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Literaturübersicht 2017 zur Koronarchirurgie

Literature review 2017 on coronary surgery

  • Evidenzbasierte Medizin
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die Koronarchirurgie ist ein wichtiger Bestandteil der Behandlung der koronaren Herzkrankheit (KHK). Seit der Einführung der perkutanen Koronarintervention (PCI), speziell der „drug-eluting stents“, nimmt die Zahl der koronaren Bypass-Operationen kontinuierlich ab. Bisher hat keine Studie gezeigt, dass eine elektive Koronarintervention das Überleben der Patienten verlängern oder das Auftreten neuer Herzinfarkte verringern kann. Die Bypass-Operation ist die einzige Therapieform, die diese Wirkung haben kann. Allerdings wird dieser Effekt von vielen Faktoren beeinflusst und ist v. a. bei Patienten mit komplexer KHK sichtbar. Das ist der Grund dafür, dass in den aktuellen Guidelines die PCI der Bypass-Operation bei weniger ausgeprägter KHK (niedrigem SYNTAX-Score) therapeutisch gleichgestellt ist und dass die Bypass-Operation primär bei Patienten mit komplexer KHK (hoher SYNTAX-Score) empfohlen wird. Zu den Faktoren, die die Ergebnisse nach Bypass-Operation und die Langzeitoffenheitsraten beeinflussen, ist 2017 viel Interessantes publiziert worden. Folgende Aussagen werden unterstützt: 1. Die Bypass-Operation bei komplexer Mehrgefäßerkrankung beinhaltet einen möglichen Überlebensvorteil gegenüber PCI und medikamentöser Therapie und bleibt der Goldstandard. 2. Die vollarterielle Revaskularisation ist mit den besten Ergebnissen verbunden. 3. „Off-pump“-Techniken können v. a. bei Vermeidung von Aortenmanipulationen der „On-pump“-Technik überlegen sein. Die Ergebnisse scheinen abhängig vom Operateur zu sein. 4. Die nichtinvasive bildgebende Koronarcomputertomographie (Koronar-CT) nimmt einen immer größeren Stellenwert ein und kann die Entscheidungsfindung bei der Therapie der KHK stark beeinflussen.

Abstract

Coronary artery bypass surgery (CABG) is an essential component of the treatment of coronary artery disease (CAD). Since the introduction of percutaneous coronary interventions (PCI), especially drug-eluting stents, the number of CABG in Germany has continuously decreased. So far, there have been no studies showing that elective PCI can improve survival or decrease the rate of new myocardial infarctions. The CABG is the only form of treatment, which can have such an impact; however, this effect is influenced by a number of factors and is predominantly notable in patients with complex CAD. This is why in the current guidelines, PCI and CABG are given equal recommendations for patients with less complex CAD (lower SYNTAX score), and why CABG is primarily recommended in patients with complex CAD (higher SYNTAX score). There were many interesting publications in 2017 regarding factors influencing the long-term results after CABG. These data support the following conclusions: 1. CABG in complex CAD might provide a survival benefit over PCI or medicinal treatment and remains the gold standard. 2. Complete arterial revascularization is associated with the best results. 3. Off-pump techniques may be superior to on-pump techniques, especially when using no-touch aorta techniques; however, the results seem to depend heavily on surgeons’ skills. 4. Non-invasive coronary imaging using computed tomography (CT) scanning is gaining significance and might be the future of CAD diagnostics. It might also have a great influence in the process of decision making in the treatment of CAD.

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Literatur

  1. Beckmann A, Funkat A‑K, Lewandowski J et al (2017) German Heart Surgery Report 2016: the annual updated registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 65:505–518

    Article  PubMed  Google Scholar 

  2. Sipahi I, Akay MH, Dagdelen S et al (2014) Coronary artery bypass grafting vs percutaneous coronary intervention and long-term mortality and morbidity in multivessel disease: meta-analysis of randomized clinical trials of the arterial grafting and stenting era. JAMA Intern Med 174:223–230

