OPCAB IS NOT BETTER THAN CONVENTIONAL CABG
|
|
- Conrad Parsons
- 6 years ago
- Views:
Transcription
1 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
2 WHEN CABG IS PERFORMED ON CPB, THERE IS THE POSSIBILITY OF: Myocardial Ischemic Injury Strokes and Neurocognitive Deficits Activation of Inflammatory Pathways Pulmonary Insufficiency Renal Failure Coagulopathies
3 RETROSPECTIVE STUDIES Largely Single Center Lacked Randomization Selection Biases Intention to Treat Principle Not Honored Lacked Proper Equipment Usually Involved One Surgeon Short Term Outcomes Only Reported Small Sample Size
4 RETROSPECTIVE STUDIES Racz et al. JACC 2004;43: NY State Registry for CABG: ,000 Patients OPCAB vs. On-Pump CABG NO DIFFERENCE IN 30 DAY Risk Adjusted Mortality MI Sternal Wound Infections Renal Failure OPCAB Increased Incidence of GI Complications On-Pump CABG Increased Incidence of Stroke; Reoperation for Bleeding; Average 1 Day Longer Postop HOWEVER, After 3 Years, On-Pump CABG: Higher Survival Less Need for Repeat Revascularization
5 RETROSPECTIVE STUDIES Hannan et al. Circ 207;116: NY State Registry for CABG: ,830 Patients OPCAB vs. On-Pump CABG 30 DAY OUTCOMES: No Difference in Mortality. However, risk-adjusted rates favored OPCAB 1.63% OPCAB Patients Converted to CABG had a Mortality of 9.73% OPCAB had lower risk-adjusted rates for Stroke and Respiratory Failure 3-YEAR OUTCOMES No Difference in Mortality OPCAB had Higher Incidence of Re-Revascularization which was unrelated to Surgical Experience (High vs. Low Volume)
6 PROSPECTIVE RANDOMIZED TRIALS ROBY TRIAL RANDOMIZED ON/OFF BYPASS TRIAL Shrayer et al. N Engl J Med 2009;361: Prospective; Randomized Trial 2,203 Patients; 18 VA Centers; 53 Attending Surgeons Inclusion: Urgent/Elective CABG Exclusion: Emergent/Salvage CABG, CABG + Valve, Target Vessel <1.1 mm; Diffuse Disease Primary Short-Term Endpoint: 30-Day Mortality & MACE Primary Long-Term Endpoint: 1-Year Mortality, MI, Need for Repeat Revascularization
7 PROSPECTIVE RANDOMIZED TRIALS ROBY TRIAL Results STS Risk Scores and Patient Risk Factors were Similar NO DIFFERENCE in Short-Term Mortality or MACE OPCAB patients received Fewer Grafts/Patient After 1 year, OPCAB patients had: Increased Cardiac-Related Deaths Higher MACE Lower Graft Patency No Difference in Neuropysch Testing Between Groups Results Did Not Differ: Resident vs. Attending High vs. Low Volume Surgeon
8 PROSPECTIVE RANDOMIZED TRIALS ROBY TRIAL Criticisms Women were Excluded No Data Regarding LDL Values; Use of Statins, ASA, Glycemic Control OPCAB Conversion = 12.4%
9 PROSPECTIVE RANDOMIZED TRIALS SMART TRIAL Ann Thorac Surg 2011;59: Surgical Management of Arterial Revascularization Therapy Puskas et al. Single Center, Single Surgeon, Prospective Randomized Trial 297 Patients with Elective CABG (OPCAB vs. On-Pump CABG) 140 (44%) Long-Term Survivors: 87 Patients (62% of Survivors) Returned for Follow-up Imaging Following 7.5 Years: NO DIFFERENCE IN MORTALITY NO DIFFERENCE IN GRAFT PATENCY RECURRENT ANGINA WAS MORE COMMON IN THE OPCAB PATIENTS
10 META-ANALYSES NO DIFFERENCE IN SHORT-TERM MORBIDITY OR MORTALITY BETWEEN OPCAB AND ON-PUMP CABG OPCAB PATIENTS HAVE LESS GRAFTS AND A HIGHER INCIDENCE OF INCOMPLETE REVASCULARIZATION OPCAB IS ASSOCIATED WITH DECREASED GRAFT PATENCY AND A HIGHER INCIDENCE OF REPREAT REVASCULARIZATION STUDIES WHICH INITIALLY SHOWED FAVORABLE EARLY OUTCOMES WITH OPCAB FOUND THAT THESE BENEFICIAL EFFECTS WERE NOT APPARENT LONG-TERM IN SOME ANALYSES, LONG-TERM SURVIVAL IS DECREASED IN PATIENTS WITH OPCAB FACTOR CONTRIBUTING TO DECREASED LONG-TERM SURVIVAL FOLLOWING OPCAB: Incomplete Revascularization Decreased Graft patency
