Ischemic heart disease (IHD) is common in heart failure (HF), yet the association between incident coronary revascularization and mortality in these patients has not been examined in a propensity-matched study. In the Digitalis Investigation Group trial, 2853 patients without coronary revascularization and 120 patients with coronary revascularization during the first ...

BACKGROUND: Aggressive nonsurgical revascularization results in high-risk patients presenting for operation at a later stage of coronary artery disease (CAD). This study investigated the effect of temporal changes in operative characteristics on outcomes of surgical revascularization. METHODS: We compared preoperative, intraoperative, and postoperative variables of 5633 patients who underwent surgical ...

The Vineberg operation was introduced by Dr Arthur Vineberg in the early 1940s for revascularization of ischemic cardiac tissue with direct implantation of the left internal mammary artery into ventricular myocardium. We report the case of an 81-year-old man who presented to the Veterans Administration Medical Center with progressive shortness ...

The Vineberg operation was introduced by Arthur Vineberg in the early 1940s as an experimental model for revascularization of ischemic cardiac tissue in animal models with direct implantation of left internal mammary artery into ventricular myocardium. The first attempt in a human was performed in 1950, followed by 10,000 to ...

OBJECTIVES: To investigate the long-term prognostic implications of complete versus incomplete revascularization in multivessel coronary artery disease (MVD) patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). BACKGROUND: Coronary artery bypass grafting (CABG) in patients with MVD provides better outcomes when complete revascularization is achieved. There is a paucity ...

Since its inception in the 1960s, coronary revascularization has established itself as a fundamental therapy for treating the acute and chronic manifestations of atherosclerotic coronary disease. Catheter-based techniques were realized in the late 1970s and have evolved from balloon dilatation of simple, discrete stenoses to complex, multivessel interventions across the ...

BACKGROUND: Acute ST-segment elevation myocardial infarction (STEMI) caused by left main coronary artery (LMCA) obstruction is uncommon. Although the link between this catastrophic disease and very high mortality is well recognized, even after undergoing emergent revascularization, the systemic risk stratification and long-term outcome are currently unclear. The clinical presentation, parameter-related ...

OBJECTIVE: Determine the impact of 24-hour duration of arterial embolism on the outcomes of management. MATERIAL AND METHOD: A prospective study of 91 patients with acute arterial embolism of the lower extremities was carried out. RESULTS: Among the 91 patients, 31(34.1%) were with early acute embolism(< 24 hours) and 60 ...

OBJECTIVE: Traditionally integrated coronary artery revascularization has been described as a 2-stage procedure. We evaluated the safety and feasibility of 1-stage, simultaneous, hybrid, robotically assisted coronary artery bypass grafting surgery and percutaneous coronary intervention. METHODS: Fifty-eight patients underwent simultaneous, integrated coronary artery revascularization in an operating theater equipped with angiographic ...

Prompt delivery of percutaneous coronary revascularization in the acute setting has been shown to decrease mortality, length of hospitalization, and patient recovery time. However, its routine use in stable coronary disease is less validated, especially in the absence of adequate medical treatment. Several studies have looked into the benefits of ...

Cardiac surgeons are increasingly faced with a more complex patient who has developed a pattern of diffuse coronary artery disease that cannot be completely revascularized by CAGB alone. Considering the increased operative and long-term cardiac risks predicted by incomplete revascularization, and the documented operative and long-term benefits associated with sole ...

OBJECTIVE: Many studies failed to show that off-pump myocardial revascularization achieved better results than on-pump revascularization, and also invited a lot of criticism for the criteria used for selection and inclusion of patients. To avoid these limitations, we systematically treated all candidates for coronary surgery with this technique evaluating early ...

Owing to the high prevalence of atherosclerotic coronary artery disease, treatment has proceeded along three separate paths: medical, surgical, and percutaneous intervention. Medical treatment is now routinely combined with both surgical treatment and percutaneous methods; however, the surgical and percutaneous routes are often viewed as in competition. Hybrid coronary revascularization, ...

BACKGROUND: Patients with non-ST-elevation acute coronary syndrome complicated by congestive heart failure (CHF) have a poor prognosis. The aims of this study were to describe the use of revascularization in non-ST-elevation acute coronary syndrome and CHF and to analyze its impact on survival. METHODS AND RESULTS: In the Global Registry ...

Coronary artery disease involving the left main stem is of prognostic relevance. Current guidelines in the United States and Europe provide Class I recommendation for surgical revascularization in these patients (Level of evidence A). The guidelines are based on data from the Veterans Administration Cooperative Study, the European Coronary Surgery ...

The Coronary Artery Revascularization Prophylaxis (CARP) study showed no survival benefit with preoperative coronary artery revascularization before elective vascular surgery. The generalizability of the trial results to all patients with multivessel coronary artery disease (CAD) has been questioned. The objective of this study was to determine the impact of prophylactic ...

BACKGROUND: Clinicians treating coronary revascularization patients need to be able to identify those who require more intensive medical therapy or follow-up. However, predictors of survival after coronary revascularization are often reported in terms of hazard ratios, which are accurate but difficult to convert to concrete values. We sought to develop ...