    Article  PubMed  Google Scholar 

  3. Doenst T, Strüning C, Moschovas A et al (2016) Cardiac surgery 2015 reviewed. Clin Res Cardiol 105:801–814

    Article  PubMed  Google Scholar 

  4. Doenst T, Essa Y, Jacoub K et al (2017) Cardiac surgery 2016 reviewed. Clin Res Cardiol 106:851–867

    Article  PubMed  Google Scholar 

  5. Nielsen S, Bjorck L, Jeppsson A et al (2017) Trends in mortality risks among 94,328 patients surviving 30days after a first isolated coronary artery bypass graft procedure from 1987 to 2006: a population-based study. Int J Cardiol 244:316–321

    Article  PubMed  Google Scholar 

  6. Gaudino M, Antoniades C, Benedetto U et al (2017) Mechanisms, consequences, and prevention of coronary graft failure. Circulation 136:1749–1764

    Article  PubMed  Google Scholar 

  7. Ruzieh M, Moza A, Siddegowda Bangalore B et al (2017) Effect of transradial catheterisation on patency rates of radial arteries used as a conduit for coronary bypass. Heart Lung Circ 26:296–300

    Article  PubMed  Google Scholar 

  8. Abdallah MS, Wang K, Magnuson EA et al (2017) Quality of life after surgery or DES in patients with 3‑vessel or left main disease. J Am Coll Cardiol 69:2039–2050

    Article  PubMed  Google Scholar 

  9. Stone GW, Sabik JF, Serruys PW et al (2016) Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med 375:2223–2235

    Article  PubMed  CAS  Google Scholar 

  10. Samano N, Bodin L, Karlsson J et al (2017) Graft patency is associated with higher health-related quality of life after coronary artery bypass surgery. Interact Cardiovasc Thorac Surg 24:388–394

    PubMed  Google Scholar 

  11. Al-Lamee R, Thompson D, Dehbi HM et al (2017) Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet 391(10115):31–40. https://doi.org/10.1016/S0140-6736(17)32714-9

    Article  PubMed  Google Scholar 

  12. Faerber G, Doenst T (2017) Cardiac (valve) surgery in the elderly—who decides you are too old? J Thorac Cardiovasc Surg. https://doi.org/10.1016/j.jtcvs.2017.12.025

    Article  PubMed  Google Scholar 

  13. Diegeler A, Borgermann J, Kappert U et al (2013) Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med 368:1189–1198

    Article  PubMed  CAS  Google Scholar 

  14. Faerber G, Zacher M, Reents W et al (2017) Female sex is not a risk factor for post procedural mortality in coronary bypass surgery in the elderly: a secondary analysis of the GOPCABE trial. PLoS ONE 12:e184038

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Roberts JK, Rao SV, Shaw LK et al (2017) Comparative efficacy of coronary revascularization procedures for multivessel coronary artery disease in patients with chronic kidney disease. Am J Cardiol 119:1344–1351

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nichols EL, Mccullough JN, Ross CS et al (2017) Optimal timing from myocardial infarction to coronary artery bypass grafting on hospital mortality. Ann Thorac Surg 103:162–171

    Article  PubMed  Google Scholar 

  17. Members ATF, Windecker S, Kolh P et al (2014) 2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–2619

    Article  Google Scholar 

  18. Thiele H, Rach J, Klein N et al (2011) Optimal timing of invasive angiography in stable non-ST-elevation myocardial infarction: the Leipzig Immediate versus early and late PercutaneouS coronary Intervention triAl in NSTEMI (LIPSIA-NSTEMI Trial). Eur Heart J 33:2035–2043

    Article  PubMed  Google Scholar 

  19. Weimar C, Bilbilis K, Rekowski J et al (2017) Safety of simultaneous coronary artery bypass grafting and carotid endarterectomy versus isolated coronary artery bypass grafting: a randomized clinical trial. Stroke 48:2769–2775

    Article  PubMed  PubMed Central  Google Scholar 

  20. Al-Atassi T, Kimmaliardjuk DM, Dagenais C et al (2017) Should we ablate atrial fibrillation during coronary artery bypass grafting and aortic valve replacement? Ann Thorac Surg 104:515–522

    Article  PubMed  Google Scholar 

  21. Moss AJ, Williams MC, Newby DE et al (2017) The updated NICE guidelines: cardiac CT as the first-line test for coronary artery disease. Curr Cardiovasc Imaging Rep 10:15

