Pub Date : 2025-03-03DOI: 10.1053/j.semtcvs.2025.01.008
Omar Toubat MD, PhD, Max Shin MD, Michael A. Catalano MD, Amit Iyengar MD, MSE, Pavan Atluri MD (Professor of Surgery)
{"title":"Contemporary Surgical, Hybrid, and Transcatheter Approaches to the Dysfunctional Mitral Valve with Mitral Annular Calcification","authors":"Omar Toubat MD, PhD, Max Shin MD, Michael A. Catalano MD, Amit Iyengar MD, MSE, Pavan Atluri MD (Professor of Surgery)","doi":"10.1053/j.semtcvs.2025.01.008","DOIUrl":"10.1053/j.semtcvs.2025.01.008","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 240-246"},"PeriodicalIF":2.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-03DOI: 10.1053/j.semtcvs.2025.02.003
Tarek Malas MD, Marc Gillinov MD
{"title":"The Only Mitral Valve Repair Techniques That Everyone Ever Needs to Know","authors":"Tarek Malas MD, Marc Gillinov MD","doi":"10.1053/j.semtcvs.2025.02.003","DOIUrl":"10.1053/j.semtcvs.2025.02.003","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 247-251"},"PeriodicalIF":2.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.semtcvs.2024.08.005
Dawn S. Hui MD , Victor Dayan MD , David P. Taggart
{"title":"Expert Opinion: What should Revascularization Trials that Inform the Guidelines Look Like?","authors":"Dawn S. Hui MD , Victor Dayan MD , David P. Taggart","doi":"10.1053/j.semtcvs.2024.08.005","DOIUrl":"10.1053/j.semtcvs.2024.08.005","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 1-5"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.semtcvs.2024.09.003
Marc Ruel MD, MPH , Michael E. Halkos MD, MSc
Coronary artery bypass grafting (CABG) remains one of the most commonly performed operations worldwide. However, most CABG operations performed today are as invasive —apart from saphenous vein harvesting— as they were 50 years ago. While heart valve operations have become less invasive, CABG faces formidable challenges in doing so. Valve surgery requires a single surgical exposure to the valve intervened on, but less invasive CABG necessitates multiple surgical exposures to harvest internal thoracic artery conduits, source their inflow plus that of other grafts, and expose each coronary target to be grafted —including anterior, lateral, posterior, and inferior vessels. In this article, we rationalize why we believe that conventional CABG remains unduly invasive, associated with morbidity and prolonged recovery, and why less invasive CABG in its many forms, which we describe, represents a safe, practical, diffusible, and less invasive alternative to sternotomy CABG. Centers of excellence in coronary artery surgery should dedicate resources and expertise to developing high-quality, safe, durable, and advanced forms of lesser invasive CABG.
{"title":"Minimally Invasive Coronary Artery Bypass Grafting is the Future: Pro","authors":"Marc Ruel MD, MPH , Michael E. Halkos MD, MSc","doi":"10.1053/j.semtcvs.2024.09.003","DOIUrl":"10.1053/j.semtcvs.2024.09.003","url":null,"abstract":"<div><div>Coronary artery bypass grafting (CABG) remains one of the most commonly performed operations worldwide. However, most CABG operations performed today are as invasive —apart from saphenous vein harvesting— as they were 50 years ago. While heart valve operations have become less invasive, CABG faces formidable challenges in doing so. Valve surgery requires a single surgical exposure to the valve intervened on, but less invasive CABG necessitates multiple surgical exposures to harvest internal thoracic artery conduits, source their inflow plus that of other grafts, and expose each coronary target to be grafted —including anterior, lateral, posterior, and inferior vessels. In this article, we rationalize why we believe that conventional CABG remains unduly invasive, associated with morbidity and prolonged recovery, and why less invasive CABG in its many forms, which we describe, represents a safe, practical, diffusible, and less invasive alternative to sternotomy CABG. Centers of excellence in coronary artery surgery should dedicate resources and expertise to developing high-quality, safe, durable, and advanced forms of lesser invasive CABG.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 34-42"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.semtcvs.2024.10.005
