A practical approach to percutaneous interventions in chronic total occlusions
Ever D. Grech in Practical Interventional Cardiology, 2017
Ultimately, the indications and rationale for CTO PCI are similar to those for non-CTO PCI: reduction in symptoms with improvement in quality of life, a reduction in ischaemia and possibly, a decrease in mortality and myocardial infarction. A growing body of evidence, mostly from large registry studies, supports the utility of CTO PCI in achieving these key clinical benefits, but there remains a reluctance to refer patients for these procedures. Indeed, the presence of a CTO is amongst the most common indications for referral to coronary artery bypass grafting (CABG),2 despite evidence that revascularisation of CTOs in multi-vessel CABG is frequently suboptimal (68% in the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery [SYNTAX] trial cohort).3 Though there remains a need for randomised controlled trial evidence to pinpoint the exact clinical scenarios in which CTO PCI is most beneficial, there is a clear signal that these procedures are safe and effective in achieving the goals of revascularisation in the appropriately selected patient.
Cardiovascular Disease
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
Cardiac surgery is an effective treatment for ischaemic heart disease and valve disease, relieving symptomatic angina and prolonging survival in selected patient groups. Standard indications for coronary artery bypass surgery include left main stem or triple vessel coronary artery disease, particularly in patients with diabetes and/or LV dysfunction where there is prognostic benefit. Surgery is offered for severe heart valve disease providing specific criteria are met, with either repair or replacement with bioprosthetic or mechanical valves. Surgical treatments for severe HF include cardiac transplantation or LV assist device implantation for eligible patients. Patients with complex congenital heart disease frequently require surgical correction.
Cardiac CT and MRI: State of the Art
Phillip M. Boiselle, Charles S. White in New Techniques in Cardiothoracic Imaging, 2007
Cardiac MRI remains an important part of the imaging armamentarium because of its versatility and lack of ionizing radiation and iodinated contrast material (53). However, an adequate study requires that the patient remain in the magnet for some length of time. Acquisition of a diagnostic examination may be challenging in patients who are uncooperative or disoriented. However, if the patient is only mildly uncooperative, it is possible to obtain much useful information with fast imaging techniques, depending on the indication. Similar to MRI studies of other parts of the body, cardiac MRI is contraindicated in patients with a variety of foreign devices, including certain aneurysm clips, cochlear implants, and penile prostheses. MRI is also contraindicated in patients who have pacemakers or implantable cardioverter defibrillator (ICD) devices, although this limitation is being reconsidered. In general, MRI can be performed in patients who have prosthetic cardiac valves. Patients who have undergone recent cardiac surgery (coronary artery bypass graft or valve surgery) can probably be studied 1–2 weeks after the procedure, although this has not been documented conclusively.
Effects of remote ischemic preconditioning on platelet activation and reactivity in patients undergoing cardiac surgery using cardiopulmonary bypass: a randomized controlled trial
Published in Platelets, 2022
Youn Joung Cho, Karam Nam, Sol Ji Yoo, Seohee Lee, Jinyoung Bae, Ji-Young Park, Hang-Rae Kim, Tae Kyong Kim, Yunseok Jeon
Eligible patients were adult patients (age >18 years) who were scheduled for cardiac surgery using CPB at Seoul National University Hospital. Cardiac surgery included cardiac valve surgery, aorta replacement, intracardiac mass excision, and combined surgical procedures, using CPB. Patients were excluded if they met any of the following criteria: preoperative left ventricular ejection fraction <30% or receipt of mechanical ventricular support; presence of peripheral vascular disease or poorly controlled diabetes; use of non-steroidal anti-inflammatory drugs within 3 days, intravenous heparin within 6 h, low-molecular-weight heparin within 24 h, or platelet inhibitors within 24 h prior to surgery; known thrombocytopenia or platelet dysfunction; end-stage renal disease or requirement for hemodialysis; active infectious disease; pregnancy; or refusal to participate (Figure 1).
CABG in patients with liver cirrhosis: to pump or not to pump?
Published in Expert Review of Cardiovascular Therapy, 2022
Stephanie M. Jiang, Kiera Liblik, Adrian Baranchuk, Darrin Payne, Mohammad El-Diasty
Patients with established liver cirrhosis are known to have a poorer prognosis following cardiac surgery.1 Complications of cirrhosis, paired with associated decreased immune function and coagulopathies, lead to higher rates of postoperative complications, including increased transfusion requirements, re-operations, and mechanical ventilation times [1–5]. The use of cardiopulmonary bypass (CPB) has further been associated with widespread post-operative inflammatory response and perioperative derangement of liver function [6–8]. The detrimental systemic inflammatory response to CPB and the co-morbidity of liver cirrhosis may result in the limited use of CPB in cardiac surgical procedures. Coronary artery bypass grafting (CABG) is one of the few operations in cardiac surgery that can be completed without CPB. However, there is no evidence that avoiding the use of CPB in CABG is superior to use of CPB in this complex patient group. Current practice is dependent on the surgeon’s preference as there are no guidelines. The present study consolidated the available knowledge on the difference in outcome between on-pump coronary artery bypass grafting (ONCABG) and off-pump coronary artery bypass grafting (OPCAB) in patients with established liver cirrhosis. Our goal of the review was to summarize the information available on this topic so that medical professionals can be more informed in their clinical decision-making. Primarily, we investigated the mortality and morbidity of ONCABG and OPCAB in this population.
An entire coronary system arising from right coronary cusp: a rare anomaly
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Muhammad Shabbir Rawala, Syed Imran Rizvi, Syed Bilal Rizvi
Our patient did not have any obstructive coronary artery disease but still was having symptoms on exercise possibly due to the mechanisms described above. There are no general guidelines to manage this particular CAA; however, due to the association of SCD with anomalous artery and exercise, patients are generally advised to avoid strenuous activity. The management of coronary artery disease in the setting of CAA include medical management, percutaneous coronary intervention (PCI) or surgical repair [5]. PCI is generally complex and technically demanding in these anomalous arteries due to its angulation from aorta, ostial configuration, site of atherosclerotic lesion and the course of the artery [10]. Cardiac surgery includes direct repair of origin of the anomalous artery in the aortic root and coronary artery bypass surgery (CABG). CABG is more feasible; however, it also has limitations due to the longevity of the grafts [6].
Related Knowledge Centers
- Congenital Heart Defect
- Coronary Artery Bypass Surgery
- Coronary Artery Disease
- Endocarditis
- Rheumatic Fever
- Surgery
- Heart
- Great Vessels
- Surgeon
- Valvular Heart Disease