diabetics: All Arterial or Hybrid? Dr. Daniel Navia M.D. Chief Cardiac Surgery Department ICBA, Buenos Aires Argentina, 2018 No disclosures 2 Current evidence The FREEDOM
More informationIs bypass surgery needed for elderly patients with LMT disease? From the surgical point of view
CCT 2003 (Kobe) Is bypass surgery needed for elderly patients with LMT disease? From the surgical point of view Hitoshi Yaku, MD, PhD Department of Cardiovascular Surgery Kyoto Prefectural University of
More informationAdults With Diagnosed Diabetes
Adults With Diagnosed Diabetes 1990 No data available Less than 4% 4%-6% Above 6% Mokdad AH, et al. Diabetes Care. 2000;23(9):1278-1283. Adults With Diagnosed Diabetes 2000 4%-6% Above 6% Mokdad AH, et
More informationIncremental Value of Multiple Arterial conduits in CABG
Incremental Value of Multiple Arterial conduits in CABG Nirav C Patel MD FRCS CTh Professor Zucker School of Medicine at Hofstra Northwell Director of Robotic Cardiac Surgery Northwell Health Vice Chairman
More informationVCU Pauley Heart Center: A 2009 US News Top 50 Heart and Heart Surgery Hospital
VCU Pauley Heart Center: A 2009 US News Top 50 Heart and Heart Surgery Hospital Complex PCI: Multivessel Disease George W. Vetrovec, MD. Kimmerling Chair of Cardiology VCU Pauley Heart Center Virginia
More informationMichael Mack, M.D. Baylor Healthcare System Heart Hospital Baylor Plano Dallas, TX
Michael Mack, M.D. Baylor Healthcare System Heart Hospital Baylor Plano Dallas, TX Maquet, Inc.,- unpaid consultant Cordis, Inc.,- unpaid consultant Boston Scientific, Inc.,- travel expenses paid for Syntax
More informationMinimally Invasive Coronary Artery Bypass Graft Surgery. Original Policy Date
MP 7.01.47 Minimally Invasive Coronary Artery Bypass Graft Surgery Medical Policy Section Surgery Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013
More informationControversies in Cardiac Surgery
Controversies in Cardiac Surgery 3 years after SYNTAX : Percutaneous Coronary Intervention for Multivessel / Left main stem Coronary artery disease Pro ESC Congress 2010, 28 August 1 September Stockholm
More informationThe SYNTAX-LE MANS Study
The SYNTAX-LE MANS Study Synergy Between PCI with TAXUS Express and Cardiac Surgery: Late (15-month) Left Main Angiographic Substudy A. Pieter Kappetein, MD, PhD Erasmus MC, Rotterdam, NL SYNTAX-LE MANS
More informationBenefit of Performing PCI Based on FFR
Benefit of Performing PCI Based on FFR William F. Fearon, MD Associate Professor Director, Interventional Cardiology Stanford University Medical Center Benefit of FFR-Guided PCI FFR-Guided PCI vs. Angiography-Guided
More informationImproved long-term survival has been demonstrated by
Benefit of Bilateral Over Single Internal Mammary Artery Grafts for Multiple Coronary Artery Bypass Grafting Masahiro Endo, MD; Hiroshi Nishida, MD; Yasuko Tomizawa, MD; Hiroshi Kasanuki, MD Background
More informationCoronary Artery Disease: Revascularization (Teacher s Guide)
Stephanie Chan, M.D. Updated 3/15/13 2008-2013, SCVMC (40 minutes) I. Objectives Coronary Artery Disease: Revascularization (Teacher s Guide) To review the evidence on whether percutaneous coronary intervention
More informationhigh SYNTAX Score? I Sheiban Division of Cardiology Interventional Card. University of Turin Turin / Italy
What to do with patients with high SYNTAX Score? I Sheiban Division of Cardiology Interventional Card. University of Turin San Giovanni Battista Hospital Turin / Italy Who are the patients with high SYNTAX
More informationOff Pump CABG is Dead. Hopeman Lecture Debate T. Brett Reece, MD September 10, 2007
Off Pump CABG is Dead Hopeman Lecture Debate T. Brett Reece, MD September 10, 2007 OPCAB Potential Pitfalls Technically Demanding Steep learning curve Incomplete revascularization Intraoperative ischemia
More informationFFR Incorporating & Expanding it s use in Clinical Practice
FFR Incorporating & Expanding it s use in Clinical Practice Suleiman Kharabsheh, MD Consultant Invasive Cardiology Assistant professor, Alfaisal Univ. KFHI - KFSHRC Concept of FFR Maximum flow down a vessel
More informationCoronary interventions