Andrea Wolf MD, MPH , Billy W. Loo Jr, MD, PhD , Raymond H. Mak MD , Michael Liptay MD , Brian Pettiford MD , Gaetano Rocco MD , Michael Lanuti MD , Robert E. Merritt MD , Homa Keshavarz PhD , Robert D. Suh MD , Alessandro Brunelli MD , Gerard J. Criner MD , Peter J. Mazzone MD , Garrett Walsh MD , Q. Eileen Wafford MSt, MLIS , Sudish Murthy MD, PhD , M. Blair Marshall MD , Betty Tong MD , James Luketich MD , Matthew J. Schuchert MD , Scott J. Swanson MD, Co-Chair Writing Committee
Stereotactic ablative radiotherapy (SABR) has emerged as an alternative, non-surgical treatment for high-risk patients with stage I non-small cell lung cancer (NSCLC) with increased use over time. The American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) assembled an expert panel and conducted a systematic review of the literature evaluating the results of SABR, which is also referred to as stereotactic body radiation therapy (SBRT) or stereotactic radiosurgery (SRS), prior to developing treatment recommendations for high-risk patients with stage I NSCLC based on expert consensus. Publications detailing the findings of 16 prospective studies of SABR and 14 retrospective studies of SABR for the management of early-stage lung cancer in 54,697 patients were identified by systematic review of the literature with further review by members of our expert panel. Medical inoperability (93–95%) was the primary reason for utilizing SABR. The median rate of histologically confirmed cancer in treated patients was 67% (range 57–86%). In retrospective studies and prospective studies, the most common dosing regimens were 48–54 Gy in 3–5 fractions and 44–66 Gy in 3–5 fractions respectively. The median follow-up after SABR was 30 months (range 15–50). The complications, oncological results and quality of life after SABR in high-risk patients with early-stage NSCLC are summarized in this Expert Review article. Further prospective randomized trials are needed and are currently underway to compare outcomes after SABR with outcomes after sublobar resection to fully evaluate treatment options applicable this high-risk group of patients.
随着时间的推移，立体定向消融放射治疗（SABR）已成为高风险 I 期非小细胞肺癌（NSCLC）患者的一种替代性非手术疗法。美国胸外科协会（AATS）临床实践标准委员会（CPSC）组建了一个专家小组，对评估 SABR（也称为立体定向体放射治疗（SBRT）或立体定向放射外科（SRS））效果的文献进行了系统性回顾，然后根据专家共识为 I 期 NSCLC 高危患者制定了治疗建议。通过对文献进行系统性审查，并由我们的专家组成员进行进一步审查，我们确定了16篇关于SABR治疗早期肺癌的前瞻性研究和14篇关于SABR治疗早期肺癌的回顾性研究的文献，共54 697名患者接受了SABR治疗。医学上无法手术（93%-95%）是使用 SABR 的主要原因。在接受治疗的患者中，组织学确诊癌症的中位比例为 67%（范围为 57-86%）。在回顾性研究和前瞻性研究中，最常见的给药方案分别是 48-54 Gy，3-5 次分次给药和 44-66 Gy，3-5 次分次给药。SABR术后的中位随访时间为30个月（15-50个月）。本专家评论文章总结了早期NSCLC高危患者SABR术后的并发症、肿瘤治疗效果和生活质量。目前正在进行更多前瞻性随机试验，以比较SABR术后与球下切除术后的疗效，从而全面评估适用于这一高风险患者群体的治疗方案。
{"title":"Systematic Review of Stereotactic Ablative Radiotherapy (SABR)/Stereotactic Body Radiation Therapy (SBRT) for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer","authors":"Andrea Wolf MD, MPH , Billy W. Loo Jr, MD, PhD , Raymond H. Mak MD , Michael Liptay MD , Brian Pettiford MD , Gaetano Rocco MD , Michael Lanuti MD , Robert E. Merritt MD , Homa Keshavarz PhD , Robert D. Suh MD , Alessandro Brunelli MD , Gerard J. Criner MD , Peter J. Mazzone MD , Garrett Walsh MD , Q. Eileen Wafford MSt, MLIS , Sudish Murthy MD, PhD , M. Blair Marshall MD , Betty Tong MD , James Luketich MD , Matthew J. Schuchert MD , Scott J. Swanson MD, Co-Chair Writing Committee","doi":"10.1053/j.semtcvs.2024.10.005","DOIUrl":"10.1053/j.semtcvs.2024.10.005","url":null,"abstract":"<div><div>Stereotactic ablative radiotherapy (SABR) has emerged as an alternative, non-surgical treatment for high-risk patients with stage I non-small cell lung cancer (NSCLC) with increased use over time. The American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) assembled an expert panel and conducted a systematic review of the literature evaluating the results of SABR, which is also referred to as stereotactic body radiation therapy (SBRT) or stereotactic radiosurgery (SRS), prior to developing treatment recommendations for high-risk patients with stage I NSCLC based on expert consensus. Publications detailing the findings of 16 prospective studies of SABR and 14 retrospective studies of SABR for the management of early-stage lung cancer in 54,697 patients were identified by systematic review of the literature with further review by members of our expert panel. Medical inoperability (93–95%) was the primary reason for utilizing SABR. The median rate of histologically confirmed cancer in treated patients was 67% (range 57–86%). In retrospective studies and prospective studies, the most common dosing regimens were 48–54<!