11 OPCAB AND INCOMPLETE REVASCULARIZATION INCOMPLETE REVASCULARIZATION FOLLOWING SURGICAL OR MEDICAL THERAPY RESULTS IN INCREASED MORTALITY, RE- REVASCULARIZATION, RECURRENT MIs, AND REPEAT HOSPITALIZATION Synnegren et al. JTCVS 2008;136:29-36 Effects of Incomplete Surgical Revascularization Over 5 Years in a Non- Randomized Cohort of 9,408 Patients: Incomplete Revascularization was More Common Following OPCAB In Patients with 3-Vessel Disease, Survival was Decreased Following OPCAB Procedures Proponents of OPCAB Argue: Fewer Grafts with OPCAB Because Surgeons are More Likely to Perform OPCAB in Patients with SINGLE and DOUBLE Vessel Disease However, Studies Looking at the Ratio of Grafted vs. Diseased Vessels Continue to Show That OPCAB Patients are Under-Revascularized
12 CONSEQUENCE OF CONVERSION FROM OPCAB TO ON-PUMP CABG CONVERTING FROM OPCAB TO ON-PUMP CABG ON AN UNPLANNED BASIS INCREASED: Mortality Strokes Renal Failure Pulmonary and GI Complications Hospital Length of Stay Medical Costs Jin et al. Circ 2005;112:I332-I337
13 OPCAB DOES NOT ELIMINATE THE DETRIMENTAL EFFECTS OF CPB INFLAMMATION NEUROLOGIC AND COGNITIVE CHANGES QUALITY OF LIFE
14 OPCAB DOES NOT ELIMINATE THE DETRIMENTAL EFFECTS OF CPB INFLAMMATORY RESPONSES AND BIO MARKERS Both OPCAB and On-Pump CABG Activate Inflammatory Responses OPCAB May Decrease Some Components of Complement But DOES NOT Alter the Production of Cytokines or Chemokines Which Modulate Neutrophil and Platelet Activation Myocardial Ischemia Alone, REGARDLESS OF CPB, is a Major Activator of C5b9 Many Clinical Trials Used Cardiotomy Suction, Non-Bonded CPB Circuits, and Increased Heparin Dosages in the Patients Undergoing On-Pump CABG Castellheim A. et al. Ann Thorac Surg 2008;85:
15 OPCAB DOES NOT ELIMINATE THE DETRIMENTAL EFFECTS OF CPB NEUROLOGIC AND COGNITIVE CHANGES The Majority of Trials Show NO BENEFIT In Reducing Strokes With OPCAB OPCAB DOES NOT Eliminate The Need For Aortic Clamping Neurological Injuries Can Occur During Periods of Hypotension and LV Manipulation Single Clamp Technique Has Significantly Reduced The Incidence of Strokes in On-Pump CABG Patients OPCAB FAILS To Prevent The Decline in Cognitive Function Associated With Coronary Surgical Revascularization Advanced Age and Atherosclerosis Are More Important Determinants of Long-Term Cognitive Dysfunction Than The Type of CABG Procedure Performed Nishiyama KE et al. Ann Thorac Surg 2009;87:
16 OPCAB DOES NOT ELIMINATE THE DETRIMENTAL EFFECTS OF CPB QUALITY OF LIFE OPCAB RESULTS IN NO DIFFERENCE IN: Quality of Life Return to Active Physical Activity Mental Health Kapetanakis et al. J Card Surg 2008;23:
17 IMPACT OF OPCAB ON GENDER Fu et al. Ann Thorac Surg 2009;87: ,359 Patients Undergoing Coronary Revascularization; Mean Follow-up = 5 Years 30-Day Mortality Was Higher Regardless of The Revascularization Technique In Female Patients Females Undergoing OPCAB Less Likely to Have Received Complete Revascularization Less Likely to Be Free From Long-Term MACE Gender Was An Independent Risk Factor For 30-Day Mortality in On-Pump CABG Patients vs. OPCAB. However, There Was No Difference in Late Survival Between Males and Females Regardless of Whether They Received OPCAB vs. On-Pump CABG Puskus et al. Circ 2007;116:I192-I196 Puskus et al. Ann Thorac Surg 2008;86: OPCAB Resulted in a Reduction in 30-Day Mortality in Women However, After a 10-Year Follow-up, There Was NO DIFFERENCE IN SURVIVAL BETWEEN OPCAB VS. ON-PUMP CABG REGARDLESS OF GENDER
