Search

The aims of this study were to examine rates of radial artery access in post-coronary artery bypass grafting (CABG) patients undergoing diagnostic catherization and/or percutaneous coronary intervention (PCI), whether operators with higher procedural volumes and higher percentage radial use were more likely to perform diagnostic catherization and/or PCI via the radial approach in post-CABG patients, and clinical and procedural outcomes in post-CABG patients who undergo diagnostic catherization and/or PCI via the radial or femoral approach.There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI.Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009, to March 31, 2018 (n = 1,279,058, 1,173 sites) were evaluated. Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access.The rate of transradial access increased from 1.4% to 18.7% over the study period. Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57; 95% CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38; 95% CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11; 95% CI: 1.06 to 1.16; p 0.0001), and significantly decreased contrast volume across all procedure types. Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only. Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG.The rate of transradial artery access in patients with prior CABG undergoing diagnostic catheterization and/or PCI has increased over the past decade in the United States, and it was more often performed by operators using a transradial approach in non-CABG patients. Compared with transfemoral access, transradial access was associated with improved clinical outcomes in patients with prior CABG.

Fractional flow reserve (FFR) provides an objective measurement of the severity of ischemia caused by coronary stenoses in downstream myocardial regions. Data from the interventional cardiology realm have suggested benefits of a FFR-guided percutaneous coronary intervention (PCI) strategy. Limited evidence is available on the use of FFR to guide coronary artery bypass grafting (CABG). The most recent data have shown that FFR might simplify CABG procedures and optimize patency of arterial grafts without any clear impact on clinical outcomes. The aim of this review was to summarize the available data on FFR-based CABG and discuss the rationale and potential consequences of a switch toward FFR-based surgical revascularization strategy.

Highlights •RAO remains the most frequent post-procedural complication of transradial access, restricting the use of the same radial artery for future procedures, as a conduit for coronary artery bypass grafting or for arteriovenous fistula creation in patients requiring hemodialysis. •The real-world reported incidence of RAO remains high, with wide variability in the uptake of RAO prevention strategies. •The paper reviews the main recent advances in the field of RAO prevention and provides a series of expert recommendations to prevent RAO. •This consensus document is meant to provide guidance to increase the adoption of simple and effective methods to achieve an institutional rate of RAO

Coronary artery bypass grafting surgery (CABG) is the preferred revascularization modality in patients with highly complex anatomy. However, the atherosclerosis process is accelerated after CABG, leading to development of a chronic total occlusion (CTO) in up to 46% of the bypassed native arteries

An 80-year-old woman on oral anticoagulation therapy, with previous mitral valve reconstruction, subsequent coronary artery bypass grafting with aortic and mitral valve (29-mm Mosaic, Medtronic, Dublin, Ireland) replacement, and 10 years later, transcatheter mitral valve replacement (TMVR) with a 26

The use of fractional flow reserve (FFR) to guide coronary artery bypass grafting surgery (CABG) is controversial, but recent data from the IMPAG (Impact of Preoperative FFR on Arterial Bypass Graft Function) trial [(1)][1] suggest that pre-operative FFR closely correlate with 6-month arterial

In the paper on the update on cardiac catheterization in patients with prior coronary artery bypass grafting surgery, Xenogiannis et al. ([1][1]) performed a broad review describing clinical data about vein graft cardiac catheterization and intervention. However, the technical aspect of vein graft

Revascularization for left anterior descending artery (LAD) chronic total occlusion (CTO) lesions usually requires coronary artery bypass grafting (CABG) via sternotomy. Recent advances in CTO percutaneous coronary intervention (PCI) techniques, including a rapid escalation of the hybrid algorithm

A 74-year-old woman with prior coronary artery bypass grafting presented with CCS (Canadian Cardiovascular Society) class III angina and underwent disobliteration of a circumflex coronary artery occlusion ([Figure 1][1]). Seven months later, she developed a recurrence of effort angina. Repeat

We thank Dr. Cao and colleagues for their interesting observations and for commenting on our paper ([1][1]). A clear contradiction exists among observational and randomized evidences on the impact of preoperative fractional flow reserve (FFR) in patients undergoing coronary artery bypass grafting (

Coronary-artery bypass grafting still represents the most successful treatment of coronary artery disease. The patency of the graft could be dependent on precise surgical technique (conventional (vsK) or endoscopic (vsE) harvesting), and potentially also on the hypoxic damage of the vein wall. The

Coronary-artery bypass grafting (CABG) still represents the most successful treatment of coronary artery disease. The patency of the graft could depend on surgical technique (endoscopic or conventional harvesting) which could cause damage of saphenous vein (SV). The aim of our study was to elucidate

An 80-year-old man with severe aortic stenosis and history of coronary artery bypass grafting and extensive peripheral artery disease underwent a failed transapical aortic valve implantation attempt complicated by apical tear and bleeding. A completely percutaneous transaxillary aortic valve