Controversial issues in the management of ischemic heart failure Coronary interventions Maciej Lesiak Department of Cardiology, University Hospital in Poznan none DECLARATION OF CONFLICT OF INTEREST CHF
More informationEXCEL vs. NOBLE: How to Treat Left Main Disease in 2017 AATS International Cardiovascular Symposium December 8-9, 2017
EXCEL vs. NOBLE: How to Treat Left Main Disease in 2017 AATS International Cardiovascular Symposium December 8-9, 2017 Igor F. Palacios, MD Director of Interventional Cardiology Professor of Medicine Massachusetts
More informationPCI for Left Anterior Descending Artery Ostial Stenosis
PCI for Left Anterior Descending Artery Ostial Stenosis Why do you hesitate PCI for LAD ostial stenosis? LAD Ostial Lesion Limitations of PCI High elastic recoil Involvement of the distal left main coronary
More informationSouthern Thoracic Surgical Association CABG in 2012: Implications of the New ESC/EACTS Guidelines
Southern Thoracic Surgical Association 2011 CABG in 2012: Implications of the New ESC/EACTS Guidelines David P Taggart MD PhD FRCS Professor of Cardiovascular Surgery, University of Oxford Conflicts of
More informationEvidence-Based Management of CAD: Last Decade Trials and Updated Guidelines
Evidence-Based Management of CAD: Last Decade Trials and Updated Guidelines Enrico Ferrari, MD Cardiac Surgery Unit Cardiocentro Ticino Foundation Lugano, Switzerland Conflict of Interests No conflict
More informationSurgery Grand Rounds
Surgery Grand Rounds Coronary Artery Bypass Grafting versus Coronary Artery Stenting Charles Ted Lord, R1 Coronary Artery Disease Stenosis of epicardial vessels Metabolic & hematologic Statistics 500,000
More informationBetter CABGs vs Better PCI Devices
CABG vs PCI 2017 Multivessel Coronary Disease Better CABGs vs Better PCI Devices ACC New York, Dec 8, 2017 No Disclosures CABG vs PCI 2017 Stable Multivessel Coronary Disease 1. Are These The two Critical
More informationDrug-Eluting Stents Versus Bilateral Internal Thoracic Grafting for Multivessel Coronary Disease
Drug-Eluting Stents Versus Bilateral Internal Thoracic Grafting for Multivessel Coronary Disease Itzhak Herz, MD, Yaron Moshkovitz, MD, Dan Loberman, MD, Gideon Uretzky, MD, Rony Braunstein, PhD, Alberto
More informationMedical Rx vs PCI vs CABG
Medical Rx vs PCI vs CABG S. Hinan Ahmed, MD Associate Professor: Cardiology and Cardiothoracic Surgery Program Director: Interventional Fellowship Program Assoc Editor: Cath and Cardiovasc Intervention
More informationHow to approach non-infarct related artery disease in patients with STEMI in a limited resource setting
How to approach non-infarct related artery disease in patients with STEMI in a limited resource setting Ahmed A A Suliman, MBBS, FACP, FESC Associate Professor, University of Khartoum Interventional Cardiologist,
More informationChronic Total Occlusion: a case for coronary artery bypass grafting
Chronic Total Occlusion: a case for coronary artery bypass grafting Rune Haaverstad Professor & Chief Dept. of Cardiothoracic Surgery Haukeland University Hospital Bergen, Norway Disclosure Research cooperation
More informationISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions
Julinda Mehilli, MD Deutsches Herzzentrum Technische Universität Munich Germany ISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions Background Left main
More informationFinal Clinical and Angiographic Results From a Nationwide Registry of FIREBIRD Sirolimus- Eluting Stent: Firebird In China (FIC) Registry (PI R. Gao)
The Microport FIREBIRD Polymer-based Sirolimus- Eluting Stent Clinical Trial Program Update: The FIC and FIREMAN Registries Junbo Ge, MD, FACC, FESC, FSCAI On behalf of Runlin Gao (FIC PI) and Haichang
More informationRationale for Percutaneous Revascularization ESC 2011
Rationale for Percutaneous Revascularization Marie Claude Morice, Massy FR MD, FESC, FACC ESC 2011 Paris Villepinte - 27-31 August, 2011 Massy, France Potential conflicts of interest I have the following
More informationMost Patients with Elective Left Main Disease. Farrel Hellig
Most Patients with Elective Left Main Disease Should be Treated with PCI! Farrel Hellig Sunnnghill and Sunward Park Hospitals Johannesburg South Africa Everything that can be invented has been invented
