Authors: Ono M; Hara H; Gao C et al.
Source: Heart (British Cardiac Society) [Heart] 2022 Jun 22. Date of Electronic Publication: 2022 Jun 22.
Abstract:
Objective: We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).
Methods: This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.
Results: Among 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, p interaction =0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; p interaction =0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality.
Conclusions: Among patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG.

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Authors: Su F;  Gao C; D Liu J et al.
Source: JAMA network open [JAMA Netw Open] 2022 May 02; Vol. 5 (5), pp. e2214594. Date of Electronic Publication: 2022 May 02
Abstract:
Importance: Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation for patients with atrial fibrillation. However, the performance of LAAO among East Asian patients is unknown.
Objective: To document the procedural success rate and configurations, major adverse event rates, and antithrombotic medication regimens during and after LAAO procedures among patients in China.

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Author(s): Garg S. et al
Source: Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Apr 13; Vol. 9, pp. 821380. Date of Electronic Publication: 2022 Apr 13 (Print Publication: 2022).
Abstract: The safety and efficacy of drug-coated balloon (DCB) treatment for de novo coronary chronic total occlusion (CTO) remain uncertain. The aim of this study was to evaluate the outcomes of DCB only treatment for de novo CTO.
Methods: In this retrospective study, 101 vessels with de novo CTO lesions dilated by balloon angioplasty with thrombolysis in myocardial infarction flow grade 3 were included. Among them, 93 vessels successfully treated with DCB only treatment were analyzed. The study endpoint was major adverse cardiac events (MACE) at 2 years, a composite of cardiac death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR), and target vessel thrombosis. The secondary endpoint was late lumen loss (LLL) on follow-up coronary angiography.

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Author(s): Garg S. et al.
Source: American heart journal [Am Heart J] 2022 Apr; Vol. 246, pp. 32-43. Date of Electronic Publication: 2022 Jan 03.
Abstract: Current ESC guidelines recommend the use of intra-coronary pressure guidewires for functional assessment of intermediate-grade coronary stenoses. Angiography-derived quantitative flow ratio (QFR) is a novel method of assessing these stenoses, and guiding percutaneous coronary intervention (PCI). The PIONEER IV trial is a prospective, all-comers, multi-center trial, which will randomize 2,540 patients in a 1:1 ratio to PCI guided by angiography-derived physiology or usual care, with unrestricted use in both arms of the Healing-Targeted Supreme sirolimus-eluting stent (HT Supreme). 

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Authors: Al-Tawil M; Chikhal R; Abdelhaliem A; 
Source: Journal of cardiac surgery [J Card Surg] 2022 Apr; Vol. 37 (4), pp. 1002-1003. Date of Electronic Publication: 2021 Dec 27.
Abstract: Uncomplicated Type B aortic dissection (un-TBAD) is still managed conservatively with optimal medical therapy (OMT) despite evidence in favour of thoracic endovascular aortic repair (TEVAR) for un-TBAD. OMT aims to regulate heart rate and blood pressure and patients require long-term follow-up to evaluate the extent of dissection, however, many un-TBAD patients are lost to follow-up. Several trials and observational studies evaluated the use of TEVAR in combination with OMT in un-TBAD and proved the safety, effectiveness, and comparability of TEVAR relative to OMT alone. What remains in question is the optimal time window to intervene with TEVAR. This was recently addressed in a fascinating review by Jubouri et al. AIMS: This commentary aims to discuss the recent review by Jubouri et al. which further proved that TEVAR is safe and effective in un-TABD and investigated the optimal timing of TEVAR in un-TBAD.