--> <!-->Gy in 3–5 fractions and 44–66<!--> <!-->Gy in 3–5 fractions respectively. The median follow-up after SABR was 30 months (range 15–50). The complications, oncological results and quality of life after SABR in high-risk patients with early-stage NSCLC are summarized in this Expert Review article. Further prospective randomized trials are needed and are currently underway to compare outcomes after SABR with outcomes after sublobar resection to fully evaluate treatment options applicable this high-risk group of patients.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 89-98"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.semtcvs.2024.12.003
Bob Kiaii MD , Bradley Taylor MD
Subspecialization in surgery is increasingly common and for great reasons. Over the past 20 years, there has been evidence in support of the link between subspecialization in the disciplines of orthopedic surgery, general, thoracic surgery, neurosurgery, and in interventional cardiology and better patient outcomes and technical advances in their respective fields. In addition, studies suggest that increased hospital and surgeon volume throughout surgery may lead to improved surgical outcomes. The degree of specialization has been shown to reduce operative mortality in a variety of procedures and highlights that the level of sophistication and fund of knowledge required within each area is so great that no one surgeon can “do it all” and do it well. Cardiac surgery has become more subspecialized; however, many still view coronary artery surgery as a generalist procedure. There is debate as to the relative contribution of hospital volume, surgeon volume, or degree of specialization on perioperative mortality following isolated coronary artery bypass grafting. In this paper, we will discuss the current data supporting the need for specialization in coronary surgery and present arguments in favor of further specialization in this field.
{"title":"CABG Should Be a Subspecialty","authors":"Bob Kiaii MD , Bradley Taylor MD","doi":"10.1053/j.semtcvs.2024.12.003","DOIUrl":"10.1053/j.semtcvs.2024.12.003","url":null,"abstract":"<div><div>Subspecialization in surgery is increasingly common and for great reasons. Over the past 20 years, there has been evidence in support of the link between subspecialization in the disciplines of orthopedic surgery, general, thoracic surgery, neurosurgery, and in interventional cardiology and better patient outcomes and technical advances in their respective fields. In addition, studies suggest that increased hospital and surgeon volume throughout surgery may lead to improved surgical outcomes. The degree of specialization has been shown to reduce operative mortality in a variety of procedures and highlights that the level of sophistication and fund of knowledge required within each area is so great that no one surgeon can “do it all” and do it well. Cardiac surgery has become more subspecialized; however, many still view coronary artery surgery as a generalist procedure. There is debate as to the relative contribution of hospital volume, surgeon volume, or degree of specialization on perioperative mortality following isolated coronary artery bypass grafting. In this paper, we will discuss the current data supporting the need for specialization in coronary surgery and present arguments in favor of further specialization in this field.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 6-11"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.semtcvs.2024.11.009
Ahmed H. Aly MD, PhD, Nahush A. Mokadam MD
Refractory angina is a debilitating disease with limited therapeutic options that is primarily caused by microvascular dysfunction and desertification. Toward addressing this unmet need, microvascular revascularization therapy has progressively evolved from the lizard heart–inspired transmyocardial revascularization to precisely inducing vascular endothelial growth factor with gene therapy. Gene therapy with adenoviral vehicles or naked modified ribonucleic acid is safe and shows early signs of clinical promise but has not yet been proven effective due to gaps in optimization.