The assumption that males and females are physiologically similar has led to females being clinically evaluated and treated as males. However, there is growing evidence in the literature that, other than the reproductive system, there are other fundamental physiological differences between the two genders. The manifestation of these differences starts ...

We present an 80-year-old woman with hibernating myocardium in the left anterior descending coronary artery (LAD) territory who underwent surgical revascularization and metabolic evaluation of the dysfunctioning segments by microdialysis (microD) technique. Myocardial lactate, pyruvate, and glucose did not show obvious changes throughout the procedure. Conversely, myocardial glycerol and glutamate ...

This study was conducted to determine the results of left subclavian artery (LSA) coverage during thoracic endovascular aortic repair (TEVAR). We retrospectively reviewed the results of 308 patients who underwent TEVAR from 1999 to 2007. The LSA was completely covered in 70 patients (53 men, 13 women), with a mean ...

In order to evaluate the left ventricular remodeling in patients with myocardial infarction after revascularization with intravenous real-time myocardial contrast echocardiography (RT-MCE), intravenous RT-MCE was performed on 20 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using ...

Therapy advice based on dual-source computed tomography (DSCT) in comparison with coronary angiography (CAG) was investigated and the results evaluated after 1-year follow-up. Thirty-three consecutive patients (mean age 61.9 years) underwent DSCT and CAG and were evaluated independently. In an expert reading (the "gold standard"), CAG and DSCT examinations were ...

It has been almost a decade since transmyocardial laser revascularization (TMR) was approved for clinical use in the United States. The safety of TMR was demonstrated initially with nonrandomized studies in which TMR was used as the only treatment for patients with severe angina. TMR efficacy was proven after multiple ...

Until recently the role of endovascular revascularization in the infrapopliteal arteries was limited. Endo-vascular management including percutaneous transluminal angioplasty and subintimal angioplasty is now being considered as a primary alternative in critical limb ischaemia revascularization with a decreasing number of major amputations (above the ankle) performed. Endovascular treatment has been ...

OBJECTIVES: The aim of the present study was to estimate the need for late lower limb revascularization and/or major amputation after coronary artery bypass grafting (CABG). DESIGN: Retrospective study. PATIENTS AND METHODS: 1307 residents of Oulu who underwent CABG from 1990 to 2006 formed the basis of this community-wide study. ...

OBJECTIVES: We evaluated the effect of metabolic syndrome (a risk factor for the development of coronary artery disease) on survival in patients with established coronary artery disease. METHODS: Survival was determined for 2886 patients with coronary artery disease diagnosed by cardiac catheterization performed between 1990 and 2005 at a Department ...

PURPOSE OF REVIEW: Coronary artery disease is the most common cause of heart failure and is referred to as 'ischaemic cardiomyopathy'. There are no established guidelines for the role of revascularization in patients with heart failure in the absence of angina. This review evaluates the current state of knowledge on ...

Patients undergoing vascular surgery are at increased risk for cardiac complications related to the presence of underlying coronary artery disease. Preoperative cardiac evaluation may help to identify high-risk patients in whom coronary angiography may be planned with subsequent coronary revascularization for the purpose of improving perioperative and long-term cardiac outcomes. ...

INTRODUCTION: The risk of death after coronary revascularization is markedly higher for dialysis patients than for the general population and the cause is inadequately explained. We analyzed cause-specific mortality of dialysis patients after coronary revascularization. METHODS: This was a retrospective analysis of dialysis patients hospitalized for first surgical coronary revascularization ...

OBJECTIVE: A significant number of patients have coronary artery disease that is not amenable to traditional revascularization. Prospective, randomized clinical trials have demonstrated therapeutic benefits with transmyocardial laser revascularization in this cohort. The molecular mechanisms underlying this therapy, however, are poorly understood. The focus of this study was evaluation of ...

Many centers across the country have used collaborative techniques to identify problems and come up with innovative solutions. Excellent improvements have been made in every aspect of the patient's journey through the cardiac surgery services, such as decreased length of stay, reduced clinical variation and costs, and improved outcome. We ...

BACKGROUND: Does preoperative revascularization of the myocardium reduce cardiac risk in noncardiac surgery? The aim of this study was to evaluate the clinical effectiveness of preoperative cardioprotection by coronary artery revascularization in abdominal nonvascular surgery under general anesthesia. MATERIALS AND METHODS: The observational clinical study included 111 consecutive patients with ...

BACKGROUND: The purpose of this study was to validate myocardial microdialysis measurements in patients after myocardial infarction with or without associated postoperative functional recovery in order to develop a highly sensitive tool for real-time in vivo detection of microcellular disorder during cardiac operations. METHODS: In 20 patients undergoing coronary artery ...

Myocardial revascularization among patients with porcelain aorta is a real dilemma regarding bypass technique, choice of conduit and site of proximal anastomosis. The experience reported here is about two cases of patients (aged 28 and 73 years) with porcelain aorta. Both patients had successful myocardial revascularization using beating heart technique. ...