More informationFFR in Multivessel Disease
FFR in Multivessel Disease April, 26 2013 Coronary Physiology in the Catheterization Laboratory Location: European Heart House, Nice, France Pim A.L. Tonino, MD, PhD Hartcentrum, Eindhoven, the Netherlands
More informationCardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology
Cardiac evaluation for the noncardiac patient Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Objectives! Review ACC / AHA guidelines as updated for 2009! Discuss new recommendations
More informationLésions du tronc commun: Reste t il une place pour la chirugie? Pierre Deharo, CHU TIMONE, Marseille
Lésions du tronc commun: Reste t il une place pour la chirugie? Pierre Deharo, CHU TIMONE, Marseille Disclosure Statement of Financial Interest I currently have, or have had over the last two years, an
More informationPCI for Left Main Coronary Artery Stenosis. Jean Fajadet Clinique Pasteur, Toulouse, France
PCI for Left Main Coronary Artery Stenosis Jean Fajadet Clinique Pasteur, Toulouse, France Athens, October 19, 2018 Left Main Coronary Artery Disease Significant unprotected left main coronary artery disease
More informationRADIATION HEART DISEASE: MANAGEMENT STRATEGIES
RADIATION HEART DISEASE: MANAGEMENT STRATEGIES AMMAR CHAUDHARY MBChB, ABIM, FRCPC ASSOCIATE CONSULTANT CARDIOLOGIST KING FAISAL SPECIALIST HOSPITAL & RESEARCH CENTER - JEDDAH Scope of the Problem ~ 50
More informationPCI vs. CABG From BARI to Syntax, Is The Game Over?
PCI vs. CABG From BARI to Syntax, Is The Game Over? Seung-Jung Park, MD, PhD Professor of Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea PCI vs CABG Multi-Vessel Disease
More informationDiabetic Patients: Current Evidence of Revascularization
Diabetic Patients: Current Evidence of Revascularization Alexandra J. Lansky, MD Yale University School of Medicine University College of London The Problem with Diabetic Patients Endothelial dysfunction
More informationManagement of High-Risk CAD : Surgeons Perspective
Management of High-Risk CAD : Surgeons Perspective Steven F. Bolling, M.D. Professor of Cardiac Surgery University of Michigan Conflict : Cardiac Surgeon! High Risk CABG 77 year old with prior large anterior
More informationReoperative Coronary Artery Bypass Grafting: Analysis of Early And Late Outcomes
Original Article Reoperative Coronary Artery Bypass Grafting: Analysis of Early And Late Outcomes AR Jodati, MA Yousefnia From Department of Cardiothoracic Surgery, Madani Heart Hospital, Tabriz University
More informationAssessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington
Assessing Cardiac Risk in Noncardiac Surgery Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Disclosure None. I have no conflicts of interest, financial or otherwise. CME
More informationDisclosures The PREVENT IV Trial was supported by Corgentech and Bristol-Myers Squibb
Saphenous Vein Grafts with Multiple Versus Single Distal Targets in Patients Undergoing Coronary Artery Bypass Surgery: One-Year Graft Failure and Five-Year Outcomes from the Project of Ex-vivo Vein Graft
More informationSafety of Single- Versus Multi-vessel Angioplasty for Patients with AMI and Multi-vessel CAD
Safety of Single- Versus Multi-vessel Angioplasty for Patients with AMI and Multi-vessel CAD Mun K. Hong, MD Associate Professor of Medicine Director, Cardiovascular Intervention and Research Weill Cornell
More informationCoronary Heart Disease in Patients With Diabetes
Journal of the American College of Cardiology Vol. 49, No. 6, 2007 2007 by the American College of Cardiology Foundation ISSN 0735-1097/07/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.09.045
More informationOptimal Conduit Strategy in 2017
SAHA 2017 Optimal Conduit Strategy in 2017 David P Taggart MD PhD FRCS Professor of Cardiovascular Surgery, University of Oxford Conflicts of Interest: None Relevant (i) Clinical: Cardiac Surgeon and OPCABG
More informationPerioperative Management After Coronary Stenting: Risk Assessment Before Surgery. Christian Seiler No conflict of interest to declare.
