New functional evaluation methods for coronary artery lesions have received widespread attention at home and abroad. As a new functional evaluation technique, the clinical value of quantitative flow ratio (QFR) in the accuracy and feasibility of diagnosing myocardial ischemia caused by coronary artery stenosis has been confirmed in many clinical trials. Compared with the traditional gold standard fractional flow reserve (FFR) for diagnosing coronary artery stenosis, QFR has the advantages of simple operation, time-saving and low cost. This article reviews the comparison of the diagnostic accuracy of FFR and QFR and the progress of clinical research, aiming to explore whether QFR may replace FFR as a functional evaluation method of coronary artery disease and guide clinical blood circulation reconstruction.
Hybrid coronary revascularization (HCR) combines the advantages of minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI), and avoids its relative shortcomings, which has received particular attention in recent years. HCR seems to have become the third revascularization strategy for multi-vessel disease in coronary heart diseases. However, the clinical researches on HCR are still limited. This article will systematically review the comparison of HCR with coronary artery bypass grafting (CABG) and PCI, the results of HCR in specific patients, and the clinical results of different HCR strategies.
As the indications for transcatheter aortic valve replacement (TAVR) expand to low-risk young patients, the number of patients undergoing percutaneous coronary intervention (PCI) after one or more TAVR may increase. The coronary access for PCI after TAVR has become a very practical and severe problem. Coronary re-intervention poses technical difficulties, and compared to balloon expandable valve, the use of self-expanding valve is more challenging for the coronary access for PCI after TAVR. This article discusses the selection of appropriate valves before TAVR, the implementation of intraoperative commissural alignment technology, and the techniques for mastering the coronary access for PCI after TAVR, in order to improve the success rate of the coronary access for PCI after TAVR.
Transcatheter aortic valve replacement (TAVR) has become one of the main treatments for severe aortic stenosis. However, percutaneous coronary intervention (PCI) is often required in elderly patients who combine with coronary artery disease. This paper reports a case of one-stop TAVR+PCI operation for a 71-year-old male patient with left main bifurcation lesions and severe aortic stenosis. During the procedure, first of all, the coronary arteries were assessed by angiography, and the pigtail catheter was implanted in the left ventricle after the straight guidewire transvalved successfully; then PCI was performed on the diseased coronary arteries; finally, the stenosis of aortic valve was treated with TAVR. After operation, the hemodynamics of the patient was stable and symptoms were significantly improved, showing a good clinical effect of one-stop operation of TAVR+PCI.
ObjectiveTo compare the perioperative results of hybrid coronary revascularization (HCR), off-pump coronary artery bypass (OPCAB) and percutaneous coronary intervention (PCI) in elderly patients with three-vessel coronary artery disease involving left anterior descending (LAD) branch and explores the safety of surgery.MethodsWe prospectively enrolled patients with coronary heart disease over 65 years who were admitted to General Hospital of People’s Liberation Army from January 2018 to September 2019. Coronary angiography results were all three-vessel lesions involving the anterior descending artery. After preoperative examination and assessment by the cardiovascular team, all patients were suitable for OPCAB or PCI treatment. According to the patient’s preference, HCR, OPCAB or PCI were performed. The preoperative baseline data and perioperative results were collected, and SPSS 22.0 was used for statistical analysis.ResultsA total of 110 patients met the criteria and were included in the study, 28 in the HCR group, 45 in the OPCAB group, and 37 in the PCI group, with an average age of 71.4±5.6 years. There was no statistical difference in the preoperative baseline data of patients among the three groups. The intubation time (P=0.039), perioperative drainage volume (P<0.001), blood transfusion (P=0.021) in the HCR group were lower than those in the OPCAB group. There was no statistical difference in the main organ adverse events (MOAE, P=0.096) and in-hospital mortality (P=0.784) among the three groups of patients. The use of antibiotics in the PCI group was significantly lower than the other two groups (P<0.001).ConclusionHCR combines the advantage of CABG and PCI including proved long-term patency rate with left internal mammary artery-LAD grafting, less trauma and superior long-term patency with PCI in non-LAD territory. Compared with OPCAB and PCI, there is no increase in perioperative major organ adverse events and in-hospital mortality. It is a safe and reliable minimally invasive myocardial revascularization technique for elderly patients with three-vessel coronary artery disease involving the anterior descending artery.
Hybrid coronary revascularization (HCR) combining with coronary artery bypass grafting (CABG) has a long-term patency of left internal mammary artery to left anterior descending artery (LIMA-LAD) grafting, and the percutaneous coronary intervention (PCI) has a minimal invasiveness. It provides an alternative revascularization for patients with coronary heart disease. For patients who meet the HCR indications, most studies suggest that HCR can significantly reduce perioperative trauma, and offer favorable mid- and long-term prognosis, which is comparable with traditional revascularization strategies. Based on the major research results in this field in the past 10 years, we review the current application status and discuss the potential future direction of HCR in this paper.
