The brain‐before‐heart strategy for coronary artery bypass grafting in the severely atherosclerotic aorta: A single‐institution experience

Nazer, Rakan I.; Albarrati, Ali

doi:10.1002/clc.23913

Cited by 2 publications

(1 citation statement)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the same context, Nazer RI et al [20] proposed the brain-before-heart strategy for coronary artery grafting in severely atherosclerotic aorta. The authors stated that early detection and individualized therapeutic strategies are effective in reducing atheroembolic brain injury and are associated with better prognosis.…”

Section: Discussionmentioning

confidence: 99%

Multivessel Coronary Disease and Severe Atherosclerotic Aorta: Real-World Experience

Gasparovic,

Artemiou,

Domonkos

et al. 2023

Medicina

View full text Add to dashboard Cite

Background and Objectives: Surgical revascularisation of patients with atherosclerosis of the ascending aorta remains a challenge. Different surgical strategies have been described in coronary surgical patients to offer alternative revascularisation strategies other than the conventional surgical revascularisation in patients unsuitable for it. The aim of this study is to compare the real-world outcomes between two groups of patients who underwent off-pump surgery (left internal mammary artery graft to the left anterior descending artery) or a hybrid with a percutaneous revascularisation procedure at a later stage. Materials and Methods: This is a single-centre retrospective observational study. Between the years 2010 and 2021, 91/6863 patients (1.33%) were diagnosed with severe atherosclerosis of the ascending aorta. All the patients were treated with off-pump revascularisation (91 patients), and the cardiologist would decide at a later stage whether the rest of the vessels would be treated with percutaneous revascularisation (25 patients). Results: There was no statistical difference in the various preoperative characteristics, except for coronary artery left main disease (30.30% vs. 64%; p = 0.0043). The two groups had no statistical differences in the perioperative characteristics and postoperative complications. The 1-, 5-, and 10-year mortality rates in the two groups were 6.1% vs. 0%, 59% vs. 80%, and 93.9% vs. 100%, respectively (off-pump vs. hybrid with percutaneous revascularisation procedure, p = 0.1958). Conclusions: Both strategies have high long-term comparable mortality. The off-pump surgery and the HCR procedure at a later stage may be solutions for these high-risk patients, but the target treatment should be complete HCR revascularisation during the index hospitalization.

show abstract

Section: Discussionmentioning

confidence: 99%

Multivessel Coronary Disease and Severe Atherosclerotic Aorta: Real-World Experience

Gasparovic,

Artemiou,

Domonkos

et al. 2023

Medicina

View full text Add to dashboard Cite

show abstract

The brain‐before‐heart strategy for coronary artery bypass grafting in the severely atherosclerotic aorta: A single‐institution experience

Nazer

Albarrati

2022

Clinical Cardiology

View full text Add to dashboard Cite

Background: Severe atherosclerosis of the ascending aorta (SAA) in patients undergoing surgical revascularization by coronary artery bypass grafting (CABG) is becoming an increasing problem as more elderly patients are diagnosed with coronary artery disease. Strokes and other neurologic insults are common complications in this group, with devastating impacts on outcomes and prognoses.Hypothesis: Early detection of the atherosclerotic aorta and the application of a stroke prevention protocol will reduce the risk of stroke in patients with SAA.Methods: In 2012, we adopted a protocol devised to preemptively detect and manage patients suspected of having SAA. From the time of the application of the protocol, we compared the immediate and late outcomes of CABG in SAA in the 8 years preceding the protocol in a "control" group (30 patients) and in the 8 years following the protocol in a "brain" group (69 patients).Results: More patients with SAA were detected after the initiation of the protocol.They had significantly more history of stroke, renal dysfunction, and left main coronary disease. The percutaneous coronary intervention was utilized more after the protocol (26% vs. 7%) and there was far less utilization of replacement of the ascending aorta (12% vs. 37%). Postoperative stroke rates were significantly less after the protocol (2% vs. 18%), with an almost twofold reduction in stroke associated with SAA even after risk adjustment. The composite endpoints of cardiac death, nonfatal myocardial infarction, and stroke were significantly reduced after initiating the protocol at a median of 2.3 years from the time of revascularization. Conclusion:Early detection of SAA and individualized therapeutic strategies for revascularization is effective in reducing athero-embolic brain injury and are associated with better prognosis.

show abstract

The brain‐before‐heart strategy for coronary artery bypass grafting in the severely atherosclerotic aorta: A single‐institution experience

Cited by 2 publications

References 14 publications

Multivessel Coronary Disease and Severe Atherosclerotic Aorta: Real-World Experience

Multivessel Coronary Disease and Severe Atherosclerotic Aorta: Real-World Experience

The brain‐before‐heart strategy for coronary artery bypass grafting in the severely atherosclerotic aorta: A single‐institution experience

Contact Info

Product

Resources

About