18 OFF-PUMP CABG DOES NOT PRESERVE RENAL FUNCTION BETTER THAN ON-PUMP CABG: A CASE MATCHED STUDY Elmistekawy et al. J Thorac Cardiovasc Surg 2012;143: ,589 Patients; Single Center; Non-Randomized Propensity Matching OPCAB Patients Had: A Greater Increase in Postop Creatinine; p=0.007 A Greater Decrease in Creatinine Clearance; p=0.007
19 OPCAB IS NOT SUPERIOR TO ON-PUMP CABG IN PATIENTS AT HIGH-RISK FOR RENAL DYSFUNCTION Shayan et al. J Card Surg 2011;26: Retrospective; Non-Randomized Trial 43 Renal Transplant Recipients Undergoing Coronary Revascularization: 21 OPCAB vs. 22 On-Pump CABG OPCAB Patients Were Older; More REOPS in On-Pump CABG RESULTS On-Pump CABG Patients Received More Grafts No Difference in 30-Day or 8-Year Survival No Change in Serum Creatinine at 30 Days Rate of Return to Permanent Dialysis Was Similar in Both Groups
20 OPCAB OFFERS NO ADVANTAGE IN ELDERLY PATIENTS Li et al. JTCS 2008;136: Non-Randomized Trial of 1,191 Patients > 65 Years OPCAB = 447 vs. On-Pump CABG = 774 OPCAB Patients Had a Higher Rate of Incomplete Revascularization But Lower Rates of Infection and Pulmonary Complications However, at 30 Days, NO DIFFERENCE in Mortality Between Groups At a Mean of 47 Months: OPCAB Patients Had A Higher Incidence of: Stroke MI Readmissions for Angina Re-revascularization Procedures
21 CONCLUSIONS: OPCAB VS. ON-PUMP CABG THERE IS NO IMPROVEMENT IN SHORT-TERM MORBIDITY OR MORTALITY WITH OPCAB ANY SHORT-TERM BENEFITS WITH OPCAB ARE NO LONGER APPARENT LONG-TERM THERE IS EVIDENCE TO SUGGEST THAT LONG-TERM SURVIVAL MAY BE REDUCED WITH OPCAB OPCAB: Results in Incomplete Revascularization Increases The Need For Re-Revascularization Procedures Decreases Long-Term Freedom From Recurrent Angina and The Need For Hospitalization Is Associated With Decreased Graft Patency
22 CONCLUSIONS: OPCAB VS. ON-PUMP CABG PROPONENTS OF OPCAB ARGUE: Early Trials Underestimate The Value of OPCAB Inadequate Equipment Stabilizers, Positioning Devices, Intracoronary shunts Inadequate Surgeon Experience HOWEVER: On-Pump CABG and CPB Have Also Improved: Single Cross Clamp Techniques Heparin-Bonded Circuits Miniaturized Pump Circuitry Reduction in ACT Levels During CPB
23 CONCLUSIONS: OPCAB VS. ON-PUMP CABG PROPONENTS OF OPCAB ARGUE: OPCAB Is Best Performed In High-Volume Centers After Cases Have Been Performed HOWEVER: The Volume of CABG Surgery Is Declining CABG Surgery Must Be Performed: Under All Circumstances On All Patients At All Institutions; Regardless of Hospital or Surgeon Cardiac Volume
24 GOALS OF CABG SURGERY COMPLETE REVASCULARIZATION TECHNICALLY PERFECT ANASTOMOSIS OPTIMAL USE OF CONDUITS MINIMIZE HEMODYNAMIC INSTABILITY ENHANCE LONG-TERM SURVIVAL DECREASE THE NEED FOR RE-REVASCULARIZATION ON-PUMP CABG IS THE BEST METHOD TO ACHIEVE THESE GOALS
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 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 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 informationCurrent outcomes of off-pump coronary artery bypass grafting: evidence from real world practice
Review Article Current outcomes of off-pump coronary artery bypass grafting: evidence from real world practice Piroze M. Davierwala Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig,
More informationECMO vs. CPB for Intraoperative Support: How do you Choose?