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tsuneyoshi H, Komiya T, Kadota K et al (2017) Coronary artery bypass surgery is superior to second generation drug-eluting stents in three-vessel coronary artery disease: a propensity score matched analysis. Eur J Cardiothorac Surg 52:462–468

    Article  PubMed  Google Scholar 

  23. Sa M, Soares AF, Miranda RGA et al (2017) CABG surgery remains the best option for patients with left main coronary disease in comparison with PCI-DES: meta-analysis of randomized controlled trials. Braz J Cardiovasc Surg 32:408–416

    PubMed  PubMed Central  Google Scholar 

  24. Takagi H, Ando T, Umemoto T (2017) Drug-eluting stents versus coronary artery bypass grafting for left-main coronary artery disease. Catheter Cardiovasc Interv 91(4):697–709. https://doi.org/10.1002/ccd.27235

    Article  PubMed  Google Scholar 

  25. Palmerini T, Serruys P, Kappetein AP et al (2017) Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: a meta-analysis of 6 randomized trials and 4,686 patients. Am Heart J 190:54–63

    Article  PubMed  Google Scholar 

  26. Shah R, Morsy MS, Weiman DS et al (2017) Meta-analysis comparing coronary artery bypass grafting to drug-eluting stents and to medical therapy alone for left main coronary artery disease. Am J Cardiol 120:63–68

    Article  PubMed  Google Scholar 

  27. Head SJ, Milojevic M, Daemen J et al (2018) Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet 391(10214):939–948. https://doi.org/10.1016/S0140-6736(18)30423-9

    Article  PubMed  Google Scholar 

  28. Nystrom T, Sartipy U, Franzen S et al (2017) PCI versus CABG in patients with type 1 diabetes and multivessel disease. J Am Coll Cardiol 70:1441–1451

    Article  PubMed  Google Scholar 

  29. Ikeno F, Brooks MM, Nakagawa K et al (2017) SYNTAX score and long-term outcomes: the BARI-2D trial. J Am Coll Cardiol 69:395–403

    Article  PubMed  Google Scholar 

  30. Iqbal MB, Ilsley C, De Robertis F et al (2017) Comparison of outcomes of coronary artery bypass grafting using internal mammary graft versus percutaneous coronary intervention for isolated proximal left anterior descending narrowing. Am J Cardiol 119:719–726

    Article  PubMed  Google Scholar 

  31. Taggart DP, Altman DG, Gray AM et al (2016) Randomized trial of bilateral versus single internal-thoracic-artery grafts. N Engl J Med 375:2540–2549

    Article  PubMed  Google Scholar 

  32. Taggart DP, Altman DG, Flather M et al (2017) Associations between adding a radial artery graft to single and bilateral internal thoracic artery grafts and outcomes: insights from the arterial revascularization trial. Circulation 136:454–463

    Article  PubMed  Google Scholar 

  33. Locker C, Schaff HV, Daly RC et al (2017) Multiarterial grafts improve the rate of early major adverse cardiac and cerebrovascular events in patients undergoing coronary revascularization: analysis of 12 615 patients with multivessel disease. Eur J Cardiothorac Surg 52:746–752

    Article  PubMed  Google Scholar 

  34. Iribarne A, Schmoker JD, Malenka DJ et al (2017) Does use of bilateral internal mammary artery grafting reduce long-term risk of repeat coronary revascularization? A multicenter analysis. Circulation 136:1676–1685

    Article  PubMed  Google Scholar 

  35. Buttar SN, Yan TD, Taggart DP et al (2017) Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: a meta-analysis. Heart 103:1419–1426

    Article  PubMed  Google Scholar 

  36. Robinson BM, Paterson HS, Denniss AR (2017) Composite Y‑grafting using the left internal thoracic artery: survival and angiography in 198 cases. Heart Lung Circ 26:724–729

    Article  PubMed  Google Scholar 

  37. Janiec M, Dimberg A, Nazari Shafti TZ et al (2017) No improvements in long-term outcome after coronary artery bypass grafting with arterial grafts as a second conduit: a Swedish nationwide registry study. Eur J Cardiothorac Surg. https://doi.org/10.1093/ejcts/ezx280

