22. Off-Pump Versus On-Pump Bypass Surgery for Left Main Coronary Artery Disease.
Journal of the American College of Cardiology, Volume 74, Issue 6, August 2019
“Among patients with left main disease treated with CABG in the EXCEL trial, off-pump surgery was associated with a lower rate of revascularization of the coronary arteries supplying the inferolateral wall and an increased risk of 3-year all-cause death compared with on-pump surgery.”
21. Complete Revascularization with Multivessel PCI for Myocardial Infarction.
The New England Journal of Medicine, September 1, 2019
When complete myocardial revascularization was performed using stenting even in the setting of a heart attack excellent outcomes were demonstrated irrespective of diabetes status.
20. 10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease.
Journal Of The American College of Cardiology VOL. 72, NO. 23, 2018
“In patients with significant Left Main Coronary artery disease, as compared with coronary bypass surgery stenting showed similar rates of death and serious composite outcomes.”
19. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data.
The Lancet Volume 391, Issue 10124, P939-948, MARCH 10, 2018
“In this large pooled analysis of 11,518 patients 5 year all-cause mortality for Left Main disease was similar regardless of diabetes status and SYNTAX score.”
18. Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization.
Journal of American College of Cardiology Volume 72, Issue 4, July 2018
“5-year stroke rates were significantly lower after stenting compared with Coronary Bypass Surgery and the greater risk of stroke after surgery was confined to patients with multivessel disease and diabetes. Moreover, five-year mortality was markedly higher for patients experiencing a stroke within 30 days of surgery.”
17. Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate.
Journal of the American Heart Association. Vol 7, No. 16, 2018
“More than 30 years after the introduction of beating heart surgery (off pump coronary artery bypass), its role remains debated as in the long term inferior outcomes have been reported with this technique.”
16. What Is the Optimal Revascularization Strategy in Patients With Cerebrovascular Disease (stroke)?
JACC Cardiovasc Interv. December 18, 2018.
“History of previous stroke was associated with a higher 30 day and 3-year rate of recurrent stroke after coronary bypass surgery as compared with coronary stenting.”
15. Incidence, Predictors, and Outcomes of In-Hospital Percutaneous Coronary Intervention Following Coronary Artery Bypass Grafting.
Journal of the American Collgee of Cardiology Volume 73, Issue 4, February 2019
“Paradoxically there is now being reported a significant incidence of urgent Coronary or Bypass graft stenting within 24 hours after surgery.
14. Thirty-Year Mortality After Coronary Artery Bypass Graft Surgery: A Danish Nationwide Population-Based Cohort Study.
Circulation: Cardiovascular quality and outcomes Vol 10, No. 5 MAY 2017
“In this large population based study patients who had Cornary Bypass Surgery had a higher mortality than the general population immediaty after surgery and 10 years later.”
13. PCI in Patients With 3VD: SYNTAX II Study Results.
Journal of the American College of Cardiology August, 2017
“In this study, one year outcomes after stenting and coronary bypass surgery demonstrate equipoise.”
12. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease (EXCEL).
The New England Journal of Medicine VOL. 375, NO. 23 December, 2016
“In patients with left main coronary artery disease major outcomes after stenting and coronary bypass surgery were similar at 3 years.”
11. TCT-397 10-year outcome after complete versus incomplete revascularization of patients with multivessel coronary artery disease.
Journal of the American College of Cardiology, Vol. 66, No. 15, Suppl B, 2015
“In multi vessel coronary artery disease, complete revascularization is assocaited with similar long term benefit with either coronary bypass surgery or with stenting.”
10. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial.
Lancet Vol381 February,2013
“In patients with non complex albeit multiple coronary blockages including Left main coronary artery disease rates of death and stroke were similar.”
9. Cognitive dysfunction after cardiac surgery: Pathophysiological mechanisms and preventive strategies.
US National Library of Medicine, National Institutes of Health, Netherland Heart Journal. 2013 Feb; 21(2): 70- 73.
“In this study, some degree of impairment in mental function was noted after coronary bypass surgery (pump head) in up to 40 % of patients at 5 years.”
8. Infectious Complications of Cardiac Surgery: A Clinical Review
Journal of Cardiothroacic Vascular Anesthesia 2012
“Infectious complications after cardiac surgery are common and increase perioperaitve mortality and morbidity several fold.”