ECMO vs. CPB for Intraoperative Support: How do you Choose? Shaf Keshavjee MD MSc FRCSC FACS Director, Toronto Lung Transplant Program Surgeon-in-Chief, University Health Network James Wallace McCutcheon
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 informationIntraoperative application of Cytosorb in cardiac surgery
Intraoperative application of Cytosorb in cardiac surgery Dr. Carolyn Weber Heart Center of the University of Cologne Dept. of Cardiothoracic Surgery Cologne, Germany SIRS & Cardiopulmonary Bypass (CPB)
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 informationIschemic Heart Disease Interventional Treatment
Ischemic Heart Disease Interventional Treatment Cardiac Catheterization Laboratory Procedures (N = 89) is a regional and national referral center for percutaneous coronary intervention (PCI). A total of
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 informationMeasure #167 (NQF 0114): Coronary Artery Bypass Graft (CABG): Postoperative Renal Failure National Quality Strategy Domain: Effective Clinical Care
Measure #167 (NQF 0114): Coronary Artery Bypass Graft (CABG): Postoperative Renal Failure National Quality Strategy Domain: Effective Clinical Care 2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE
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 informationOff-Pump Cardiac Surgery is not Dead
Off-Pump Cardiac Surgery is not Dead Gonzalo J. Carrizo, M.D. Fellow Cardiothoracic Surgery Division Cardiothoracic Surgery Department of Surgery University of Colorado Hopeman Lectureship September 10,2007
More informationImplications 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 informationChairman and O. Wayne Isom Professor Department of Cardiothoracic Surgery Weill Cornell Medicine
Leonard N. Girardi, M.D. Chairman and O. Wayne Isom Professor Department of Cardiothoracic Surgery Weill Cornell Medicine New York, New York Houston Aortic Symposium Houston, Texas February 23, 2017 weill.cornell.edu
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 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 informationPCI in Patients with Transplant Coronary Artery Disease. Michael S. Lee, MD, FACC, FSCAI Assistant Professor UCLA School of Medicine
PCI in Patients with Transplant Coronary Artery Disease Michael S. Lee, MD, FACC, FSCAI Assistant Professor UCLA School of Medicine Faculty Disclosure Honararia for Boston Scientific, BMS, Daiichi Sankyo,
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 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 informationSurgery for patients with diffuse atherosclerotic disease
Surgery for patients with diffuse atherosclerotic disease Special hospital for surgery Skopje Macedonia September, 2012 Mitrev Z, Anguseva T, E.Stoicovski, Hristov N, E.Idoski Oktomvri, 2008 Atherosclerosis
More informationTed Feldman, M.D., MSCAI FACC FESC
Support Technologies and High Risk Intervention Patient Selection: When Not to Use Them Ted Feldman, M.D., MSCAI FACC FESC Evanston Hospital SCAI Fall Fellows Course Las Vegas December 7-10 th, 2014 Ted
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 informationCost-effectiveness of minimally invasive coronary artery bypass surgery Arom K V, Emery R W, Flavin T F, Petersen R J
Cost-effectiveness of minimally invasive coronary artery bypass surgery Arom K V, Emery R W, Flavin T F, Petersen R J Record Status This is a critical abstract of an economic evaluation that meets the
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 informationMitral Valve Surgery: Lessons from New York State
Mitral Valve Surgery: Lessons from New York State Joanna Chikwe, MD Professor of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai Chairman & Program Director Department of Cardiovascular
More informationCoronary Artery Bypass Graft: Monitoring Patients and Detecting Complications
Coronary Artery Bypass Graft: Monitoring Patients and Detecting Complications Madhav Swaminathan, MD, FASE Professor of Anesthesiology Division of Cardiothoracic Anesthesia & Critical Care Duke University
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 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 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 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 informationNavigating the Dichotomies Between Literature and Your Clinical Practice
Navigating the Dichotomies Between Literature and Your Clinical Practice Robert Groom, CCP, FPP Cardiovascular Institute at Maine Medical Center Disclosures No relevant conflicts related to this presentation
More information2016 Physician Quality Reporting System Data Collection Form: Coronary Artery Bypass Graft (CABG) (for patients aged 18 years and older)
2016 Physician Quality Reporting System Data Collection Form: Coronary Artery Bypass Graft (CABG) (for patients aged 18 years and older) IMPORTANT: Any measure with a 0% performance rate (100% for inverse
More informationConventional coronary artery bypass grafting (CCAB) is
ORIGINAL ARTICLES Off-Pump versus Conventional Coronary Artery Bypass Grafting: A Meta-Analysis and Consensus Statement From The 2004 ISMICS Consensus Conference John Puskas, MD, a Davy Cheng, MD, b John
More informationWith Regards to Afflictions of the Heart, Are Men and Women Created Equal?
