New revascularization after coronary artery bypass graft (CABG) is often needed, be it because of severe bridge lesion, intimal hyperplasia, thrombosis, atherosclerosis, or native vessel lesion progression. We therefore need to determine the best revascularization strategy, namely native or graft percutaneous intervention, venous or arterial, or repeat surgery, with the risk it entails. There is…
EuroPCR 2022 | Changes in Cardiac Damage after Surgical Aortic Valve Replacement
This study presented at EuroPCR 2022 analyzed the PARTNER study pool and included 1974 patients with a complete echocardiogram. Surgical risk was 17.3% extreme/inoperable, 54.3% intermediate and 28.4% low. 60% received transcatheter aortic valve replacement (TAVR) and the rest surgical aortic valve replacement (SAVR). 6.1% of patients were in stage 0 (no damage), 14.5% were…
Low Risk Patients: TAVR with Self-Expanding Valves Offers Similar Outcomes to Surgery Based on a Bayesian Analysis?
When compared against surgical valve replacement (SAVR) transcatheter aortic valve replacement (TAVR) has shown benefits across different risk groups, not only in events as death and stroke, but also in quality of life (especially in the first months post procedure) and improved symptoms. However, a catch-up phenomenon was observed in low-risk patients between the first…
AHA 2021 | Meta-Analysis of Surgery vs. Angioplasty in Left Main Coronary Artery Disease
According to this new meta-analysis (presented at AHA 2021 and published in The Lancet), mortality is similar between surgery and angioplasty to treat left main coronary artery in patients with simple or intermediate anatomy. This new study estimates that, after 5 years, mortality with surgery would be 11.2% vs. 10.2% with angioplasty, a non-significant difference. This debate…
AHA 2021 | RAPID CABG: Safety of Early Surgical Intervention in Acute Coronary Syndrome
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…
Best Revascularization Strategy in Patients with Left Ventricular Deterioration
Multivessel disease associated to ventricular function deterioration is challenging in terms of risk, when choosing a revascularization strategy. According to this recent analysis of the SCAAR registry published in the European Heart Journal, long term followup seems to justify taking a higher risk initially, higher risk being myocardial revascularization surgery (CABG). The study looked at…
DAPT vs. Monotherapy: The Dilemma Remains After Surgery
Patients who undergo myocardial revascularization surgery and are discharged on dual antiplatelet therapy (DAPT)—aspirin plus clopidogrel—have a lower risk of major cardiovascular and cerebral events than patients on aspirin monotherapy. Furthermore, the risk of bleeding is not increased for those receiving DAPT. This information comes from a registry of over 18,000 patients recently published in the…
ACC 2021 | Emergent CABG for acute MI: Benefits Despite Risk
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…
FREEDOM with FFR: Different Outcomes?
The FREEDOM has clearly established the benefit of myocardial revascularization surgery (CABG) over percutaneous coronary intervention (PCI) in diabetic patients with multivessel disease. Coronary physiology as guideline for revascularization works best precisely in this kind of patients and its impact has never been studied in diabetics. This study, published in Circ Cardiovasc Interv, assessed the…
AHA 2020 | Effect of Evolocumab in Complex Coronary Revascularization
Evolocumab, a PCSK9 inhibitor, has shown significant reduction of complex coronary disease requiring revascularization (be it PCI or CABG). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors induce plaque regression and could eventually reduce the risk of coronary revascularization, especially complex revascularization. The FOURIER study randomized 27564 patients with stable CAD already on statins to evolocumab…