When deciding on the optimal coronary artery revascularization treatment of coronary artery disease (CAD) patients, physicians normally assessed clinical presentation, surgical risk, survival expectation, and the likelihood of a better quality of life. Decisions are made after careful consideration, by the Heart Team, who will ponder options such as coronary artery bypass graft (CABG), percutaneous...
Multiple studies support the use of an early invasive approach in high risk patients with non-ST elevation acute coronary syndrome (NST ACS). This benefit of an invasive strategy over the expected management has been shown in randomized studies and meta-analysis. Patients with a history of cardiac artery bypass graft (CABG) represent approximately 10% of ACS...
Cardiac revascularization surgery (CABG) has shown positive results at long term in CAD patients with multivessel or left main disease. However, we are well aware that, after CABG, there might be native disease progression over time. Also, at followup, we often see high incidence of venous graft failure. According to registry data, approximately 1 in...
Left main lesions in acute coronary syndrome (ACS) represent a major risk and, at present, the best revascularization strategy is a matter of debate. Though many studies and registries have excluded this group of patients, there is data on the pros and cons of both percutaneous coronary intervention (PCI) and cardiac artery bypass graft (CABG). ...
Suspending ticagrelor a couple of days before surgery was non-inferior to waiting 5-6 days in terms of bleeding in patients with acute coronary syndrome (ACS) requiring myocardial revascularization surgery. Patients who waited longer had more ischemic events and longer hospitalizations. Current American guidelines recommend waiting at least 5 days before operating on patients with ACS who...
The latest figures show a lower number of emergency CABG for acute MI, and in turn increased primary PCI. The combination of surgeons not willing to take risks and interventional cardiologists empowered to treat practically any lesion has resulted in fewer patients receiving emergency CABG. Only a few years ago, interventional cardiologists at least had...
The 2-year outcomes in patients with severe aortic stenosis and low surgical risk continue to show a numerical benefit in favor of transcatheter aortic valve replacement (TAVR) vs. surgical replacement (CABG) for the primary end point of death, stroke or repeat hospitalization for cardiovascular reasons. However, the initially higher advantage of TAVR has been narrowing...
Coronary artery bypass graft (CABG) anastomosed to one vessel with normal or nearly normal fractional flow reserve (FFR) have poorer graft patency at one year compared against anastomosed grafts to vessels with functionally significant lesions shown by FFR. However, the recent study FARGO (Fractional Flow Reserve Versus Angiography Randomization for Graft Optimization) did not show...
Fractional Flow reserve (FFR) guided myocardial revascularization surgery (CABG) has similar graft failure rate and clinical outcomes as angiography guided CABG. When planning PCI, the value of FFR for lesion assessment pose no questions, but we know little when it comes to CABG. Since the early start, back when Dr. Mason Sones performed catheterizations and...
In-hospital PCI right after CABG is extremely rare, but it does increase morbidity, mortality and costs significantly. It is still unclear what predictors can be modified to prevent these very early angiography and angioplasty procedures in patients that generally leave the OR with visible EKG changes. Graft failure, distal vascular bed quality, technical error or...