With Regards to Afflictions of the Heart, Are Men and Women Created Equal? Jennifer S. Lawton, M.D. Associate Professor of Surgery Washington University School of Medicine AATS/STS Adult Cardiac Surgery
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 informationSolving Definitional Issues at the Society of Thoracic Surgeons
Solving Definitional Issues at the Society of Thoracic Surgeons DeLaine Schmitz, MSHL Quality Reporting Executive STA Annual Meeting January 12, 2017 aqihq.org DISCLOSURES None 2017 AMERICAN SOCIETY OF
More informationSurgical Mininvasive Approach for Mitral Repair Prof. Mauro Rinaldi
Surgical Mininvasive Approach for Mitral Repair Prof. Mauro Rinaldi SC Cardiochirurgia U Universita degli Studi di Torino PORT-ACCESS TECNIQUE Reduce surgical trauma Minimize disruption of the chest wall
More informationManaging Hypertension in the Perioperative Arena
Managing Hypertension in the Perioperative Arena Optimizing Perioperative Management Strategies for Hypertension in the Cardiac Surgical Patient Objectives: Treatment of hypertensive emergencies. ALBERT
More informationHigh Risk PCI for Heart Failure
High Risk PCI for Heart Failure Ray Matthews MD Professor of Clinical Medicine Chief, Division of Cardiovascular Medicine University of Southern California Los Angeles, California Disclosures Abiomed Research
More informationCatheter-based mitral valve repair MitraClip System
Percutaneous Mitral Valve Repair: Results of the EVEREST II Trial William A. Gray MD Director of Endovascular Services Associate Professor of Clinical Medicine Columbia University Medical Center The Cardiovascular
More informationAdvances in Transfusion and Blood Conservation
Advances in Transfusion and Blood Conservation Arman Kilic, MD Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD No relevant financial relationships to disclose.
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 informationBlood Management of the Cardiac Patient in the Postoperative Period
Blood Management of the Cardiac Patient in the Postoperative Period Al Stammers, MSA, CCP, Eric Tesdahl, PhD Andy Stasko MS, CCP, RRT, Linda Mongero, BS, CCP, Sam Weinstein, MD, MBA Goal To examine the
More informationSupplementary Online Content
Supplementary Online Content Inohara T, Manandhar P, Kosinski A, et al. Association of renin-angiotensin inhibitor treatment with mortality and heart failure readmission in patients with transcatheter
More informationValve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal
Valve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal I have nothing to disclose. Wide Spectrum Stable vs Decompensated NYHA II IV? Ejection
More informationOutcomes of off-pump versus on-pump coronary artery bypass grafting: Impact of preoperative risk
ACQUIRED CARDIOVASCULAR DISEASE Outcomes of off-pump versus on-pump coronary artery bypass grafting: Impact of preoperative risk Marek Polomsky, MD, a Xia He, MS, b Sean M. O Brien, PhD, b and John D.
More informationUseful? Definition of High-risk? Pre-OP/Intra-OP/Post-OP? Complication vs Benefit? Mortality? Morbidity?
