TRAILS ON CORONARY REVASCULARIZATION (1).pptx

trails in cabg

1. TRAILS ON CORONARY REVASCULARIZATION

2. TRAILS COMPARING PCI VS CABG the Coronary Artery Surgery Study (CASS) Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) Coronary Artery Revascularization in Diabetes ( CARDia )

3. TRAILS ONCAB VS OPCAB CORONARY TRAIL ROOBY TRAIL DOORS TRAIL GOPCABE TRAIL PRAGUE 6 TRAIL

4. CORONARY TRAIL CABG ON PUMP OFF PUMP REVASCULARIZATION STUDY (2006-2011) 4752 PTS 79 CENTRES 19 COUNTRIES STUDIED ON OUTCOME OF DEATH – MI –STROKE – RENAL FAILURE –REPEAT REVASCULARISATION RESULT – NO DIFFERENCE IN MORTALITY AT 1 YR WITH SLIGHT HIGHER RATE OF REVASCULARIZATION IN OFF PUMP participating surgeons were required to have at least 2 years of experience involving more than 100 procedures performed OPCAB patients had shorter operations and ventilator times, fewer blood-product transfusions, fewer repeat operations for bleeding, and lower rates of respiratory complications and acute kidney injury

5. However, fewer bypass grafts were completed in the OPCAB group, and the rates of incomplete revascularization were higher. Similar findings regarding fewer numbers of grafts and lower rates of revascularization have been reported in other trials, and these factors are thought to contribute to the inferior long-term outcomes of OPCAB. INCLUSION CRITERIA - ELECTIVE ISOLATED CABG WITH MEDIAN STRNOTOMY WITH ATLEAST ONE OR MORE RISK FACTORS –AGE >=70, PERIPHERAL ARTERIAL DISEASE, CVA, CAROTID STENOSIS>70% , AKI EXCLUSION CRITERIA - ASSOCIATED WITH VALVE SURGERY, LIFE EXPECTENCY < 2 YRS, EMERGENCY, CONVERSION OF OFF TO ON PUMP.

6. ROOBY TRAIL R andomized O npump O ffpump B ypass stud y 2009 the first large, multicenter, prospectively randomized study 2203 PTS 18 CENTRES PARTICIPATING SURGEONS SHOULD HAVE COMPLETED 20 OFF PUMP SURGERY PATIENT SELECTION: URGENT / ELECTIVE CABG ONLY EXCLUSION CRITERIA: VALVE DISEASE, SMALL TARGETS, DIFFUSE DISEASE, HIGH RISK STUDIED ON MORTALITY 15% OPCAB VS 12% ONCAB AT 5 YR RESULT : OPCAB HAD HIGHER MORTALITY AT 5 YR COMPARED TO ONCAB

7. NO SIGNIFICANT CHANGES B/W ON AND OFF PUMP IN: 1.HOSPITAL STAY 2. ICU STAY 3. VENTILATOR 4. EARLY MORTALITY 5. NEUROLOGICAL PATENCY OF SVG - BETTER IN ON PUMP GRAFT PATENCY WAS CONSISTENTLY AND SIGNIFICANTLY WORSE WITH OFFPUMP FOR ALL 3 MAJOR CORONARY REGIONS

8. DOORS TRAIL D ANISH O NPUMP O FFPUMP R ANDOMIZATION S TUDY 900 PTS – MULTICENTR RCT GRAFT PATENCY WAS CHECKED WITH REPEAT CAG AT 6 MONTHS POST-OP 481/900 PTS WERE AVAILABLE FOR REPEAT CAG RESULT : BETTER GRAFT PATENCY WITH ONCAB(86%) THAN OPCAB(76%)

9. GOPCABE TRAIL G ERMAN O FF P UMP VS ONPUMP CAB G IN E LDERLY 2539 PTS IN MULTICENTRE STUDY PEOPLE > 75 YRS UNDERGOING 1 ST CABG COMPOSITE END POINT OF DEATH – MI – TSROKE – RENAL FAILURE RESULT :OPCAB (13.1%) VS ONCAB (14%) EVEN IN ELDERLY THE RATE OF COMPOSITE OUTCOME IS SIMILAR WITH OPCAB NOT SHOWING ANY ADVANTAGE . IN FACT OPCAB NEEDED MUCH MORE FREQUENT REVASCULRISATION

10. PRAGUE 6 SMALL EASTERN EUROPEAN MULTICENTRE TRAIL WITH 202 PTS WITH RESULTS VERY SIMILAR TO GOPCABE . OPCAB HAD AN EDGE AT 1 MONTH THAT WAS LOST AT 6 MONTHS WHEN RESULTS MERGED.

11. SMART TRAIL S URGICAL M ANAGEMENT OF A RTERIAL R EVASCULARIZATION T HERAPIES TRAIL 200 PTS UNSELECTED WERE RANDOMLY ASSIGNED FOR OPCAB / ONPUMP(2000-2001) AIM: TO COMPARE LONG TERM SURVIVAL, GRAFT PATENCY, MORTALITY RESULT : SIMILAR IN GRAFT PATENCY , REINTERVENTION, LONG TERM SURVIVAL