We report four cases of lower extremity malperfusion complicating acute type A dissection. Two patients were treated with acute type A dissection repair, followed by axillobifemoral bypass grafting when malperfusion persisted after aortic replacement and required dialysis. Two patients were managed with lower extremity revascularization procedures before acute type A ...

Health disparities and vulnerability are embedded within the context of historical and contemporary dynamics, and are confounded by inequities in access to quality healthcare. Early management and preventive therapy has been the cornerstone of cardiovascular medicine for acute coronary syndromes. Invasive cardiac strategies, including revascularization with percutaneous coronary intervention or ...

BACKGROUND: Intravenous immunoglobulin (IVIG) may cause thromboembolic events. Although such events are usually associated with large IVIG doses administered to treat neurologic diseases, thromboembolic events may also occur with standard immunodeficiency doses. OBJECTIVE: We describe a 65-year-old man with common variable immunodeficiency (CVID) who experienced angina and myocardial infarction with ...

OBJECTIVES: This study aimed to investigate whether baseline serum levels of matrix metalloproteinases (MMPs) could predict long-term prognosis of coronary revascularizations. DESIGNS AND METHODS: Ninety-one consecutive patients receiving coronary revascularizations (58 percutaneous coronary interventions and 33 coronary artery bypass graft surgeries) for stable coronary artery disease (CAD) were studied. Baseline ...

OBJECTIVE: In patients with multivessel coronary artery disease and total occlusion of major epicardial vessel, completeness of revascularization has not been investigated in specific trials comparing the surgical and the percutaneous revascularization strategy. Analyzing the database of the CABRI study, which randomized a substantial number of these patients, we investigated ...

PURPOSE OF REVIEW: Clinical decision-making in coronary artery disease relies heavily on evidence-based medicine. Data from randomized controlled trials constitute the highest order of evidence and remain the standard for comparisons between therapies. While comprehensive, observational databases lack the scientific rigor of randomized controlled trials, they represent a more accurate ...

Computed tomographic angiography (CTA) has been validated for noninvasive assessment of coronary anatomy. The aim was to establish whether CTA could guide the use of invasive coronary angiography (ICA) in symptomatic patients with intermediate risk after myocardial perfusion stress imaging (MPSI). From April 2005 to February 2006, patients referred for ...

BACKGROUND: Whether patency of a second diseased vessel still impacts myocardial perfusion when complete revascularization of the left anterior descending coronary artery (LAD) territory has been achieved is currently undetermined. In patients with 2-vessel coronary artery disease and complex LAD lesions, we evaluated the impact of single LAD or integrated ...

BACKGROUND: Magnetocardiography (MCG) is sensitive to minute cardiac electric abnormalities, but its clinical utility in diagnosing ischemic heart disease (IHD) has not been established. The present study examined the usefulness of an integral MCG value of ventricular repolarization in patients with IHD. METHODS AND RESULTS: MCG was performed at rest ...

The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial showed that coronary interventional procedures added little to optimal medical therapy with respect to the long-term outcome of patients with stable coronary disease when used as initial therapy. Detractors opine that: 1) the trial was unrealistic in design and ...

PURPOSE: The benefits of prophylactic coronary revascularization for patients undergoing noncardiac surgery are uncertain. The purpose of this study was to systematically evaluate the effect of coronary revascularization and medical management on short- and long-term outcomes after noncardiac surgery. METHOD: Ten electronic databases including MEDLINE and EMBASE (1980 to February ...

We report that the use of transmyocardial laser revascularization combined with intramyocardial injection is a therapeutic option for patients with severe ischemic heart disease (IHD) not amenable to conventional myocardial revascularization. Recently, cell therapy with autologous bone marrow cells (BMC) has been tested in clinical trials for severe IHD. We ...

Percutaneous coronary revascularization is rarely complicated by infection. Necrotizing fasciitis (NF) is a severe, deep-seated, potentially life-threatening infection of fascia and subcutaneous tissues. We report herein 2 cases of NF in patients undergoing percutaneous transluminal coronary revascularization for treatment of acute coronary syndrome. These are the first 2 reported cases ...

This study evaluated the effect of heart failure (HF) and ejection fraction (EF) at baseline on long-term cardiac mortality in patients undergoing coronary revascularization and investigated the effect of diabetes mellitus (DM) on mortality. We evaluated long-term outcomes of patients without HF, HF and a preserved EF, and HF and ...

OBJECTIVES: The purpose of this research was to perform a feasibility study of prophylactic coronary revascularization in patients with preoperative extensive stress-induced ischemia. BACKGROUND: Prophylactic coronary revascularization in vascular surgery patients with coronary artery disease does not improve postoperative outcome. If a beneficial effect is to be expected, then at ...

Myocardial infarction and ischemic heart disease are among the most common causes of morbidity and mortality in the industrial world. Surgical and percutaneous intravascular approaches are commonly used to treat these diseases. Regrettably, a significant number of patients are either ineligible or demonstrate suboptimal responses to these therapies. In an ...