The technology of drug eluting stents for percutaneous coronary intervention (PCI) has improved over time with resultant improvements in patient outcomes. Although prior studies have demonstrated the benefit of surgical coronary artery bypass grafting (CABG) over transcatheter PCI among patients with multivessel coronary artery disease (CAD), these studies did not incorporate newer generation drug-eluting stents. […]
Tag: CABG
Surgical Repair of Moderate Mitral Regurgitation at the Time of CABG Lacks Clear Benefit
Ischemic mitral regurgitation (MR) is common and associated with poor outcomes among patients undergoing bypass surgery. However, it remains unknown whether repair of ischemic MR concurrent to CABG leads to better patient outcomes. To address this important clinical question, this multi-center study randomly assigned 301 patients with moderate ischemic MR to CABG alone or CABG […]
Quality of Life following Coronary Artery Bypass Graft Surgery versus Guideline-based Medical Therapy in Ischemic Cardiomyopathy
It remains uncertain if surgical revascularization improves patient outcomes in the setting of coronary artery disease with reduced systolic function. This is particularly true in light of the STICH trial, a contemporary randomized control trial of coronary artery bypass graft surgery (CABG) with optimal medical therapy compared to optimal medical therapy alone in patients with […]
Bilateral internal mammary grafts in diabetics: benefits outweigh perioperative risks
Patients with diabetes have more severe coronary disease at presentation and worse overall outcomes than their non-diabetic counterparts, even following surgical revascularisation. Whilst use of the left internal thoracic artery (LITA) is well established and improves event free survival when anastomosed to the LAD, the use of both right and left internal thoracic arteries in […]
SYNTAX II: Improved predictive value
The anatomical SYNTAX score is advocated in both US and European guidelines to help establish the best revascularisation approach in patients with complex coronary artery disease. The purpose of this study was to improve the SYNTAX score further by including prognostically important clinical variables, as opposed to the anatomical variables that are used for the […]
FREEDOM: CABG superior to PCI in diabetics
Diabetes is one of the principle aetiological factors for coronary artery disease with vascular disease in diabetics displaying a particularly aggressive phenotype, often resulting in multivessel disease. Current evidence suggests that CABG is particularly beneficial in these patients as compared with PCI. however, much of this evidence was either gathered in the era before modern […]
PCI in centres without surgical backup
As percutaneous coronary intervention (PCI) has advanced, improved technology and increased collective experience have led to a marked reduction in the need for emergency coronary artery bypass surgery (CABG), with only 0.15% of patients requiring emergency surgical intervention in 2002. In fact, PCI is now commonly practiced in hospitals without on-site cardiothoracic back-up, something that […]
EuroSCORE updated
The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is one of the most widely used cardiac risk models for predicting mortality after cardiac surgery and forms the basis of many pre-operative discussions surrounding risk/benefit ratios and gaining informed consent for a procedure. First published in 1999 and derived from an international European database, the […]
Stroke following CABG and long term outcomes
Stroke is a potentially devastating complication following cardiothoracic surgery with a reported incidence of between 2 and 10%. While numerous risk factors have been described for stroke, little data are available regarding its temporal relationship to the surgical procedure and whether this predicts long term outcomes. […]
STICH examines the role of CABG in heart failure
While the efficacy of CABG in improving both morbidity and mortality in patients with severe coronary artery disease and angina was established in the 1970’s, the majority of patients who took part in these initial ground-breaking studies had normal or near normal ventricular function. The role of CABG in treating patients with poor systolic LV […]