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Persistent Racial and Sex Disparities in Outcomes After Coronary Artery Bypass Surgery: A Retrospective Clinical Registry Review in the Drug-eluting Stent Era
Objective: The purpose of this study was to assess the temporal trends in 30-day mortality by race group for patients undergoing coronary artery bypass grafting (CABG) between 2011 and 2018 and to investigate the effect of race and sex on postoperative outcomes after CABG. Summary Background Data: Cardiovascular diseases remain a leading cause of death in the United States with studies demonstrating increased morbidity and mortality for black and female patients undergoing surgery. In the post drug-eluting stent era, studies of racial disparities CABG are outdated. Methods: We performed a retrospective analysis of ...
Source: Annals of Surgery - September 17, 2020 Category: Surgery Tags: PAPERS CHOSEN FOR PRESENTATION AT THE 2020 ANNUAL MEETING OF THE AMERICAN SURGICAL ASSOCIATION Source Type: research

Carotid endarterectomy is not indicated for most patients scheduled for coronary artery bypass grafting
Klarin et  al1 evaluated whether performing concomitant carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) in patients with concurrent carotid and coronary atherosclerotic disease is associated with reduced postoperative stroke rates compared with those undergoing CABG alone (ie, without CEA).1 They included 994 off-pump CABG patients (497 CABG only and 497 CABG-CEA) and 5952 on-pump CABG patients (2976 CABG only and 2976 CABG-CEA). For on-pump operations, patients undergoing concomitant CEA and CABG had no difference in rates of in-hospital stroke (odds ratio [OR], 0.93; 95% confi dence interval [CI]...
Source: Journal of Vascular Surgery - July 22, 2020 Category: Surgery Authors: Kosmas I. Paraskevas Tags: Letter to the Editor Source Type: research

Synchronous versus staged carotid artery stenting and coronary artery bypass graft for patients with concomitant severe coronary and carotid artery stenosis: A systematic review and meta-analysis.
CONCLUSION: The simultaneous approach was associated with an increased risk of 30-day stroke compared to staged CAS and CABG. However, no statistically significant difference was found in long-term results of mortality, MI and stroke between the two approaches. Future studies are warranted to validate our results. PMID: 32493182 [PubMed - as supplied by publisher]
Source: Vascular - June 2, 2020 Category: Surgery Authors: Tzoumas A, Giannopoulos S, Charisis N, Texakalidis P, Kokkinidis DG, Zisis SN, Machinis T, Koullias GJ Tags: Vascular Source Type: research

Endovascular Repair Of Ascending Aortic Pseudoaneurysm Using Transfemoral Frame-Coiling Under Total Cerebral Protection.
We present a patient with a prior coronary artery bypass grafting who was referred for an incidental 3cm saccular ascending aortic pseudoaneurysm who was successfully treated with frame coiling under total cerebral embolic protection using the SENTINEL device.
Source: Annals of Vascular Surgery - May 27, 2020 Category: Surgery Authors: Jeanette H. Man, Mel J. Sharafuddin Tags: Case Report Source Type: research

Protamine sulfate use during tibial bypass does not appear to increase thrombotic events or affect short-term graft patency.
CONCLUSIONS: Heparin reversal with protamine sulfate after tibial or peroneal bypass grafting is not associated with higher cardiovascular morbidity, bypass thrombosis, amputation, or mortality. Additionally, there was no statistically significant difference in post-operative bleeding or thrombosis complications for patients who did not receive protamine, although the findings are suggestive of a potential difference in a more adequately powered study. Our results suggest that protamine sulfate is safe for intraoperative use without increased risk of thrombotic complications or early tibial bypass graft failure. PMID:...
Source: Vascular - May 10, 2020 Category: Surgery Authors: Phair J, Futchko J, Trestman EB, Carnevale M, Friedmann P, Shukla H, Garg K, Koleilat I Tags: Vascular Source Type: research

Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates
We examined the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database to evaluate the association of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) with postoperative outcomes.
Source: Journal of Vascular Surgery - February 13, 2020 Category: Surgery Authors: Derek Klarin, Virendra I. Patel, Shuaiqi Zhang, Ying Xian, Andrzej Kosinski, Babatunde Yerokun, Vinay Badhwar, Vinod H. Thourani, Thoralf M. Sundt, David Shahian, Serguei Melnitchouk Source Type: research

Staged Carotid Artery Stenting and Coronary Artery Bypass Grafting Procedures: A Word of Caution
In their systematic review and meta-analysis (n=5 studies; 16,712 patients), Giannopoulos et al.1 compared synchronous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) vs. staged carotid artery stenting (CAS) followed by CABG. They demonstrated that perioperative stroke (3% [447/15,727] vs. 3% [33/985], for CEA/CABG vs. CAS/CABG, respectively; odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.43-1.64; I2=39.1%) and transient ischemic attack (TIA) rates (1% [2/193] vs 4% [4/95] for CEA/CABG vs.
Source: Annals of Vascular Surgery - October 13, 2019 Category: Surgery Authors: Kosmas I. Paraskevas Tags: Correspondence Source Type: research

Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting.
CONCLUSIONS: Among screened patients with untreated asymptomatic patients, CS ≥ 90% was an independent predictor of post-operative stroke. As this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, pre-operative screening of asymptomatic CS before CABG may not be justified. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov. Unique identifier: NCT02319083. PMID: 30197287 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - September 6, 2018 Category: Surgery Authors: Santarpino G, Nicolini F, De Feo M, Dalén M, Fischlein T, Perrotti A, Reichart D, Gatti G, Onorati F, Franzese I, Faggian G, Bancone C, Chocron S, Khodabandeh S, Rubino AS, Maselli D, Nardella S, Gherli R, Salsano A, Zanobini M, Saccocci M, Bounader K, R Tags: Eur J Vasc Endovasc Surg Source Type: research