Preoperative intraaortic balloon counterpulsation in high-risk CABG Stefan Klotz, M.D. Preoperative IABP in high-risk CABG Questions?? Useful? Definition of High-risk? Pre-OP/Intra-OP/Post-OP? Complication
More informationΑΓΓΕΙΟΠΛΑΣΤΙΚΗ ΣΤΟ ΔΙΑΒΗΤΙΚΟ ΑΣΘΕΝΗ
ΑΓΓΕΙΟΠΛΑΣΤΙΚΗ ΣΤΟ ΔΙΑΒΗΤΙΚΟ ΑΣΘΕΝΗ Νίκος Μεζίλης MD, FESC Κλινική Άγιος Λουκάς Why diabetes is associated with restenosis endothelial dysfunction metabolic alterations accelerated platelet deposition
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 informationPrevention and Management of Cardiac Adverse Event
Prevention and Management of Cardiac Adverse Event Carlo Cernetti Department of Interventional Cardiology Mirano (Italy) Cannes MEEC 14 June 2007 Are these risks factors of Haemodynamic Instability
More informationMeasure #164 (NQF 0129): Coronary Artery Bypass Graft (CABG): Prolonged Intubation National Quality Strategy Domain: Effective Clinical Care
Measure #164 (NQF 0129): Coronary Artery Bypass Graft (CABG): Prolonged Intubation National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY DESCRIPTION:
More informationEACTS Adult Cardiac Database
EACTS Adult Cardiac Database Quality Improvement Programme List of changes to Version 2.0, 13 th Dec 2018, compared to version 1.0, 1 st May 2014. INTRODUCTORY NOTES This document s purpose is to list
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 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 informationMinimally Invasive Mitral Valve Repair: Indications and Approach
Minimally Invasive Mitral Valve Repair: Indications and Approach Juan P. Umaña, M.D. Chief Medical Officer Director, Cardiovascular Medicine FCI - Institute of Cardiology Bogota Colombia 1 Mitral Valve
More informationValve Disease. Valve Surgery. Total Volume. In 2016, Cleveland Clinic surgeons performed 3039 valve surgeries.
Valve Surgery Total Volume 1 1 Volume 35 3 5 15 1 5 1 13 1 N = 773 5 79 15 93 1 339 In 1, surgeons performed 339 valve surgeries. surgeons have implanted more than 1, bioprosthetic aortic valves since
More informationRandomized comparison of single versus double mammary coronary artery bypass grafting: 5 year outcomes of the Arterial Revascularization Trial
Randomized comparison of single versus double mammary coronary artery bypass grafting: 5 year outcomes of the Arterial Revascularization Trial Embargoed until 10:45 a.m. CT, Monday, Nov. 14, 2016 David
More informationQuality Measures MIPS CV Specific
Quality Measures MIPS CV Specific MEASURE NAME Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy CAHPS for MIPS Clinician/Group Survey Cardiac Rehabilitation Patient Referral from
More informationESC Congress 2011 SIMULTANEOUS HYBRID REVASCULARIZATION OF CAROTID AND CORONARY DISEASE INITIAL RESULTS OF A NEW THERAPEUTIC APPROACH
ESC Congress 2011 SIMULTANEOUS HYBRID REVASCULARIZATION OF CAROTID AND CORONARY DISEASE IN PATIENTS WITH ACUTE CORONARY SYNDROME: INITIAL RESULTS OF A NEW THERAPEUTIC APPROACH AUTHORS: Marta Ponte 1, RICARDO
More information'Coronary artery bypass grafting in patients with acute coronary syndromes: perioperative strategies to improve outcome'
'Coronary artery bypass grafting in patients with acute coronary syndromes: perioperative strategies to improve outcome' Miguel Sousa Uva Chair ESC Cardiovascular Surgery WG Hospital da Cruz Vermelha Portuguesa
More informationTissue vs Mechanical What s the Data??
