Meta-analysis on the use of the Heartstring anastomotic device to prevent stroke in patients undergoing off-pump coronary artery bypass grafting

Biancari, Fausto; Yli-Pyky, Sanna

doi:10.1016/j.ejcts.2011.02.022

Cited by 15 publications

(11 citation statements)

References 25 publications

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“…In addition, we used proximal anastomotic device in patients with calcified ascending aorta, as Gold, et al 26) and Biancari, et al reported before. 27) Taken together, these precautions might contribute to the similar peri-procedural stroke rate in our CABG patients comparing with PCI. However, larger study is needed before any conclusions can be made.…”

Section: Discussionmentioning

confidence: 82%

Coronary Artery Bypass Surgery versus Percutaneous Coronary Intervention for Left Main Coronary Artery Disease with Chronic Kidney Disease

Lin

Huang

et al. 2018

Int. Heart J.

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Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD). However, the optimal treatment for ULMCAD concomitant with chronic kidney disease (CKD) was rarely addressed. Herein, we compare the long-term outcomes of these patients treated with CABG or PCI.From January 2004 to December 2010, 185 patients with ULMCAD and CKD undergoing PCI (n = 84) or CABG (n = 101) were matched for the selection criteria. The primary end points included all-cause death, myocardial infarction (MI), stroke, repeat revascularization and major adverse cardiovascular and cerebrovascular event (MACCE).The mean age was 73.4 ± 10.3 years with male (84%) predominance. Baseline characteristics of both groups were similar, except that patients in CABG group were more frequently associated with significant stenosis of right coronary artery and triple vessel disease. Furthermore, most patients belonged to higher surgical risk population (EuroSCORE ≥ 6, PCI group: 80.9%, CABG group: 75.2%). After treatment, the 30-day mortality was 3.5% in PCI and 8.9% in CABG (P = 0.14). During the median follow-up of 3.5 years, the risk of MACCE (67% versus 55%, P = 0.048), MI (15.5% versus 6.9%, P = 0.024), and repeat revascularization (30.9% versus 7.9%, P < 0.001) was significantly higher in the PCI compared with CABG. There were no significant differences in long-term all-cause death, stroke, and impact on renal function.CABG was associated with significantly less long-term risk of MI and repeat revascularization in patients with ULMCAD and CKD.

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Section: Discussionmentioning

confidence: 82%

Coronary Artery Bypass Surgery versus Percutaneous Coronary Intervention for Left Main Coronary Artery Disease with Chronic Kidney Disease

Lin

Huang

et al. 2018

Int. Heart J.

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“…Similar results have been reported by other investigators. 2,8,36) To the best of our knowledge, cerebral microembolization of atheromatous material during manipulation of the aorta is the main cause of postoperative stroke. 23,24) Neurologic derangement after CABG has been attributed to hypoxia, embolism, hemorrhage, and metabolic abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Proximal Seal System on Neurologic Outcomes of Off-Pump Coronary Artery Bypass Grafting

et al. 2019

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Severe aortic atherosclerosis is a risk factor for stroke during coronary artery bypass grafting (CABG). The purpose of this study was to evaluate the incidence of postoperative neurologic complications after off-pump CABG (OPCAB) with a proximal seal system (Heartstring). From January 2011 to December 2014, 729 patients underwent isolated OPCAB. The cohort was divided into two groups (Heartstring [HS] and aortic no-touch [NT]). The severity of aortic atherosclerosis (Katz grade) was evaluated by intraoperative epiaortic ultrasonography (EUS). The primary endpoints were postoperative neurologic complications (early stroke and minor events (delirium, transient ischemic attack, and syncope)), and the secondary endpoints were late major adverse cardiac and cerebrovascular events (MACCEs) and death. The mean age of all patients was 65.1 ± 9.5 years, and a severe Katz grade (IV or V) was demonstrated to be an independent risk factor of long-term mortality (HR 3.53; 95% CI 1.06-11.75; P = 0.04) and MACCEs (HR 2.41; 95% CI 1.19-4.92; P = 0.02), but no significant differences were found for early stroke (0.9% versus 1.7%; P = 0.53) and minor neurologic complications (14.6% versus 9.9%; P = 0.05) between the groups regardless of the Katz grade. The 5-year overall survival rate did not differ significantly between the groups (90.9% versus 87.6%; P = 0.61). Although a higher Katz grade was identified as an independent risk factor of death and MACCEs, the HS group was not inferior in terms of neurologic complications regardless of the Katz grade. Therefore, the Heartstring system might be safely and efficiently used with EUS to decrease the incidence of neurologic complications.

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“…Use of off-pump surgery and a no-touch aorta technique in the case of diseased ascending aorta, 28,29 improving CPB techniques and materials, 30 reducing CPB and aorta clamping times, 31 and avoidance of intraoperative hypoperfusion, 32 are measures which may significantly reduce the risk of postoperative CVA.…”

Section: Discussionmentioning

confidence: 99%

Stroke after Coronary Artery Surgery: A Single Center Report

AlWaqfi

Ibrahim

2014

Int J Angiol

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Stroke or cerebrovascular accident (CVA) is a devastating complication of coronary surgery. In this report, the incidence, and correlates of CVA following isolated coronary artery bypass grafting (CABG) surgery were evaluated. Data were collected retrospectively. Between 2006 and 2009, 855 patients underwent isolated CABG surgery. CVA was defined as any new neurological deficit lasting more than 24 hours. Univariate and multivariate analyses were utilized as appropriate. The incidence of CVA was 1.4% (n = 12). Age, previous CVA, and emergency surgery were correlated by univariate analysis. Multivariate analysis revealed age, previous CVA, and chronic renal impairment as predictors of CVA. Ten (83.3%) of the 12 patients were diagnosed to have CVA in the first 24 hours. Length of hospital stay was 20.9 ± 20.34 days for CVA patients and 9.2 ± 5.17 days for non-CVA patients (p ≤ 0.001). There were 4 (33.3%) deaths in CVA group and 27 (3.2%) for non-CVA patients (p = 0.001). Postoperative CVA is a major contributor to mortality, prolonged hospitalization, and other adverse postoperative complications. Further studies are needed to develop better strategies to minimize the occurrence of CVA among patients undergoing CABG.

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Meta-analysis on the use of the Heartstring anastomotic device to prevent stroke in patients undergoing off-pump coronary artery bypass grafting

Cited by 15 publications

References 25 publications

Coronary Artery Bypass Surgery versus Percutaneous Coronary Intervention for Left Main Coronary Artery Disease with Chronic Kidney Disease

Coronary Artery Bypass Surgery versus Percutaneous Coronary Intervention for Left Main Coronary Artery Disease with Chronic Kidney Disease

Effects of a Proximal Seal System on Neurologic Outcomes of Off-Pump Coronary Artery Bypass Grafting

Stroke after Coronary Artery Surgery: A Single Center Report

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