Explore the vast range of titles available.

We aim to compare hospital costs of robotic-assisted coronary artery bypass grafting (CABG) versus conventional CABG. All consecutive 1,173 patients who underwent conventional and robotic-assisted CABG between January 2018 and June 2021 were included. After propensity-matching, 267 patients in each group (robotic-assisted vs conventional) were included in the study. Patient selection for each group was decided by a treating surgeon with a heart team based on clinical factors. Syntax score was not assessed. Total costs (direct + indirect hospital costs) of patients who underwent robotic-assisted and conventional CABG were compared. Direct cost expenses included surgical operating time, hospital stay, surgical implants and supplies, catheterization laboratory, pharmacy, radiology and ultrasound imaging, blood bank, cardiology, and so on. Indirect cost expenses included general administration medical records, and so on. Using the propensity-matched groups (n = 267), we summed the total cost by year. Results for 267 propensity-matched patients (each group) evidenced that total conventional CABG costs were $9.5 million (average of $35,580/patient), whereas robotic-assisted CABG costs were $5 million ($18,726/patient). Therefore, the differences between robotic-assisted and conventional CABG costs were $4.5 million ($16,853/patient), favoring robotic-assisted over conventional CABG. Differences in direct and indirect costs were $2.2 million and $1.8 million, respectively. When the cost of the Da Vinci robot was added ($1,200,000), the total cost was $3.3 million ($12,359 × patient) lower in the robotic-assisted CABG group. Multivariate analysis showed that, mainly, the shorter hospital length of stay (7 vs 5 days) accounts for the reduced costs observed in the robotic-assisted CABG group. In conclusion, in a mature practice, robotic-assisted CABG decreases hospital length of stay, leading to reduced hospital costs compared with conventional CABG.

New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with increased rates of adverse events (including mortality and stroke). Its incidence after coronary artery bypass grafting (CABG) is considered to be approximately 30%, and it is believed to be a transient condition. However, studies investigating POAF after CABG fail to provide appropriate data on incidence and arrhythmia patterns due to the use of intermittent rhythm detection strategies. These methods have a low sensitivity as compared with continuous monitoring. Subsequently, studies using these techniques most likely do not identify all patients with arrhythmia and do not adequately demonstrate the long-term incidence of arrhythmia, which in turn may affect its association with adverse events. The Characterization of Post Coronary Artery Bypass Grafting Atrial Fibrillation Patterns (CABG-AF) study (German Clinical Trials Register Number: DRKS00018887) tests the hypothesis that the incidence of AF in the first 12 months after CABG is significantly underestimated. CABG-AF is an investigator-initiated multicenter, prospective, observational study in which 196 patients with no history of arrhythmia who underwent first-time CABG receive an insertable cardiac monitor for continuous postoperative rhythm monitoring. The primary end point of the study is any episode of AF within the first 12 months after surgery. Secondary end points include AF burden, AF density, and the ratio of silent to symptomatic AF episodes. End points will be investigated by automatic and patient-initiated data transfers from the implanted device, by telephone interview of patients, and by follow-up forms sent to patients by mail. The patients will be followed for a planned follow-up of 3 years. In conclusion, the CABG-AF study will provide information on the true incidence of AF after CABG and on the temporal patterns of the arrhythmia. [Display omitted]

Abstract Objectives We aimed to determine whether high-sensitivity cardiac troponin I (hs-cTnI) thresholds associated with increased 30-day mortality isolated coronary artery bypass grafting (CABG) differed between those undergoing off-pump (OPCAB) and on-pump (ONCAB) CABG. Methods We conducted a subanalysis of patients who underwent isolated CABG in the Vascular Events in Surgery Patients Cohort Evaluation (VISION) Cardiac Surgery Study. Cox regression was used to determine the hazard ratios (HRs) for mortality based on postoperative day 1 log-transformed hs-cTnI adjusted by EuroSCORE II, with OPCAB versus ONCAB as an interaction term. HRs were modelled as a function of hs-cTnI, and the lowest troponin associated with HR ≥ 1.00 was identified for each group. Results Of the original VISION cohort, 6505 patients underwent isolated CABG (OPCAB = 1141, ONCAB = 5364). Median hs-cTnI after CABG was 2446 ng/L (interquartile range [IQR] 1164-5654), and lower after OPCAB (640 ng/L [264-1689]) than ONCAB (2972 ng/L [1536-6448], P < .001). There were no differences in 30-day mortality between OPCAB and ONCAB (1.7% vs 1.4%, P = .5). Increased log-peak hs-cTnI was associated with greater mortality after CABG (adjusted HR = 1.7 [95% CI, 1.4-2.1]). The hs-cTnI threshold associated with HR ≥ 1.00 for isolated CABG was 6549 ng/L (95% CI, 3609-8381). OPCAB versus ONCAB had a significant interaction effect on the association between hs-cTnI and mortality (interaction P = .002). The hs-cTnI threshold associated with mortality after OPCAB was ≥4708 ng/L (95% CI, 581-7177), compared to ≥6806 ng/L (95% CI, 4001-13 993) after ONCAB. Conclusions The clinically significant hs-cTnI threshold after CABG associated with an increased risk of 30-day mortality above the baseline is substantially higher than defined by current guidelines, but lower in patients undergoing OPCAB compared to ONCAB. Coronary artery bypass grafting (CABG) remains the gold standard for treating severe multivessel coronary artery disease. Graphical abstract