Biological (Tissue) Valve in a 60 year old patient: Debate Tissue vs Mechanical What s the Data?? Joseph E. Bavaria, MD Immediate-Past President - Society of Thoracic Surgeons (STS) Brooke Roberts-William
More informationCPORT E Trial. Atlantic C PORT
CPORT E Trial Randomized trial comparing medical, economic and quality of life outcomes of non primary PCI at hospitals with and without on site cardiac surgery Mo#va#on for Trial Sustain primary PCI program
More informationEdward P. Chen MD. Director Thoracic Aortic Surgery Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta, Georgia
David Procedure in Acute Type A Dissection Edward P. Chen MD Director Thoracic Aortic Surgery Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta, Georgia The Houston Aortic
More informationTHE NATIONAL QUALITY FORUM
THE NATIONAL QUALITY FORUM National Voluntary Consensus Standards for Patient Outcomes Table of Measures Submitted-Phase 1 As of March 5, 2010 Note: This information is for personal and noncommercial use
More informationTransfusion & Mortality. Philippe Van der Linden MD, PhD
Transfusion & Mortality Philippe Van der Linden MD, PhD Conflict of Interest Disclosure In the past 5 years, I have received honoraria or travel support for consulting or lecturing from the following companies:
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 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 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 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 informationCARDIOCHIRURGIA MINI-INVASIVA: INVASIVA: efficacia per il paziente efficienza per la sanita. Dott. Davide Ricci
CARDIOCHIRURGIA MINI-INVASIVA: INVASIVA: efficacia per il paziente efficienza per la sanita Dott. Davide Ricci SC Cardiochirurgia U Universita degli Studi di Torino Minimally Invasive Surgical approaches
More informationTCT mdbuyline.com Clinical Trial Results Summary
TCT 2012 Clinical Trial Results Summary FAME2 Trial: FFR (fractional flow reserve) guided PCI in all target lesions Patients with significant ischemia, randomized 1:1 Control arm: not hemodynamically significant
More informationUniversity of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives
University of Florida Department of Surgery CardioThoracic Surgery VA Learning Objectives This service performs coronary revascularization, valve replacement and lung cancer resections. There are 2 faculty
More informationTSDA ACGME Milestones
TSDA ACGME Milestones Short MW and Edwards JA. Assessing resident milestones using a CASPE March 2012 Short MW and Edwards JA. Assessing resident milestones using a CASPE March 2012 Short
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 informationDESCRIPTION: Percentage of patients aged 18 years and older undergoing isolated CABG surgery who received an IMA graft
Measure #43 (NQF 0134): Coronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA) in Patients with Isolated CABG Surgery National Quality Strategy Domain: Effective Clinical Care 2017 OPTIONS
More informationIschemic Mitral Regurgitation
Ischemic Mitral Regurgitation 1 / 6 2 / 6 3 / 6 Ischemic Mitral Regurgitation Background Myocardial infarction (MI) can directly cause (IMR), which has been touted as an indicator of poor prognosis in
More informationCoronary artery bypass grafting (CABG) is a temporary treatment for a
Surgery for Acquired Cardiovascular Disease Influence of patient characteristics and arterial grafts on freedom from coronary reoperation Joseph F. Sabik III, MD, a Eugene H. Blackstone, MD, a,b A. Marc
More informationCABG alone. It s enough? / Μόνο η αορτοστεφανιαία παράκαμψη είναι αρκετή;
LV Aneurysm and VSD in Ischaemic Heart Failure / Στεφανιαία νόσος, ανεύρυσμα αριστεράς κοιλίας και VSD CABG alone. It s enough? / Μόνο η αορτοστεφανιαία παράκαμψη είναι αρκετή; THEODOROS KARAISKOS CONSULTANT
More informationHeart Transplantation for Patients with a Fontan Procedure
Heart Transplantation for Patients with a Fontan Procedure Kirk R. Kanter MD Professor of Surgery Pediatric Cardiac Surgery Emory University School of Medicine Children s Healthcare of Atlanta Atlanta,
More informationSolving Definitional Issues at the Society of Thoracic Surgeons
Solving Definitional Issues at the Society of Thoracic Surgeons DeLaine Schmitz, MSHL Quality Reporting Executive STA Annual Meeting January 12, 2017 aqihq.org DISCLOSURES None 2017 AMERICAN SOCIETY OF
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 informationFaculty/Presenter Disclosure
Faculty/Presenter Disclosure Faculty: Andre Lamy Relationships with commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None Other: None CORONARY: The Coronary
