TY - JOUR
T1 - On-Pump Coronary Artery Bypass Graft
T2 - The State of the Art
AU - Cuminetti, Giovanni
AU - Bonadei, Ivano
AU - Vizzardi, Enrico
AU - Sciatti, Edoardo
AU - Lorusso, Roberto
N1 - Funding Information:
Abbreviations: CABG, Coronary Artery Bypass Graft; ACCF, American College of Cardiology Foundation; AHA, American Heart Association; EACTS, European Association of Cardio-Thoracic Surgery; ESC, European Society of Cardiology; GDMT, Guideline-directed Medical Therapy; LAD, Left Anterior Descending artery; CAD, Coronary Artery Disease; LV, Left Ventricle; NER, Not equivalent recommendation. * Defined in the ESC guidelines as coronary diameter stenosis ≥50% Left Main or ≥70% Non-Left Main CAD or FFR≤0.80 [2]; and in the ACC/AHA guidelines as ≥50% left main or ≥70% non-left main or FFR ≤0.80 stenosis [1]. ** This indication is ACC/AHA class I in the context of multivessel CAD, and class II in single-vessel disease § LVEF≤35% (ESC guidelines)[2]. This indication is ACC/AHA class IIa in patients with mild-moderate LV dysfunction (LVEF, 35-50%) and class IIb in patients with severe LV dysfunction (LVEF, <35%) without significant left main CAD [1]. ¥ Defined as >10% ischemic LV myocardium (ESC guidelines) [2], or >20% perfusion defect on stress MPS, high-risk criteria on stress testing or abnormal intracoronary hemodynamic evaluation (ACC/AHA guidelines) [1].
Publisher Copyright:
© 2019 Bentham Science Publishers.
PY - 2019
Y1 - 2019
N2 - Background: Coronary artery bypass grafting (CABG) remains the standard of care for patients with coronary artery disease (CAD). Debate exists concerning several factors, which include percutaneous coronary intervention (PCI) vs. CABG, single vs. bilateral mammary artery grafts, radial artery vs. saphenous vein grafts, right internal mammary artery vs. radial artery grafts, endoscopic vs. open vein-graft harvesting, and on-pump vs. off-pump surgery.Moreover, challenging is the management of diabetic patients with CAD undergoing CABG. This review reports current indications, practice patterns, and outcomes of CABG.Methods: Randomized controlled trials comparing CABG to other therapeutical strategies for CAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings.Results: Large multicenter randomized and observational studies (SYNTAX, BEST, PRECOMBAT, ASCERT) have reported excellent outcomes in CABG patients, with always fewer rates of operative mortality and major morbidity, than PCI. The 10-year follow-up of ARTS II trial showed no difference between single and bilateral mammary artery. BARI 2D, MASS II, CARDia, FREEDOM trials showed that CABG is the best choice for diabetic patients.Conclusion: CABG still represents one of the most widespread major surgeries, with well-known benefits on symptoms and prognosis in patients with CAD. However, further studies and follow-up data are needed to validate these evidences.
AB - Background: Coronary artery bypass grafting (CABG) remains the standard of care for patients with coronary artery disease (CAD). Debate exists concerning several factors, which include percutaneous coronary intervention (PCI) vs. CABG, single vs. bilateral mammary artery grafts, radial artery vs. saphenous vein grafts, right internal mammary artery vs. radial artery grafts, endoscopic vs. open vein-graft harvesting, and on-pump vs. off-pump surgery.Moreover, challenging is the management of diabetic patients with CAD undergoing CABG. This review reports current indications, practice patterns, and outcomes of CABG.Methods: Randomized controlled trials comparing CABG to other therapeutical strategies for CAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings.Results: Large multicenter randomized and observational studies (SYNTAX, BEST, PRECOMBAT, ASCERT) have reported excellent outcomes in CABG patients, with always fewer rates of operative mortality and major morbidity, than PCI. The 10-year follow-up of ARTS II trial showed no difference between single and bilateral mammary artery. BARI 2D, MASS II, CARDia, FREEDOM trials showed that CABG is the best choice for diabetic patients.Conclusion: CABG still represents one of the most widespread major surgeries, with well-known benefits on symptoms and prognosis in patients with CAD. However, further studies and follow-up data are needed to validate these evidences.
KW - 5-YEAR FOLLOW-UP
KW - Coronary artery bypass graft
KW - EVEROLIMUS-ELUTING STENTS
KW - GASTROEPIPLOIC ARTERY
KW - INTERNAL-THORACIC-ARTERY
KW - INTRAAORTIC BALLOON PUMP
KW - LONG-TERM MORTALITY
KW - PATIENTS PROPENSITY ANALYSIS
KW - POSTOPERATIVE ATRIAL-FIBRILLATION
KW - RADIAL ARTERY
KW - TOUCH SAPHENOUS-VEIN
KW - coronary artery bypass grafting
KW - diabetic patients
KW - extracorporeal circulation
KW - minimally invasive extracorporeal circulation
KW - on-pump surgical revascularization
KW - Minimally invasive extracorporeal circulation
KW - Diabetic patients
KW - Extracorporeal circulation
KW - Coronary artery bypass grafting
KW - On-pump surgical revascularization
U2 - 10.2174/1574887114666190301142114
DO - 10.2174/1574887114666190301142114
M3 - (Systematic) Review article
C2 - 30836924
SN - 1574-8871
VL - 14
SP - 106
EP - 115
JO - Reviews on Recent Clinical Trials
JF - Reviews on Recent Clinical Trials
IS - 2
ER -