Comparison of Early Outcomes and Restenosis Rate Between Carotid Endarterectomy and Carotid Artery Stenting Using Propensity Score Matching Analysis.
CONCLUSION: This PSM based observation reconfirmed previous trial results in both asymptomatic and symptomatic patients with carotid artery stenosis in routine clinical practice: CEA showed lower 30 day MACE and mid-term restenosis rates than CAS. PMID: 28893482 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - September 8, 2017 Category: Surgery Authors: Heo SH, Yoon KW, Woo SY, Park YJ, Kim YW, Kim KH, Chung CS, Bang OY, Kim DI Tags: Eur J Vasc Endovasc Surg Source Type: research

Carotid Stenting Prior to Coronary Bypass Surgery: An Updated Systematic Review and Meta-Analysis.
CONCLUSIONS: In a cohort of predominantly asymptomatic patients with unilateral carotid stenoses, the 30-day rate of death/stroke was about 8%. Notwithstanding the effect of potential biases, this meta-analysis did not find evidence that outcomes after same-day CAS + CABG were higher than after staged interventions. However, outcomes were poorer in neurologically symptomatic patients. More data are required to establish the optimal antiplatelet strategy in patients undergoing same-day or staged CAS + CABG. PMID: 28094166 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - January 12, 2017 Category: Surgery Authors: Paraskevas KI, Nduwayo S, Saratzis AN, Naylor AR Tags: Eur J Vasc Endovasc Surg Source Type: research

Coronary artery bypass grafting for left main disease and the risk of stroke: Incidence, aetiology and prevention
Publication date: Available online 3 October 2016 Source:The Surgeon Author(s): Ana-Catarina Pinho-Gomes, David P. Taggart This review explores the association between left main disease and the increased risk of perioperative stroke following coronary artery bypass grafting, specifically addressing the potential underlying mechanisms and its potential prevention. In particular, this correlation appears stronger for patients with left main disease when compared to patients with isolated triple vessel disease. Even though evidence on this topic is limited and of modest quality, there appears to be a significant association ...
Source: The Surgeon - October 3, 2016 Category: Surgery Source Type: research

Protective effects of corticosteroids in coronary artery bypass graft surgery alone or combined with valvular surgery: an updated and comprehensive meta-analysis and systematic review.
Abstract This systematic review with meta-analysis sought to determine the protective effects of corticosteroids on clinical outcomes following coronary artery bypass grafting (CABG). Medline, Embase, Elsevier and Sciences online database as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design. The effect sizes measured were odds ratio (OR) for categorical variables and weighted mean difference with 95% confidence interval (CI) for calculating differences between mean values of duration of hospitalization in intervention and control groups. Values of P <...
Source: Hand Surgery - March 3, 2015 Category: Surgery Authors: Ali-Hassan-Sayegh S, Mirhosseini SJ, Haddad F, Karimi-Bondarabadi AA, Shahidzadeh A, Weymann A, Popov AF, Sabashnikov A Tags: Interact Cardiovasc Thorac Surg Source Type: research

The Impact of Feedback of Surgical Outcome Data on Surgical Performance: A Systematic Review
Conclusions The available literature suggests that feedback can improve surgical performance and outcomes; however, given the heterogeneity and limited number of studies, in addition to their non-randomised nature, it is difficult to draw clear conclusions from the literature with regard to the efficacy of feedback and the specific nuances required to optimise the impact of feedback. There is a clear need for more rigorous studies to determine how feedback of outcome data may impact performance, and whether this low-cost intervention has potential to benefit surgical practice.
Source: World Journal of Surgery - December 2, 2014 Category: Surgery Source Type: research

Robotically assisted coronary artery bypass grafting: a systematic review and meta‐analysis
ConclusionsAlthough robotic‐assisted coronary bypass appears to be promising, the study designs were not adequate and may have a high risk of selection bias. There is a need for randomized trials to corroborate the findings and to determine the long‐term benefits of RACBS compared with traditional surgical approaches. Copyright © 2014 John Wiley & Sons, Ltd.
Source: The International Journal of Medical Robotics and Computer Assisted Surgery - September 1, 2014 Category: Surgery Authors: Anna M. Buehler, Cleusa Ferri, Uri A. P. Flato, Jefferson G. Fernandes Tags: Review Article Source Type: research

Carotid endarterectomy under local and/or regional anesthesia has less risk of myocardial infarction compared to general anesthesia: An analysis of national surgical quality improvement program database.
Abstract Multiple studies have evaluated the effect of anesthesia type on carotid endarterectomy with inconsistent results. Our study compared 30-day postoperative myocardial infarction, stroke, and mortality between carotid endarterectomy under local or regional anesthesia and carotid endarterectomy under general anesthesia utilizing National Surgical Quality Improvement Program database. All patients listed in National Surgical Quality Improvement Program database that underwent carotid endarterectomy under general anesthesia and local or regional anesthesia from 2005 to 2011 were included with the exception of ...
Source: Vascular - May 29, 2014 Category: Surgery Authors: Kfoury E, Dort J, Trickey A, Crosby M, Donovan J, Hashemi H, Mukherjee D Tags: Vascular Source Type: research

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