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Author(s): Garg S. et. al
Source: JACC: Cardiovascular Interventions; Jun2022, Vol. 15 Issue 12, p1231-1242, 12p
Abstract: Percutaneous coronary intervention (PCI) of bifurcation lesions is associated with higher rates of adverse events, and currently it is unclear whether PCI or coronary artery bypass grafting (CABG) is the safer treatment for these patients at very long-term follow-up. The aim of this study was to investigate the impact of bifurcation lesions on individual predicted and observed all-cause 10-year mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial. In the SYNTAXES (SYNTAX Extended Survival) study, 10-year observed and individual predicted mortality derived from the SYNTAX score 2020 (SS-2020) was compared between patients with ≥1 bifurcation (n = 1,300) and those with no bifurcations (n = 487). Among patients treated with PCI, patients with >1 bifurcation lesion compared with those without bifurcation lesions had a significantly higher risk for all-cause death (19.8% vs 30.1%; HR: 1.55; 95% CI: 1.12-2.14; P = 0.007), whereas following CABG, mortality was similar in patients with and those without bifurcation lesions (23.3% vs 23.0%; HR: 0.81; 95% CI: 0.59-1.12; P = 0.207; P interaction = 0.006). In PCI patients, a 2-stent vs a 1-stent technique was associated with higher mortality (33.3% vs 25.9%; HR: 1.51; 95% CI: 1.06-2.14; P = 0.021). According to the SS-2020, among those with ≥1 bifurcation, there was equipoise for all-cause mortality between PCI and CABG in 2 quartiles of the population, whereas CABG was superior to PCI in the 2 remaining quartiles. Bifurcation lesions require special attention from the heart team, considering the higher 10-year all-cause mortality associated with PCI. Careful evaluation of bifurcation lesion complexity and calculation of individualized 10-year prognosis using the SS-2020 may therefore be helpful in decision making. (Synergy Between PCI With TAXUS and Cardiac Surgery

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Author(s): Garg S. et.al
Source: Reviews in Cardiovascular Medicine, Vol 23, Iss 4, p 133 (2022)
Abstract: Background: Personalized prognosis plays a vital role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD). The aim of this study is to compare the modality of revascularization chosen by the local heart team to that recommended by using individualized predictions of medium, and long-term all-cause mortality amongst patients with 3VD screened in the Multivessel TALENT trial. Methods: The SYNTAX score II (SS-II) and SS-2020 were evaluated in 200 consecutive patients by a core laboratory and compared to the decision of the “on site” heart team. Results: According to the SS-II, CABG was the recommended treatment in 51 patients (25.5%) however 34 (66.6%) of them received PCI. According to SS-2020 the predicted absolute risk differences (ARD) between PCI and CABG were significantly higher in patients receiving CABG compared to those treated by PCI for major adverse cardiovascular and cerebrovascular events, a composite of all-cause mortality, stroke or myocardial infarction at 5-years (8.8 ± 4.6% vs 6.0 ± 4.0%, p < 0.001) and all-cause mortality at 5- (5.2 ± 3.5% vs 3.7 ± 3.0%, p = 0.008) and 10-years (9.3 ± 4.8% vs 6.2 ± 4.2%, p < 0.001). Based on the novel threshold of equipoise (individual absolute risk differences [ARD] 4.5%), only 19 received it. Conclusions: Despite the robustness of the risk models proposed for screening, several deviations from the recommended mode of revascularization were observed by the core laboratory among the first 200 patients with 3VD screened in the Multivessel TALENT trial. 

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Author(s): Garg S; et al. 
Source: Heart (British Cardiac Society) [Heart] 2022 Jun 22. Date of Electronic Publication: 2022 Jun 22.
Abstract:
Objective: We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).
Methods: This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.
Results: Among 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, p interaction =0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; p interaction =0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality.
Conclusions: Among patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG.