{"title":"New Directions in Coronary Revascularization for Refractory Angina: Gene Therapy and the Lizard Heart","authors":"Ahmed H. Aly MD, PhD, Nahush A. Mokadam MD","doi":"10.1053/j.semtcvs.2024.11.009","DOIUrl":"10.1053/j.semtcvs.2024.11.009","url":null,"abstract":"<div><div>Refractory angina is a debilitating disease with limited therapeutic options that is primarily caused by microvascular dysfunction and desertification. Toward addressing this unmet need, microvascular revascularization therapy has progressively evolved from the lizard heart–inspired transmyocardial revascularization to precisely inducing vascular endothelial growth factor with gene therapy. Gene therapy with adenoviral vehicles or naked modified ribonucleic acid is safe and shows early signs of clinical promise but has not yet been proven effective due to gaps in optimization.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 28-33"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.semtcvs.2024.10.003
Arjun Pennathur MD, Co-Chair Writing Committee , Michael Lanuti MD , Robert E. Merritt MD , Andrea Wolf MD, MPH , Homa Keshavarz PhD , Billy W. Loo Jr, MD, PhD , Robert D. Suh MD , Raymond H. Mak MD , Alessandro Brunelli MD , Gerard J. Criner MD , Peter J. Mazzone MD , Garrett Walsh MD , Michael Liptay MD , Q. Eileen Wafford MSt, MLIS , Sudish Murthy MD, PhD , M. Blair Marshall MD , Betty Tong MD , Brian Pettiford MD , Gaetano Rocco MD , James Luketich MD , Scott J. Swanson MD, Co-Chair Writing Committee
{"title":"The Importance of Pulmonary Nodule Features in the Selection of Treatment for the High-Risk Patient with Stage I Non-Small Cell Lung Cancer","authors":"Arjun Pennathur MD, Co-Chair Writing Committee , Michael Lanuti MD , Robert E. Merritt MD , Andrea Wolf MD, MPH , Homa Keshavarz PhD , Billy W. Loo Jr, MD, PhD , Robert D. Suh MD , Raymond H. Mak MD , Alessandro Brunelli MD , Gerard J. Criner MD , Peter J. Mazzone MD , Garrett Walsh MD , Michael Liptay MD , Q. Eileen Wafford MSt, MLIS , Sudish Murthy MD, PhD , M. Blair Marshall MD , Betty Tong MD , Brian Pettiford MD , Gaetano Rocco MD , James Luketich MD , Scott J. Swanson MD, Co-Chair Writing Committee","doi":"10.1053/j.semtcvs.2024.10.003","DOIUrl":"10.1053/j.semtcvs.2024.10.003","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 75-81"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.semtcvs.2024.09.002
J. Scott Rankin MD , J. Hunter Mehaffey MD , Danny Chu MD , Richard Ramsingh MD , Abhishek Sharma MD , Vinay Badhwar MD , Faisal G. Bakaeen MD
Surgical coronary bypass has evolved continually, and most analyses currently favor performing coronary grafts with autologous living arterial conduits to obtain better long-term patencies and clinical outcomes. With bilateral internal mammary artery grafts and both radial arteries, 4 excellent arterial conduits exist for creating “all-arterial” revascularization in the majority of multivessel disease patients, including those with valve disorders. Using contemporary surgical techniques, it is possible to obtain greater than 95% overall early graft patencies that translate into better late outcomes, including improved survival, freedom from myocardial infarction, fewer percutaneous coronary interventions, and redo coronary bypass procedures. The overall goal is to revascularize the 2 most important coronary systems with internal mammary artery grafts, and the rest with radial arteries, depending on the anatomy, experience, and choice of the surgeon. Using highly validated management strategies, early postoperative complications, including the incidence of sternal infections, are extremely uncommon, and in many practices, multi-arterial grafts currently are used in the majority of multivessel patients, including those with concomitant valve disease. Because patencies and outcomes are significantly better than with saphenous vein bypass or percutaneous coronary interventions, referring physicians frequently favor multi-arterial bypass procedures as the primary therapy for patients with prognostically serious multivessel disease. Thus, coronary bypass using predominantly autologous arterial conduits should play an increasingly important role in the future management of severe coronary atherosclerosis.