Transcatheter left ventricular assist pump (LVAP) is widely used in cardiogenic shock, post-circulatory hypoperfusion syndrome and high-risk percutaneous coronary intervention (PCI), and its application scenarios cover various complex environments such as ICU, operating room, emergency department and catheterization room. It is important to quickly and accurately implant the transcatheter LVAP and monitor its position in real time. This paper reported 2 male patients with high-risk PCI, aged 47 and 45 years, both with triple coronary artery disease and reduced ejection fraction (<35%). The domestically produced transcatheter LVAP was implanted using an echocardiography guidance technology system, and PCI treatment was performed under the assistance of the interventional pump. The operation was smooth, and the interventional pump assisted for 1 h in 2 patients, and the pump was successfully removed. There were no obvious complications related to the pump and PCI after the operation, and the patients were discharged smoothly.
Objective To systematically evaluate the clinical value of remote ischemic preconditioning (RIPC) in elective percutaneous coronary intervention (EPCI). Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 6, 2015), WanFang Data, CBM and CNKI from inception to June 2016, to collect randomized controlled trials (RCTs) about RIPC in EPCI. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Nine RCTs involving 1 099 patients were included. The results of meta-analysis showed that: There were no significant difference in the level of troponin I and T between the RIPC group and the control group (SMD=–0.24, 95%CI –0.63 to 0.16,P=0.24). Sensitive analysis showed that with 3×5–min remote preconditioning protocol, there was still no significant difference in the level of troponin I and T between the two groups (SMD=–0.16, 95%CI –0.36 to 0.04,P=0.12). Another, RIPC could significantly reduce the incidence of peri–procedural myocardial infarctions (RD=–0.14, 95%CI –0.20 to –0.08,P<0.000 01) and the risk of ST-segment deviation in the elective PCI procedure (RD=–0.17, 95%CI –0.26 to –0.07,P=0.000 6), but there was no significant difference in postoperative eGFR between both groups (SMD=–0.03, 95%CI –0.18 to 0.12,P=0.71). Conclusion RIPC can significant reduce the incidence of peri-procedural myocardial infarctions, and the risk of ST-segment deviation in the elective PCI procedure. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To compare and analyze the early- to mid-term outcomes of transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) combined with coronary artery bypass grafting (CABG) for the treatment of significant aortic stenosis (AS) and coronary artery disease (CAD). Methods The data of patients with significant AS and CAD who underwent surgical treatment at Central China Fuwai Hospital of Zhengzhou University from January 2018 to July 2023 were collected. These patients were divided into a TAVR+PCI group and a SAVR+CABG group according to the operation method. Propensity score matching (PSM) was used to select patients with close clinical baseline characteristics, and the early- to mid-term outcomes of the two groups were compared. Results A total of 272 patients were enrolled, including 208 males and 64 females, with a mean age of 64.16±8.24 years. There were 47 patients in the TAVR+PCI group and 225 patients in the SAVR+CABG group. After 1∶1 PSM, 32 pairs were selected. There was no statistical difference in baseline data between the two groups (P>0.05). Compared with the SAVR+CABG group, the TAVR+PCI group had significantly shorter operative time, mechanical ventilation time, ICU stay, postoperative hospital stay, and less intraoperative bleeding, and significantly lower postoperative transfusion and complete revascularization rates (P<0.05). The differences in the rates of postoperative in-hospital death, myocardial infarction, stroke, and other complications between the two groups were not statistically significant (P>0.05), and the differences in the rates of severe perivalvular leakage, death, or readmission in the mid-term follow-up were not statistically significant (P>0.05). Conclusion In patients with significant AS and CAD, the early- and mid-term rates of death and complications were similar between those treated with TAVR+PCI and SAVR+CABG, and TAVR+PCI is a safe alternative to SAVR+CABG.
ObjectiveTo retrospectively analyze the surgical treatment of Stanford type A aortic dissection after coronary artery stenting, and to explore the surgical techniques and surgical indications. MethodsClinical data of 1 246 consecutive patients who underwent operations on Stanford type A aortic dissection from April 2016 to July 2019 in Beijing Anzhen Hospital were retrospectively analyzed. Patients with Stanford type A aortic dissection after coronary artery stenting were enrolled. ResultsFinally 19 patients were collected, including 16 males and 3 females with an average age of 54±7 years ranging from 35 to 66 years. There were 11 patients in acute phase, 15 patients with AC (DeBakey Ⅰ) type and 4 patients with AS (DeBakey Ⅱ) type. In AC type, there were 10 patients receiving Sun's surgery and 5 patients partial arch replacement. Meanwhile, coronary artery bypass grafting was performed in 7 patients and mitral valve replacement in 1 patient. Stents were removed from the right coronary artery in 4 patients. In this group, 1 patient died of multiple organ failure in hospital after operation combined with malperfusion of viscera. Eighteen patients recovered after treatment and were discharged from hospital. The patients were followed up for 30 (18-56) months. One patient underwent aortic pseudoaneurysm resection, one thoracic endovascular aortic repair, one emergency percutaneous coronary intervention due to left main artery stent occlusion, and one underwent femoral artery bypass due to iliac artery occlusion. ConclusionIatrogenic aortic dissection has a high probability of coronary artery bypass grafting at the same time in patients with Stanford type A aortic dissection after coronary artery stenting. Complicated type A aortic dissection after percutaneous coronary intervention should be treated with surgery aggressively.