IntroductionProlonged waiting times for urgent Coronary Artery Bypass Graft (CABG) are associated with adverse outcomes. Historically, analysis of inpatient CABG at Liverpool Heart and Chest Hospital (LHCH) between 11/2016–1/2017 identified a 10-day median time from referral to operation (interquartile range: 7–14). In an attempt to achieve the national 7 day target, the trust introduced changes to working patterns for surgical consultants including a surgeon of the week (SOW), and daily multidisciplinary team meetings (MDM). To evaluate the effect of these changes on achieving target, a further analysis was undertaken.MethodsLHCH is a stand alone cardiothoracic centre: referrals are direct from 7 partner hospitals (19%), or internally from cardiology team (81%). Retrospective data were collected for all patients who had non-elective CABG (excluding valve and aortic surgery) during two specified periods July-September 2019, April-July 2020. Data were extracted from electronic patient records, manually reviewed and cross checked to ensure accuracy.ResultsBetween July-September 2019, the median time from referral to operation for 109 eligible patients was 7 days (interquartile range: 6–9). 60% underwent CABG within 7 days for the group referred from LHCH directly, and only 25 % had their operation within 7 days for the group referred from other trusts. Between April-July 2020, 54 eligible patients were included. The median waiting time was 8 days (interquartile range: 6–10). 42% underwent CABG within 7 days for the group referred from LHCH directly. Similar trend observed in the group referred from other trusts with only 33% had their operation within 7 days. The distributions of waiting times were not significantly different between these two time periods (Mann-Whitney U test p-value 0.12), but there was a significant improvement compared to the 2016–17 cohort, where only 25 % referred from LHCH, and 18% referred from other trusts had their CABG within 7 days.Abstract 56 Table 1Detailed breakdown of CABG waiting times (median days) for patients during different study periods Time period Original admission to operation (Days) Original admission to referral (Days) Referral to operation (Days) Referral to surgical review (Days) November 2016 – January 2017 13 3 10 1 July 2019 – September 2019 11 3 7 1 April 2020 – June 2020 11 2 8 1 Abstract 56 Figure 1Causes of long CABG waiting times between July 2019 – September 2019.Abstract 56 Figure 2Causes of long CABG waiting times between April 2020 – June 2020.ConclusionsMedian waiting times for urgent CABG I significantly improved by implementing the SOW work pattern and daily MDMs.. Despite this, 40% percent still fail to have surgery within the recommended 7 days. This reflects a national picture, highlighted by the national audit of adult cardiac surgery (NACSA) and suggests that further improvements will require substantial resources.Conflict of InterestNone