冠状动脉搭桥手术不断发展，目前大多数分析都倾向于使用自体活体动脉导管进行冠状动脉移植，以获得更好的长期通畅性和临床疗效。通过双侧乳内动脉（IMA）移植物和双侧桡动脉（RA），有四种极佳的动脉导管可为大多数多血管疾病患者（包括瓣膜疾病患者）提供 "全动脉 "血运重建。利用现代外科技术，可以获得超过 95% 的早期移植物总通畅率，从而改善后期疗效，包括提高生存率、避免心肌梗死、减少经皮冠状动脉介入治疗（PCI）和重做冠状动脉搭桥手术。总体目标是使用 IMA 移植物对两个最重要的冠状动脉系统进行血管再通，并根据解剖结构、经验和外科医生的选择，使用 RA 对其余冠状动脉系统进行血管再通。采用经过高度验证的管理策略后，术后早期并发症（包括胸骨感染）的发生率极低，目前在许多临床实践中，多动脉移植物被用于大多数多血管患者，包括合并瓣膜疾病的患者。由于其通畅性和疗效明显优于大隐静脉搭桥或 PCI，转诊医生通常倾向于将多动脉搭桥术作为预后严重的多血管疾病患者的主要治疗方法。因此，主要使用自体动脉导管的冠状动脉搭桥术应在未来严重冠状动脉粥样硬化的治疗中扮演越来越重要的角色。
{"title":"Techniques and Results of Multiple Arterial Bypass Grafting: Towards More “Curative” Coronary Revascularizations","authors":"J. Scott Rankin MD , J. Hunter Mehaffey MD , Danny Chu MD , Richard Ramsingh MD , Abhishek Sharma MD , Vinay Badhwar MD , Faisal G. Bakaeen MD","doi":"10.1053/j.semtcvs.2024.09.002","DOIUrl":"10.1053/j.semtcvs.2024.09.002","url":null,"abstract":"<div><div>Surgical coronary bypass has evolved continually, and most analyses currently favor performing coronary grafts with autologous living arterial conduits to obtain better long-term patencies and clinical outcomes. With bilateral internal mammary artery grafts and both radial arteries, 4 excellent arterial conduits exist for creating “all-arterial” revascularization in the majority of multivessel disease patients, including those with valve disorders. Using contemporary surgical techniques, it is possible to obtain greater than 95% overall early graft patencies that translate into better late outcomes, including improved survival, freedom from myocardial infarction, fewer percutaneous coronary interventions, and redo coronary bypass procedures. The overall goal is to revascularize the 2 most important coronary systems with internal mammary artery grafts, and the rest with radial arteries, depending on the anatomy, experience, and choice of the surgeon. Using highly validated management strategies, early postoperative complications, including the incidence of sternal infections, are extremely uncommon, and in many practices, multi-arterial grafts currently are used in the majority of multivessel patients, including those with concomitant valve disease. Because patencies and outcomes are significantly better than with saphenous vein bypass or percutaneous coronary interventions, referring physicians frequently favor multi-arterial bypass procedures as the primary therapy for patients with prognostically serious multivessel disease. Thus, coronary bypass using predominantly autologous arterial conduits should play an increasingly important role in the future management of severe coronary atherosclerosis.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 12-21"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/j.semtcvs.2024.08.006
Jules J. Bakhos MD, MSc, Gabriele M. Iacona MD, Marijan Koprivanac MD, Michael Z. Tong MD, Shinya Unai MD, Edward G. Soltesz MD, Haytham Elgharably MD, Faisal G. Bakaeen MD
{"title":"Internal Thoracic Arteries Injuries During Harvesting: Mitigation and Management","authors":"Jules J. Bakhos MD, MSc, Gabriele M. Iacona MD, Marijan Koprivanac MD, Michael Z. Tong MD, Shinya Unai MD, Edward G. Soltesz MD, Haytham Elgharably MD, Faisal G. Bakaeen MD","doi":"10.1053/j.semtcvs.2024.08.006","DOIUrl":"10.1053/j.semtcvs.2024.08.006","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 22-27"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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