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Commentary: Who benefits from public reporting of outcomes in coronary surgery?
There are few surgical procedures that have been studied and dissected in as much detail as coronary artery bypass grafting (CABG). CABG remains the gold standard for patients with complex and extensive coronary artery disease and is one of the most commonly performed operations globally. Cardiac surgery is inherently invasive and contains unique and serious risks including death, disabling stroke, myocardial infarctions, and renal failure that are life-altering and life-threatening. In addition, it is clear that outcomes for CABG may vary with geography, institution, within institutions at the surgeon level.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 1, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Derrick Y. Tam, Stephen E. Fremes Tags: Commentary Source Type: research

Commentary: Earlier warning for pulmonary complications: It's never too soon to take action
In 2016, Edwards and colleagues1 published an illuminating report on failure to rescue in more than 600,000 patients in the Society of Thoracic Surgeons National Database who had undergone coronary artery bypass grafting. Analyzing major complications (ie, stroke, reoperation, renal failure, and prolonged ventilation), the authors found that any 1 of those complications was reasonably tolerated, with a 5% mortality rate; however, having 2 complications increased mortality to 20% to 30%. Moreover, differences in postcomplication mortality were not explained by any complication's frequency; rather, higher rates of failure to...
Source: The Journal of Thoracic and Cardiovascular Surgery - September 28, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Arsalan Amin, Subhasis Chatterjee Tags: Commentary Source Type: research

Commentary: Statins for secondary prevention after coronary artery bypass grafting: Pleiotropic effects and dementia risk
In this issue, Pan and colleagues1  present a study using population-based data from the SWEDEHEART registry to report on the impact of statins on major adverse events after coronary artery bypass grafting (CABG). Their results demonstrate decisively that the use of statins is associated with a decreased risk of all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, the need for new revascularization or angiography, and, interestingly, dementia. These effects were observed in both men and women, and in those younger than and older than 75 years of age, and were not dependent on whether patients wer...
Source: The Journal of Thoracic and Cardiovascular Surgery - September 20, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Juan B. Grau Tags: Commentary Source Type: research

Commentary: Until we take it seriously, the status quo of postoperative atrial fibrillation management will prevail
New-onset postoperative atrial fibrillation (POAF) is common following cardiac surgery, developing in almost one-third of patients after coronary artery bypass grafting (CABG) and two-thirds of patients after valvular surgery.1 The long-standing characterization of atrial fibrillation (AF) as a transient and benign postoperative complication may be an underlying reason for the relatively limited progress in terms of its prophylaxis and management.2 This assumption has only recently been called into question by  new studies reporting varying degrees of association between POAF and mortality, stroke, myocardial infarction, or renal failure.
Source: The Journal of Thoracic and Cardiovascular Surgery - April 19, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Grace Lee, Derrick Y. Tam, Stephen E. Fremes Tags: Commentary Source Type: research

Commentary: The left main controversy: Is this a real subgroup requiring custom clinical recommendations?
For 3  decades, coronary artery bypass grafting (CABG) has been the standard of care for patients with left main coronary artery stenosis (LMCAS), a practice based on trials that showed improved survival compared with medical management.1 The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial was the first large trial to compare percutaneous coronary intervention (PCI) with CABG in the treatment of coronary artery disease.2 The SYNTAX protocol included a prespecified exploratory analysis in the subgroup of patients with LMCAS that was underpowered for t he primary composite en...
Source: The Journal of Thoracic and Cardiovascular Surgery - May 4, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Mario Gaudino, Domenico Pagano, Nick Freemantle Tags: Commentary Source Type: research

Commentary: ART: Let it rest in peace
The Arterial Revascularization Trial (ART) was a multicenter, prospective trial consisting of 3102 patients who underwent coronary artery bypass graft (CABG) randomized to receive either bilateral internal thoracic artery (BITA) or single internal thoracic artery (SITA) grafts along with guideline-directed medical therapy (GDMT).1 Both groups received saphenous vein grafts (SVGs), and 21.8% of the SITA and 19.4% of the BITA patients also received a radial artery (RA) graft. After 10  years, there was no significant difference between the groups in mortality from any cause, or the composite endpoint of death, myocardial in...
Source: The Journal of Thoracic and Cardiovascular Surgery - April 27, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Harold L. Lazar Tags: Commentary Source Type: research

Commentary: Silent brain lesions add noise to the on- versus off-pump coronary artery bypass grafting debate
The debate between on-pump (ONCABG) and off-pump coronary artery bypass grafting (OPCABG) has waged on for more than 30  years. Early proponents favored OPCABG based on the hypothesis that removing cardiopulmonary bypass (CPB) from the operation would mitigate perioperative complications such as stroke. However, after 3 large randomized controlled trials (Randomized On/Off Bypass [ROOBY], Coronary Artery Bypass Surg ery Off or On Pump Revascularization Study [CORONARY], and German Off Pump Coronary Artery Bypass Grafting in Elderly Patients [GOPCABE]) failed to show a difference in stroke rate between ONCABG and OPCABG,1-...
Source: The Journal of Thoracic and Cardiovascular Surgery - November 26, 2019 Category: Cardiovascular & Thoracic Surgery Authors: William C. Frankel, Tom C. Nguyen Tags: Commentary Source Type: research