Perioperative Management After Coronary Stenting: Risk Assessment Before Surgery Christian Seiler No conflict of interest to declare PCI Long-Term Outcome Perioperative Management After Coronary Stenting:
More informationThe radial artery is protective in women and men following coronary artery bypass grafting a substudy of the radial artery patency study
Featured Article The radial artery is protective in women and men following coronary artery bypass grafting a substudy of the radial artery patency study Derrick Y. Tam 1,2, Saswata Deb 1,2, Bao Nguyen
More informationCoronary Artery Stenosis. Insight from MAIN-COMPARE Study
PCI for Unprotected Left Main Coronary Artery Stenosis Insight from MAIN-COMPARE Study Young-Hak Kim, MD, PhD Cardiac Center, University of Ulsan College of Medicine, Asan Medical Center Current Practice
More informationApplication of Appropriate Use Criteria in Clinical Care of CAD. Peter K. Smith, MD Professor and Chief Thoracic Surgery Duke University 4/29/2012
Application of Appropriate Use Criteria in Clinical Care of CAD Peter K. Smith, MD Professor and Chief Thoracic Surgery Duke University 4/29/2012 Influence of Severity and Location of Stenosis on Cardiac
More informationCase Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)?
Cronicon OPEN ACCESS CARDIOLOGY Case Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)? Valentin Hristov* Department of Cardiology, Specialized
More informationAccepted Manuscript. Radial artery and bilateral mammary arteries in CABG: how much is too much? Derrick Y. Tam, MD, Stephen E.
Accepted Manuscript Radial artery and bilateral mammary arteries in CABG: how much is too much? Derrick Y. Tam, MD, Stephen E. Fremes, MD, MSc PII: S0022-5223(19)30032-7 DOI: https://doi.org/10.1016/j.jtcvs.2019.01.009
More informationJ. Schwitter, MD, FESC Section of Cardiology
J. Schwitter, MD, FESC Section of Cardiology CMR Center of the CHUV University Hospital Lausanne - CHUV Switzerland Centre de RM Cardiaque J. Schwitter, MD, FESC Section of Cardiology CMR Center of the
More informationThe MAIN-COMPARE Registry
Long-Term Outcomes of Coronary Stent Implantation versus Bypass Surgery for the Treatment of Unprotected Left Main Coronary Artery Disease Revascularization for Unprotected Left MAIN Coronary Artery Stenosis:
More informationIschemic Heart Disease Interventional Treatment
Ischemic Heart Disease Interventional Treatment Cardiac Catheterization Laboratory Procedures (N = 11,61) is a regional and national referral center for percutaneous coronary intervention (PCI). A total
More informationRevascularization In HFrEF: Are We Close To The Truth. Ali Almasood
Revascularization In HFrEF: Are We Close To The Truth Ali Almasood HF epidemic 1-2% of the population have HF At least one-half have heart failure with reduced ejection fraction (HF- REF) The most common
More informationOff-Pump Bilateral Internal Thoracic Artery Grafting in Right Internal Thoracic Artery to Right Coronary System
Off-Pump Bilateral Internal Thoracic Artery Grafting in Right Internal Thoracic Artery to Right Coronary System ADULT CARDIAC Hyun-Chel Joo, MD, Young-Nam Youn, MD, PhD, Gijong Yi, MD, PhD, Byung-Chul
More informationThe Influence of Previous Percutaneous Coronary Intervention in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting
Original Article The Influence of Previous Percutaneous Coronary Intervention in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting Toshihiro Fukui, MD, Susumu Manabe, MD, Tomoki Shimokawa, MD,
More informationControversies in Coronary Revascularization. Atlanta CCU April 15, 2016
Controversies in Coronary Revascularization Atlanta CCU April 15, 2016 Habib Samady MD FACC FSCAI Professor of Medicine Director, Interventional Cardiology, Emory University Director, Cardiac Catheterization
More informationDiagnostic, Technical and Medical
Diagnostic, Technical and Medical Approaches to Reduce CABG Related Stroke Pieter Kappetein, Michael Mack, M.D. Dept Thoracic Surgery, Rotterdam, The Netherlands Baylor Healthcare System Dallas, TX Background
More informationSummary HTA. Drug-eluting stents vs. coronary artery bypass-grafting. HTA-Report Summary. Gorenoi V, Dintsios CM, Schönermark MP, Hagen A
Summary HTA HTA-Report Summary Drug-eluting stents vs. coronary artery bypass-grafting in coronary heart disease Gorenoi V, Dintsios CM, Schönermark MP, Hagen A Scientific background The coronary heart
More informationHow I deploy arterial grafts
Art of Operative Techniques How I deploy arterial grafts David P. Taggart John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK Correspondence to: David P. Taggart, MD(Hons), PhD, FRCS, FESC.
More informationCORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW
CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW 2015 PQRS OPTIONS F MEASURES GROUPS: 2015 PQRS MEASURES IN CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP: #43 Coronary Artery Bypass Graft (CABG):
More informationAre Asian Patients Different? - Updates Of Biomatrix Experience In Regional Settings: BEACON II (3 Yr F up) &
Are Asian Patients Different? - Updates Of Biomatrix Experience In Regional Settings: BEACON II (3 Yr F up) & Biomatrix TM Single Center Experience (Indonesia)(Final 5 Yr F up) T. Santoso University of
More informationΔημήτριος Αγγοσράς, FETCS
ΣΕΜΙΝΑΡΙΟ ΟΜΑΔΩΝ ΕΡΓΑΣΙΑΣ Δημήτριος Αγγοσράς, FETCS Επίκοσρος Καθηγηηής Καρδιοτειροσργικής Ιαηρική Πανεπιζηημίοσ Αθηνών Πανεπιζηημιακό Γενικό Νοζοκομείο Αηηικόν Randomized Controlled Trials (RCTs) Why
More informationRobot-assisted coronary artery bypass grafting improves shortterm outcomes compared with minimally invasive direct coronary artery bypass grafting
Original Article Robot-assisted coronary artery bypass grafting improves shortterm outcomes compared with minimally invasive direct coronary artery bypass grafting Wenhui Gong*, Junfeng Cai*, Zhe Wang,
More informationDaryoush Samim, Enrico Ferrari, MD, FETCS, PD&MER
On- pump versus off- pump coronary artery bypass grafting with left internal mammary artery for left anterior descending artery stenosis: a retrospective study over 15 years Daryoush Samim, Enrico Ferrari,
More informationLeft Main Disease: what is left to surgery? Prof. Jacques Monségu CardioVascular Institute Grenoble, France
Left Main Disease: what is left to surgery? Prof. Jacques Monségu CardioVascular Institute Grenoble, France Background on LM stenosis 5% of patients undergoing angiography Of the myocardium 80% Bifurcation
More informationLessons learned From The National PCI Registry
Lessons learned From The National PCI Registry w a v e On Behalf of The Publication Committee of the National PCI Registry Objectives & Anticipated Achievements To determine the epidemiology of patients
More informationDiabetes mellitus (DM) has been identified as an independent
Diabetes Does Not Affect Long-Term Results After Total Arterial Off-Pump Coronary Revascularization Ho Young Hwang, MD, Jae-Sung Choi, MD, PhD, and Ki-Bong Kim, MD, PhD Department of Thoracic and Cardiovascular
More informationDrug Eluting Stents: Bifurcation and Left Main Approach
TCT Asia 2006 Drug Eluting Stents: Bifurcation and Left Main Approach Eberhard Grube MD FACC, FSCAI Heart Center,, Germany Stanford University, School of Medicine, CA, USA DES in High Risk Lesions TAXUS
More informationApproach to Multi Vessel disease with STEMI
Approach to Multi Vessel disease with STEMI MANAGEMENT OF ST-ELEVATION MYOCARDIAL INFARCTION Dr. Thomas Alexander, M.D; D.M; F.A.C.C. Senior Consultant and Interventional Cardiologist Kovai Medical Centre
More informationThe use of both the left and right internal thoracic arteries (ITAs) for revascularization
Angiographic evidence for reduced graft patency due to competitive flow in composite arterial T-grafts Dmitry Pevni, MD, a Itzhak Hertz, MD, b Benjamin Medalion, MD, c Amir Kramer, MD, a Yosef Paz, MD,
More informationPCIs on Intermediate Lesions NCDR Cath-PCI Registry
Practical Application Of Coronary Physiology in The Cath Lab Talal T Attar, MD, MBA, FACC PCIs on Intermediate Lesions NCDR Cath-PCI Registry Fraction of stenoses 50-70% treated with PCI without further
More information