    Article  PubMed  Google Scholar 

  38. Kim YH, Oh HC, Choi JW et al (2017) No-touch saphenous vein harvesting may improve further the patency of saphenous vein composite grafts: early outcomes and 1‑year angiographic results. Ann Thorac Surg 103:1489–1497

    Article  PubMed  Google Scholar 

  39. Pettersen O, Haram PM, Winnerkvist A et al (2017) Pedicled vein grafts in coronary surgery: perioperative data from a randomized trial. Ann Thorac Surg 104:1313–1317

    Article  PubMed  Google Scholar 

  40. Krishnamoorthy B, Critchley WR, Thompson AJ et al (2017) Study comparing vein integrity and clinical outcomes in open vein harvesting and 2 types of endoscopic vein harvesting for coronary artery bypass grafting: the VICO randomized clinical trial (Vein Integrity and Clinical Outcomes). Circulation 136:1688–1702

    Article  PubMed  PubMed Central  Google Scholar 

  41. Shroyer AL, Hattler B, Wagner TH et al (2017) Five-year outcomes after on-pump and off-pump coronary-artery bypass. N Engl J Med 377:623–632

    Article  PubMed  Google Scholar 

  42. Shroyer AL, Grover FL, Hattler B et al (2009) On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med 361:1827–1837

    Article  PubMed  CAS  Google Scholar 

  43. Lamy A, Devereaux PJ, Prabhakaran D et al (2016) Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med 375:2359–2368

    Article  PubMed  Google Scholar 

  44. Filardo G, Hamman BL, Da Graca B et al (2018) Efficacy and effectiveness of on- versus off-pump coronary artery bypass grafting: a meta-analysis of mortality and survival. J Thorac Cardiovasc Surg 155:172–179.e5. Available online 1 September 2017

    Article  PubMed  Google Scholar 

  45. Takagi H, Ando T, Mitta S (2017) Meta-analysis comparing 〉/=10-year mortality of off-pump versus on-pump coronary artery bypass grafting. Am J Cardiol 120:1933–1938

    Article  PubMed  Google Scholar 

  46. Khan H, Uzzaman M, Benedetto U et al (2017) On- or off-pump coronary artery bypass grafting for octogenarians: a meta-analysis of comparative studies involving 27,623 patients. Int J Surg 47:42–51

    Article  PubMed  Google Scholar 

  47. Furukawa N, Kuss O, Preindl K et al (2017) Anaortic off-pump versus clampless off-pump using the PAS-Port device versus conventional coronary artery bypass grafting: mid-term results from a matched propensity score analysis of 5422 unselected patients. Eur J Cardiothorac Surg 52:760–767

    Article  PubMed  Google Scholar 

  48. Zhao DF, Edelman JJ, Seco M et al (2017) Coronary artery bypass grafting with and without manipulation of the ascending aorta: a network meta-analysis. J Am Coll Cardiol 69:924–936

    Article  PubMed  Google Scholar 

  49. Rodriguez ML, Lapierre HR, Sohmer B et al (2017) Mid-term follow-up of minimally invasive multivessel coronary artery bypass grafting: is the early learning phase detrimental? Innovations (Phila) 12:116–120

    Article  Google Scholar 

  50. Doenst T, Diab M, Sponholz C, Bauer M, Färber G (2017) The opportunities and limitations of minimally invasive cardiac surgery. Dtsch Arztebl Int 114:777–784. https://doi.org/10.3238/arztebl.2017.0777

    Article  PubMed  PubMed Central  Google Scholar 

  51. Nambiar P, Kumar S, Mittal CM et al (2018) Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: will this be the future? J Thorac Cardiovasc Surg 155:190–197

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Am Klinikum 1, 07747, Jena, Deutschland

    H. Kirov, S. Bargenda, R. Safarov, M. Diab, M. Richter, I. Valchanov, B. Gloy & T. Doenst

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H. Kirov, S. Bargenda, R. Safarov, M. Diab, M. Richter, I. Valchanov, B. Gloy und T. Doenst geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kirov, H., Bargenda, S., Safarov, R. et al. Literaturübersicht 2017 zur Koronarchirurgie. Z Herz- Thorax- Gefäßchir 32, 219–227 (2018). https://doi.org/10.1007/s00398-018-0236-8

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