BackgroundA substantial body of evidence demonstrates that myocardial revascularisation using bilateral internal mammary arteries (BIMA) improves long-term survival compared with single/left internal mammary artery (LIMA) grafting. To date, limited analyses have been made regarding other short-term and long-term outcomes in BIMA strategy.ObjectivesThe primary aim of the present review is to update the difference in long-term survival between BIMA and LIMA grafting and to thoroughly investigate other secondary short-term and long-term clinical outcomes between these two grafting procedures.MethodsElectronic searches were performed using three databases from their inception to November 2015. Relevant studies comparing long-term survival between BIMA and LIMA grafting were identified. Data were extracted by two independent reviewers and analysed according to predefined clinical outcomes.ResultsTwenty-nine observational studies were identified, with a total of 89 399 patients. Overall, BIMA cohort had significantly improved long-term survival compared with LIMA cohort (HR 0.78; p<0.00001). BIMA cohort also had significantly reduced hospital mortality rates (1.2% vs 2.1%, p=0.04), cerebrovascular accidents (1.3% vs 2.9%, p=0.0003) and need for revascularisation (4.8% vs 10%, p=0.005), although the incidence of deep sternal wound infection (DSWI) was increased (1.8% vs 1.4%, p=0.0008) in this grafting strategy. Long-term cardiac-free, myocardial infarction-free and angina-free survivals were also superior for the BIMA cohort.ConclusionsBIMA grafting is associated with enhanced overall long-term outcomes compared with LIMA grafting. While the BIMA cohort demonstrates an increased incidence of DSWI, the survival benefits and other morbidity advantages outweigh this short-term risk.

Background Clinical evidence in coronary surgery is usually derived from retrospective, single institutional series. This may introduce significant biases in the analysis of critical issues in the treatment of these patients. In order to avoid such methodological limitations, we planned a European multicenter, prospective study on coronary artery bypass grafting, the E-CABG registry. Design The E-CABG registry is a multicenter study and its data are prospectively collected from 13 centers of cardiac surgery in university and community hospitals located in six European countries (England, Italy, Finland, France, Germany, Sweden). Data on major and minor immediate postoperative adverse events will be collected. Data on late all-cause mortality, stroke, myocardial infarction and repeat revascularization will be collected during a 10-year follow-up period. These investigators provided a score from 0 to 10 for any major postoperative adverse events and their rounded medians were used to stratify the severity of these complications in four grades. The sum of these scores for each complication/intervention occurring after coronary artery bypass grafting will be used as an additive score for further stratification of the prognostic importance of these events. Discussion The E-CABG registry is expected to provide valuable data for identification of risk factors and treatment strategies associated with suboptimal outcome. These information may improve the safety and durability of coronary artery bypass grafting. The proposed classification of postoperative complications may become a valuable research tool to stratify the impact of such complications on the outcome of these patients and evaluate the burden of resources needed for their treatment. Clinical Trials number NCT02319083

Restenosis, defined as the re-narrowing of an arterial lumen after revascularization, represents an increasingly important issue in clinical practice. Indeed, as the number of stent placements has risen to an estimate that exceeds 3 million annually worldwide, revascularization procedures have become much more common. Several investigators have demonstrated that vessels in patients with diabetes mellitus have an increased risk restenosis. Here we present a systematic overview of the effects of diabetes on in-stent restenosis. Current classification and updated epidemiology of restenosis are discussed, alongside the main mechanisms underlying the pathophysiology of this event. Then, we summarize the clinical presentation of restenosis, emphasizing the importance of glycemic control in diabetic patients. Indeed, in diabetic patients who underwent revascularization procedures a proper glycemic control remains imperative.

The ``obesity paradox'' is a surprising phenomenon where obesity appears to provide a protective benefit, resulting in better survival rates in certain patient groups. This paradox has been observed in patients undergoing procedures like PCI, CABG, and TAVR for heart conditions. Obese patients typically show improved short- and long-term outcomes compared to non-obese or underweight individuals. This study aimed to investigate the impact of obesity on in-hospital mortality rates for US patients receiving these cardiac procedures. In this study, we examined the 2020 National Inpatient Sample (NIS) to identify obese patients (BMI > 30) undergoing PCI, CABG, and TAVR. Using logistic and linear regression, we analyzed associations while accounting for potential confounders. A 2-tailed p-value of 0.05 was considered statistically significant for our findings. During 2020, a total of 331,520 hospitalizations were recorded for PCI, 153,744 for CABG and 77,230 for TAVR. Upon adjusting for variables such as age, race, gender, hospital bed size, location, teaching status, insurance coverage, income level, and Elixhauser comorbidities; we observed that obesity was associated with a reduced rate of in-hospital mortality for PCI (aOR 0.37, 95% CI 0.31 – 0.44), CABG (aOR 0.54, 95% CI 0.44- 0.65), and TAVR (aOR 0.45, 95% CI 0.27- 0.73) (Figure 1). Our study revealed that obese patients admitted for PCI, CABG, or TAVR had significantly lower in-hospital mortality risk. To better understand the obesity paradox, larger, robust studies are needed, which will uncover underlying mechanisms, enhance understanding, and inform improved patient care strategies.