Cardiovascular disease has become a leading cause of death for individuals with paraplegia. This is the first clinical study in the literature to investigate the clinical outcomes and treatment of AMI patients with paraplegia. We identified AMI patients with paraplegia cohort by using principal

Dual antiplatelet therapy is a Class I recommendation for patients with an acute coronary syndrome (ACS). However, whether patients should be loaded with a P2Y12 antagonist at the time of hospital admission remains controversial. Following angiography, about 10% of ACS patients are found to have

Percutaneous coronary intervention (PCI) with successful stent deployment is becoming increasingly feasible in severely calcified coronary arteries with the help of plaque modification systems. Coronary atherectomy is a popular alternative to coronary artery bypass grafting (CABG) in patients with

Transradial access has been increasingly used as an alternative to transfemoral access. Several studies demonstrated that such access is associated with lower rates of vascular and bleeding complications. Although coronary artery bypass grafting patients comprise a significant portion of the

An 80-year-old man with history of coronary artery bypass grafting and mitral annuloplasty with a semirigid Physio-1 ring 30 mm (Edwards Lifesciences, Irvine, California) for ischemic mitral regurgitation was referred to our hospital because of worsening shortness of breath. An echocardiogram

Serruys et al. [(1)][1] reported that percutaneous coronary intervention was associated with a higher rate of major adverse cardiac events compared with coronary artery bypass grafting surgery among women with unprotected left main disease, which was driven by the increased risk for periprocedural

A 48-year-old woman with history of multiple percutaneous coronary interventions and bypass grafting on the left anterior descending coronary artery presented with unstable angina. Coronary angiography showed a patent left internal mammary artery and de novo critical stenoses of the mid-shaft left

In patients evaluated for Coronary Artery Bypass Grafting (CABG), established risk scores are used to stratify patients and determine surgical candidacy. Evidence demonstrates that comorbidities also influence outcomes in patients undergoing high-risk percutaneous coronary intervention (HRPCI) and

Hybrid coronary revascularization (HCR) involves a combination of surgical and percutaneous techniques, which in selected patients may present an alternative to conventional coronary artery bypass grafting (CABG). A meta-analysis was performed to evaluate the effectiveness of HCR compared to CABG

Patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS) have extremely high mortality rates. We sought to assess the effect of previous surgical revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) on in-hospital outcomes

The management of multivessel coronary artery disease (MVD) in STEMI setting is under debate. Complete surgical revascularization with CABG is not usually considered due to the need for emergency revascularization of the culprit vessel, which is performed faster percutaneously. Many patients who are

History of prior coronary artery bypass grafting (CABG) may be associated with increased incidence of major adverse cardiac events (MACE) in patients undergoing repeat CABG, percutaneous coronary intervention, or medical treatment. In this analysis, one year safety outcomes were evaluated in

Coronary artery bypass grafting is the standard of care for most patients with obstructive left main (LM) coronary disease. In poor surgical candidates, high-risk percutaneous coronary artery intervention (PCI) is a consideration. The results from randomized trials examining short-term mortality

A 78-year-old woman with a history of coronary artery bypass grafting underwent transapical transcatheter aortic valve replacement with a Sapien XT (Edwards, Irvine, California) prosthesis that was complicated by an apical left ventricular pseudoaneurysm (LVPA). Unsuccessful attempts at closure

A 47-year-old man presented to our hospital after he was successfully resuscitated from ventricular fibrillation. He had experienced chest pain while seated at home. He had undergone successful sequential coronary artery bypass grafting 17 months previously, by the use of left internal mammary

We report the clinical outcomes of patients who underwent percutaneous coronary intervention (PCI) with orbital atherectomy for severely calcified unprotected left main coronary artery (ULMCA) disease. Although coronary artery bypass grafting is the gold standard for patients with ULMCA disease not

As a result of the demonstrated survival benefit of coronary artery bypass surgery over medical treatment, and the unfavorable initial results of coronary balloon angioplasty, coronary artery bypass grafting (CABG) has been the standard care for significant left main coronary artery (LMCA) stenosis

A 69-year-old man with Behcet disease (BD) was referred for treatment of a rapidly growing giant aneurysm (38 × 31 mm) of the right coronary artery (RCA), as detected by computed tomography ([Fig. 1][1]A). The patient initially underwent surgery for single coronary artery bypass grafting and RCA

The radial artery is a commonly used conduit for coronary artery bypass grafting. Long-term patency rates are at least as good and in some series are better than for saphenous vein grafts ([1,2][1]). However, radial artery graft failure remains a significant problem ([3][2]), in particular in cases

Percutaneous coronary intervention (PCI) has traditionally been used as first-line therapy for limited coronary artery disease while coronary artery bypass grafting (CABG) has been the mainstay of therapy for patients with more advanced multivessel and left main disease. With the more frequent use