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      Improving coronary artery bypass grafting: a systematic review and meta-analysis on the impact of adopting transit-time flow measurement

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          Despite there being numerous studies of intraoperative graft flow assessment by transit-time flow measurement (TTFM) on outcomes after coronary artery bypass grafting (CABG), the adoption of contemporary TTFM is low. Therefore, on 31 January 2018, a systematic literature search was performed to identify articles that reported (i) the amount of grafts classified as abnormal or which were revised or (ii) an association between TTFM and outcomes during follow-up. Random-effects models were used to create pooled estimates with 95% confidence intervals (CI) of (i) the rate of graft revision per patient, (ii) the rate of graft revision per graft and (iii) the rate of graft revision among grafts deemed abnormal based on TTFM parameters. The search yielded 242 articles, and 66 original articles were included in the systematic review. Of those articles, 35 studies reported on abnormal grafts or graft revisions (8943 patients, 15 673 grafts) and were included in the meta-analysis. In 4.3% of patients (95% CI 3.3–5.7%, I 2  = 73.9) a revision was required and 2.0% of grafts (95% CI 1.5–2.5%; I 2 = 66.0) were revised. The pooled rate of graft revisions among abnormal grafts was 25.1% (95% CI 15.5–37.9%; I 2 = 80.2). Studies reported sensitivity ranging from 0.250 to 0.457 and the specificity from 0.939 to 0.984. Reported negative predictive values ranged from 0.719 to 0.980 and reported positive predictive values ranged from 0.100 to 0.840. This systematic review and meta-analysis showed that TTFM could improve CABG procedures. However, due to heterogeneous data, drawing uniform conclusions appeared challenging. Future studies should focus on determining the optimal use of TTFM and assessing its diagnostic accuracy.

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          Most cited references 69

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          2018 ESC/EACTS Guidelines on myocardial revascularization

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            Coronary artery bypass grafting: Part 1--the evolution over the first 50 years.

            Surgical treatment for angina pectoris was first proposed in 1899. Decades of experimental surgery for coronary artery disease finally led to the introduction of coronary artery bypass grafting (CABG) in 1964. Now that we are approaching 50 years of CABG experience, it is appropriate to summarize the advancement of CABG into a procedure that is safe and efficient. This review provides a historical recapitulation of experimental surgery, the evolution of the surgical techniques and the utilization of CABG. Furthermore, data on contemporary clinical outcomes are discussed.
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              Coronary artery bypass grafting: Part 2--optimizing outcomes and future prospects.

              Since first introduced in the mid-1960s, coronary artery bypass grafting (CABG) has become the standard of care for patients with coronary artery disease. Surprisingly, the fundamental surgical technique itself did not change much over time. Nevertheless, outcomes after CABG have dramatically improved over the first 50 years. Randomized trials comparing percutaneous coronary intervention (PCI) to CABG have shown converging outcomes for select patient populations, providing more evidence for wider use of PCI. It is increasingly important to focus on the optimization of the short- and long-term outcomes of CABG and to reduce the level of invasiveness of this procedure. This review provides an overview on how new techniques and widespread consideration of evolving strategies have the potential to optimize outcomes after CABG. Such developments include off-pump CABG, clampless/anaortic CABG, minimally invasive CABG with or without extending to hybrid procedures, arterial revascularization, endoscopic vein harvesting, intraprocedural epiaortic scanning, graft flow assessment, and improved secondary prevention measures. In addition, this review represents a framework for future studies by summarizing the areas that need more rigorous clinical (randomized) evaluation.

                Author and article information

                Eur J Cardiothorac Surg
                Eur J Cardiothorac Surg
                European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
                Oxford University Press
                October 2019
                25 March 2019
                25 March 2019
                : 56
                : 4
                : 654-663
                [1 ]Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre , Rotterdam, Netherlands
                [2 ]Department of Cardiovascular Surgery, University of Oxford , John Radcliffe Hospital, Oxford, UK
                [3 ]Division of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta , University of Calgary, Calgary, Canada
                [4 ]Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre , University of Duisburg-Essen, Duisburg, Germany
                [5 ]Department of Cardiac Surgery, Università degli Studi “G. D’Annunzio” Chieti-Pescara , Chieti, Italy
                [6 ]Department of Cardiothoracic Surgery, Veterans Affairs Medical Centre , Washington, DC, USA
                [7 ]Department of Cardiovascular Surgery, Mount Sinai Saint Luke’s , New York, NY, USA
                Author notes
                Corresponding author. Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands. Tel: +31-(0)10-7035411; fax: +31-(0)10-7033993; e-mail: s.head@ 123456erasmusmc.nl (S.J. Head).
                © The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                Page count
                Pages: 10


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