7. Cognitive Outcomes After On- Versus Off-Pump Coronary Artery Bypass Surgery.
The Annals of Thoracic surgery Volume 90, Issue 4, Pages 1134–1141 October 2010.
“In this randomized trial comparing conventional on-pump vs beating heart (off-pump) coronary bypass surgery impairment in mental function if any, was similar.”
6. Atrial Fibrillation after Cardiac Surgery: Where are we now?
Indian Pacing Electrophysiology Journal November 2008
“In this study, Irregular heartbeat called Atrial fibrillation which can be a cause of stroke was noted to occur in a very high percentage of patients undergoing cardiac surgery.”
5. The Final 10-Year Follow-Up Results From the BARI Randomized Trial.
Journal of the American College of Cardiology Vol. 49, No. 15, 2007
“In this epic trial comparing the precursor of modern stenting (PTCA) with coronary bypass surgery, long term survival was similar (except in diabetics).”
4. Postoperative Atrial Fibrillation and Mortality After Coronary Artery Bypass Surgery.
Journal of American College of Cardiology, Vol. 43, No. 5, 2004
“In this paper, irregular heart beat called Atrial fibrillation was noted to occur in 16% of patients undergoing Coronary artery bypass surgery resulting in increased morbidity and mortality in this subset.”
3. Complete myocardial revascularization: Between myth and reality.
European heart journal. Zimarino, Marco & Calafiore, Antonio & Caterina, Raffaele. (2005)
“In non diabetics with a strong heart functionally complete revascularization with either Cornary bypass surgery or stenting has similar beneﬁts in terms of survival.”
2. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery.
Journal of the American College of Cardiology, Volume 43, Issue 5, March 2004.
“In this study, Irregular heartbeat called atrial fibrillation which can cause strokes and is associated with reduced long term survival was noted to occur in 16% of patients after coronary bypass surgery.”
1. Cognitive problems after heart bypass linked to long-term decline.
American Psychology Association Vol 32, No. 5, May 2001 Monitor on Psychology.
“In this study, 53% of patients experienced significant mental impairment shortly after surgery, 36% at six weeks and 24% at six months were noted to have a persisting impairment of mental function.”
Conflicting Scientific Data
Strategies for Multivessel Revascularization in Patients with Diabetes (FREEDOM).
The New England Journal of Medicine, Vol. 367 No. 25. December, 2012.
“In this study, diabetics with multiple coronary blockages demonstrated improved survival after Coronary Bypass Surgery versus Coronary stenting except that they had a higher rate of stroke.”
Coronary Artery Bypass Surgery Improves Outcomes in Patients With Diabetes and Left Ventricular Dysfunction.
Journal of the American College of Cardiology Volume 71 Issue 8, February 2018
“In this long-term follow up study, patients with multiple blockages and diabetes who had a weak heart faired better with Coronary Bypass surgery as compared with coronary stenting.”
Contemporary Outcomes Following Coronary Artery Bypass Graft Surgery for Left Main Disease.
Journal of the American College of Cardiology Volume 73, Issue 15, April 2019
“Over the past several years significant improvements in surgical outcomes following bypass surgery for Left main disease have been noted.”
Rebuttal regarding above article TCT MD News, April 2019
“Experts opine that a key factor translating into what appears to be improvement following Coronary Artery Bypass surgery for Left main disease is not the quality of the surgery per se but other aspects of care.”
Long-Term Survival Following Multivessel Revascularization in Patients With Diabetes: The FREEDOM Follow-On Study
Journal of the American College of Cardiology November 2018
“In diabetics with multiple blockages coronary bypass surgery as compared to coronary stenting has improved outcomes at 8 years.”
Editorial rebuttal regarding above article
The “Fragility” of Mortality Benefit of Coronary Artery Bypass Graft Surgery in Diabetics
Editorial, Journal of the American College of Cardiology November 2018
“In an editorial rebuttal accompanying the above article, Nationally renowned experts questioned the reliability of the mortality benefit in FREEDOM trial.
They point out that just 16 more deaths in the CABG arm would have rendered the between-group difference statistically nonsignificant.
Additionally, it was suggested that data from more recent clinical trials and registries has shown even more improved results with new-generation drug -eluting stents.”