Commentary: Silent brain lesions after coronary artery bypass grafting —Reexamining the sound of silence
Stroke remains one of the most feared complications after coronary artery bypass grafting (CABG) and is associated with as much as 10 times greater in-hospital mortality.1 Although large series have investigated clinical cerebrovascular events and identified risk factors, such as history of cerebrovascular disease or prolonged cardiopulmonary bypass time, subclinical neurologic events and their long-term impact remain poorly understood.2,3 These so-called silent infarcts refer to new brain lesions on postoperative imaging in patients without any correlating focal neurologic findings.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 13, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Andrew M. Vekstein, Shu S. Lin Tags: Commentary Source Type: research

Commentary: Nuisance or nemesis? Postoperative atrial fibrillation increases long-term mortality regardless of sex
Postoperative atrial fibrillation (POAF) complicates approximately 30% of coronary artery bypass grafting (CABG) procedures.1 POAF has been associated with perioperative adverse outcomes including stroke, reoperation for bleeding, myocardial infarction, and pacemaker use.1,2 Patients with POAF are known to have a significantly increased risk of mortality in short-term, midterm, and long-term follow-up. POAF also lengthens hospital stay by 3 to 5  days and increases hospitalization cost from $10,000 to $20,000 per patient.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 5, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Malak Elbatarny, Derrick Y. Tam, Stephen E. Fremes Tags: Commentary Source Type: research

Commentary: Reinventing the wheel: Off- versus on-pump redo coronary artery bypass grafting
The use of off-pump techniques for coronary artery bypass grafting (CABG) peaked in the 1990s but continues to decline. In 2016, only 13% of all CABG surgery were performed off-pump.1 It was originally introduced to avoid the adverse effects of cardiopulmonary bypass and minimize aortic manipulation. However, multiple trials have failed to show a clear advantage for the off-pump CABG. The CABG Off- or On-Pump Revascularization Study (CORONARY) did not show a significant difference in the composite outcome of death, stroke, renal failure, myocardial infarction, and the need for repeat revascularization up to 5  years.
Source: The Journal of Thoracic and Cardiovascular Surgery - May 22, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Tamer Attia, Michael E. Halkos Tags: Commentary Source Type: research

Commentary: Off-pump surgery —Choice, not religion
For more than 2  decades, we have examined the value of off-pump coronary artery bypass grafting surgery. It has been the subject of single-institution and single-surgeon reports, randomized trials, and observational studies that have used a myriad of statistical adjustment strategies in attempts to allow comparis ons with a variety of on-pump strategies. The most common question addressed has been “Should off-pump surgery be the standard strategy used by most surgeons for most patients undergoing coronary artery bypass grafting surgery?” As their stories have unfolded, the largest studies involving heter ogeneous gro...
Source: The Journal of Thoracic and Cardiovascular Surgery - April 23, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Bruce Lytle Tags: Commentary Source Type: research

Tick, tock … Time windows for intervention for stroke after cardiac surgery
Stroke after cardiac surgery is a devastating complication and a frequently cited disadvantage of cardiac operations to percutaneous interventions. Because the atherosclerotic process is not limited to the heart and great vessels, a higher prevalence of patients undergoing cardiac surgery have concomitant cerebrovascular disease. In addition, embolic risk is present with all cardiac surgery interventions. Consequently, much has been invested in reducing neurologic complications, with stroke now a rare occurrence (1.3%) after coronary artery bypass grafting.
Source: The Journal of Thoracic and Cardiovascular Surgery - December 27, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Juan Marcano, Ravi K. Ghanta Tags: Editorial Commentary Source Type: research

Commentary: Tick, tock … Time windows for intervention for stroke after cardiac surgery
Stroke after cardiac surgery is a devastating complication and a frequently cited disadvantage of cardiac operations to percutaneous interventions. Because the atherosclerotic process is not limited to the heart and great vessels, a higher prevalence of patients undergoing cardiac surgery have concomitant cerebrovascular disease. In addition, embolic risk is present with all cardiac surgery interventions. Consequently, much has been invested in reducing neurologic complications, with stroke now a rare occurrence (1.3%) after coronary artery bypass grafting.
Source: The Journal of Thoracic and Cardiovascular Surgery - December 26, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Juan Marcano, Ravi K. Ghanta Tags: Commentary Source Type: research

The limitations of observational data in assessing surgical left atrial appendage ligation
We read with interest the study by Juo and colleagues, which examined outcomes in a cohort of patients with atrial fibrillation who underwent surgical left atrial appendage (LAA) ligation concomitantly with coronary artery bypass grafting. The authors evaluated the short-term efficacy and safety of LAA ligation in 20,664 patients among a sample of 234,642 patients from the Nationwide Inpatient Sample, and reported no significant differences in postoperative stroke, mortality, bleeding, and pericardial complications.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 14, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Saurabh Gupta, Emilie P. Belley-C ôté, Richard P. Whitlock Tags: Letter to the editor Source Type: research

Multivessel coronary artery disease and poor left ventricle function: It is consistent and clear, coronary artery bypass grafting wins again
Superiority of coronary artery bypass grafting (CABG) to medical therapy in patients with impaired ventricular function (ie, ejection fraction  ≤ 35%) has been shown in clinical trials.1,2 Observational studies have also demonstrated greater survival in patients with an impaired left ventricle undergoing CABG compared with those that are treated with percutaneous coronary intervention (PCI).3,4 Although these studies unanimously demons trated that the incidence of early stroke, renal failure, and other complications were higher in the CABG group, having a better survival rate favors CABG over PCI in the treatment of pa...
Source: The Journal of Thoracic and Cardiovascular Surgery - May 28, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Saina Attaran, William S. Weintraub, Vinod H. Thourani Tags: Editorial commentary Source Type: research

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