More information4/27/2015. Cardiac Events #1 cause of postoperative complications/ mortality- CHF, complete heart block, MI,
Not intended for medical clearance Identify, document, and evaluate health conditions Medication Management Stratify Risks Optimize conditions within context of surgical illness Recommend measures that
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 informationPCI for Renal Artery stenosis
PCI for Renal Artery stenosis Why should we treat Renal Artery Stenosis? Natural History of RAS RAS is progressive disease Study Follow-up (months) Pts Progression N (%) Total occlusion Wollenweber Meaney
More informationManagement of Heart Failure in Adult with Congenital Heart Disease
Management of Heart Failure in Adult with Congenital Heart Disease Ahmed Krimly Interventional and ACHD consultant King Faisal Cardiac Center National Guard Jeddah Background 0.4% of adults have some form
More informationIntra-operative Echocardiography: When to Go Back on Pump
Intra-operative Echocardiography: When to Go Back on Pump GREGORIO G. ROGELIO, MD., F.P.C.C. OUTLINE A. Indications for Intraoperative Echocardiography B. Role of Intraoperative Echocardiography C. Criteria
More informationManagement of Cardiogenic shock. Prof. Christian JM Vrints
Management of Cardiogenic shock Prof. Christian JM Vrints none conflicts Management of Cardiogenic Shock Incidence and trends Importance of early revascularization Multivessel disease Left main disease
More informationMinimally Invasive Stand Alone Cox-Maze Procedure For Patients With Non-Paroxysmal Atrial Fibrillation
Minimally Invasive Stand Alone Cox-Maze Procedure For Patients With Non-Paroxysmal Atrial Fibrillation Niv Ad, MD Chief, Cardiac Surgery Inova Heart and Vascular Institute Disclosures Niv Ad: Medtronic
More informationCritical Appraisal of Risk Adjusted Analysis and Public Reporting of Outcomes in Cardiac Surgery
Critical Appraisal of Risk Adjusted Analysis and Public Reporting of Outcomes in Cardiac Surgery University of Ottawa Heart Institute Jean Yves Dupuis, MD, FRCPC Cardiac Division of Anesthesiology Disclosure
More informationParis, August 28 th Gian Paolo Ussia on behalf of the CoreValve Italian Registry Investigators
Paris, August 28 th 2011 Is TAVI the definitive treatment in high risk patients? Impact Of Coronary Artery Disease In Elderly Patients Undergoing TAVI: Insight The Italian CoreValve Registry Gian Paolo
More informationIschemic Mitral Valve Disease: Repair, Replace or Ignore?
Ischemic Mitral Valve Disease: Repair, Replace or Ignore? Fabio B. Jatene Full Professor of Cardiovascular Surgery, Medical School, University of São Paulo, Brazil DISCLOSURE I have no financial relationship
More informationTAVR in patients with. End-Stage CKD or in Renal Replacement Therapy:
TAVR in patients with End-Stage CKD or in Renal Replacement Therapy: Special Considerations and Prevention of early Valve Failure Antonios Chalapas, MD, PhD, FESC THV & Hygeia Hospital Heart Team Athens,
More informationRevascularization in Severe LV Dysfunction: The Role of Inducible Ischemia and Viability Testing
Revascularization in Severe LV Dysfunction: The Role of Inducible Ischemia and Viability Testing Evidence and Uncertainties Robert O. Bonow, MD, MS, MACC Northwestern University Feinberg School of Medicine
More informationIntraaortic Balloon Counterpulsation- Supportive Data for a Role in Cardiogenic Shock ( Be Still My Friend )
Intraaortic Balloon Counterpulsation- Supportive Data for a Role in Cardiogenic Shock ( Be Still My Friend ) Stephen G. Ellis, MD Section Head, Interventional Cardiology Professor of Medicine Cleveland
More informationAggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection: Con
Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection: Con Thomas G. Gleason, M.D. Ronald V. Pellegrini Professor and Chief Division of Cardiac Surgery University of Pittsburgh Presenter
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 informationAdvances in Cardiovascular Diagnosis and Therapy. No disclosure or conflicts. Outline
Advances in Cardiovascular Diagnosis and Therapy Firas Zahr, MD Assistant Professor of Medicine Interventional Cardiology University Of Iowa No disclosure or conflicts Outline What is new with revascularization?
More informationUniversity of Bristol - Explore Bristol Research
Rogers, C., Capoun, R., Scott, L., Taylor, J., Angelini, G., Narayan, P.,... Ascione, R. (2017). Shortening cardioplegic arrest time in patients undergoing combined coronary and valve surgery: results
More information