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Author(s) Evans W. (Mbchfwe2@doctors.org.uk); Buchanan J.; Goel R.; Hardy S.
Institution(s) (Evans, Buchanan, Goel, Hardy) Department of Vascular Surgery, East Lancashire Hospitals NHS Trust, Blackburn, UK, United Kingdom
Source Annals of Vascular Surgery; Jan 2022; vol. 78 ; p. 321-327
Language English
Database EMBASE
AbstractBackground: Omniflow II biosynthetic grafts are a commonly used alternative to autologous grafts in vascular bypass procedures. They are chosen for their purported resilience to infection, often in instances of existing graft failure or infection. We examined the short term, 1-3 year outcomes of Omniflow grafts in terms of patency, limb survival and mortality in a sample of 24 individuals. Method(s): This is a single centred retrospective study of Omniflow II grafts implanted between September 23, 2015 and April 05, 2018 in our department. It includes grafts in all anatomical locations. Primary outcome measures were overall patient survival and time to this, primary graft patency (patency with no intervention) and then limb survival at 1 and 3 years. Kaplan-Meier survival analysis was plotted for the 3 primary outcome measures. Result(s): A total of 24 grafts from 24 individuals were included with mean age 71.4 +/- 11.7. We included 5 female and 19 male patients. The commonest indication was rest pain/claudication (N = 8) followed by graft occlusion (N = 6). Femoro-popliteal bypass (N = 13) and Femoro-distal bypass (N = 5) were the commonest procedures. Kaplan-Meier survival analysis demonstrated that 1 and 3-year primary patency rates were 54.2% and 37.5% respectively with Limb survival probability of 75% at 1 year and 70.8% at 3 years. These rates were all considerably lower than those found in previous comparative studies. Mortality however, compared favourably with 1 and 3-year survival probability 91.7% and 87.5% on average 296 days (range 95-451 days) after graft implantation. Conclusion(s): We found that rates of primary patency and limb salvage for this graft type were markedly lower than in comparable studies. Further work in the form of a RCT is indicated.Copyright © 2021

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Author(s) Al-Tawil M.; Chikhal R.; Abdelhaliem A. (amrhaliem@gmail.com)
Institution(s) (Al-Tawil) Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
(Chikhal) Hull York Medical School, University of York, York, United Kingdom
(Abdelhaliem) Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom
Source Journal of Cardiac Surgery; 2021
Language English
Database EMBASE
AbstractBackground: Uncomplicated Type B aortic dissection (un-TBAD) is still managed conservatively with optimal medical therapy (OMT) despite evidence in favour of thoracic endovascular aortic repair (TEVAR) for un-TBAD. OMT aims to regulate heart rate and blood pressure and patients require long-term follow-up to evaluate the extent of dissection, however, many un-TBAD patients are lost to follow-up. Several trials and observational studies evaluated the use of TEVAR in combination with OMT in un-TBAD and proved the safety, effectiveness, and comparability of TEVAR relative to OMT alone. What remains in question is the optimal time window to intervene with TEVAR. This was recently addressed in a fascinating review by Jubouri et al. Aim(s): This commentary aims to discuss the recent review by Jubouri et al. which further proved that TEVAR is safe and effective in un-TABD and investigated the optimal timing of TEVAR in un-TBAD. Material(s) and Method(s): We carried out a literature search using multiple electronic databases including PUBMED and Scopus in order to collate research evidence on intervention timeframe and outcomes of TEVAR in un-TBAD. Result(s): Performing TEVAR during the subacute phase of dissection (15-90 days since symptom onset) seems to be associated with less periprocedural complications compared to the acute phase, however, late outcomes (>30 days post-TEVAR) are comparable between the two groups and are superior to the chronic phase. Discussion(s): The introduction of TEVAR in un-TBAD presents a paradigm shift in the management of un-TBAD and a potential move towards becoming the gold-standard treatment option for un-TBAD. Intervening with TEVAR within the first 90 days since symptom onset (acute and subacute un-TBAD) gives favourable outcomes relative to intervention in the chronic phase of dissection (>90 days since symptom onset), this is due to the dissecting septum becoming less compliant over time. Conclusion(s): TEVAR is a safe and effective treatment modality for un-TBAD with a survival benefit compared to OMT alone. Offering TEVAR during the subacute phase of dissection yields optimal results which are comparable to the acute phase but superior to the chronic phase.Copyright © 2021 Wiley Periodicals LLC

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Author(s) Jubouri M.; Abdelhaliem A. (amrhaliem@gmail.com)
Institution(s) (Jubouri) Hull York Medical School, University of York, York, United Kingdom
(Abdelhaliem) Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom
Source Journal of Cardiac Surgery; 2021
AbstractBackground: The introduction of the single-step total arch replacement (TAR) with frozen elephant trunk (FET) has revolutionised the field of aortic surgery. TAR is indicated when the aortic arch is involved in aortic pathologies such as Type A aortic dissection and thoracic aortic aneurysms. Several FET devices are available commercially for global use, and example is the E-Vita Open NEO hybrid prosthesis (HP) developed by CryoLife-JOTEC. Unlike other FET devices available, this HP in particular features a design that puts it at a disadvantage as it does not incorporate gelatine or collagen in its structure, which makes it permeable to blood. Several studies have reported incidence of post-anastomotic blood oozing through the E-Vita Open NEO right after weaning from cardiopulmonary bypass. Aim(s): This commentary aims to discuss the recent study by Tan et al. which investigated E-Vita NEO device oozing as well as the implications of using BioGlue to overcome this serious complications. Method(s): We carried out a literature search on multiple electronic databases including PUBMED and Scopus in order to collate research evidence on E-Vita NEO device oozing, BioGlue health risks, and other commercially available and globally used FET devices such as Thoraflex Hybrid. Result(s): It is proven fact that the E-Vita NEO excessively oozes blood, and while BioGlue is a safe and effective agent when used in small amounts, the amount needed to coat the E-Vita Open NEO and achieve haemostasis exceeds this by a wide margin which poses patients to great potential health risks. The Thoraflex Hybrid Prosthesis developed by Terumo Aortic is a commercially available and globally used FET device with long-standing favourable outcomes. Discussion(s): Tan et al. recently conducted an interesting study which proved that the E-Vita NEO HP does excessively ooze blood and tackled the issue of pre-emptive BioGlue use to tackle this complication as suggested by Ho et al. This leads on to the main question, is the use of BioGlue with E-Vita Open NEO to overcome oozing a long-term sustainable solution or is it merely a band aid?. Conclusion(s): In the face of fierce commercial competition, the choice of design and material of the E-Vita Open NEO HP would benefit from reconsideration.Copyright © 2021 Wiley Periodicals LLC

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Author(s) Hansrani V.; Moughal S.; Elmetwally A.; Al-Khaffaf H.
Source Journal of Vascular Surgery: Venous and Lymphatic Disorders; Nov 2020; vol. 8 (no. 6); p. 1104-1110
Language English
Publication Date Nov 2020
Objective: To investigate the presentation, etiology, management and outcomes of May-Thurner syndrome (MTS) in adolescents aged under 18. Method(s): We searched electronic bibliographic databases to identify published reports of MTS in patients under 18 years of age. We conducted our review according to the PRISMA statement standards. 

Author(s) Hansrani V.; Goel R.R.; Antoniou G.A.; Halim U.A.
Source Vasa - European Journal of Vascular Medicine; Apr 2020; vol. 49 (no. 3); p. 167-174
The study objective was to evaluate the ability of computed tomography (CT) to identify technical complications intra-operatively during endovascular aneurysm repair (EVAR). Frequency of complications seen by CT and their sequelae was compared with conventional completion angiography. 

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Author(s) Hansrani V.; Muhammad K.; Charlswood N.; Al-Khaffaf H.
Source Journal of Vascular Access; Nov 2019; vol. 20 (no. 6); p. 592-596
Background: Dialysis-associated steal syndrome remains a difficult clinical scenario for vascular access surgeons. The ideal treatment would improve blood flow to the hand without compromising the fistula; however, most treatment options rarely allow for both. The study describes an innovative technique used in clinical practice over a 17-year period for the treatment of dialysis-associated steal syndrome. The procedure and long-term results are discussed.

Method(s): 27 patients with dialysis-associated steal syndrome were recruited over 17 years at two large UK University Teaching Hospitals and treated with the extension technique. All patients included were assessed for resolution of their symptoms, patency of the fistula and adequacy of needling.

Result(s): 27 patients were admitted with dialysis-associated steal syndrome and underwent surgery using the extension technique. Complete symptom resolution was seen in 26 of the 27 patients (96%), with improvements in pain, sensori-motor disturbance and temperature. All 26 patients had a patent fistula at 6-months' follow-up. At 12 months, 3 of 27 (11.1%) developed fistula thrombosis which could not be salvaged and 2 of 27 (7.4%) developed thrombosis successfully salvaged by fistulaplasty.

​Conclusion(s): Our study shows that the Extension Technique is an effective treatment method for dialysis-associated steal syndrome and results have demonstrated a high level of fistula patency and a low rate of complications. It has several advantages when compared with other established treatment methods and has the versatility to be used as a method for dialysis-associated steal syndrome prevention in high-risk groups as well as treatment.Copyright © The Author(s) 2019.