Myocardial Revascularization Surgery: JACC Historical Breakthroughs in Perspective.

Coronary artery bypass grafting (CABG) was introduced in the 1960s as the first procedure for direct coronary artery revascularization and rapidly became one of the most common surgical procedures worldwide, with an overall total of more than 20 million operations performed. CABG continues to be the most common cardiac surgical procedure performed and has been one of the most carefully studied therapies. Best CABG techniques, optimal bypass conduits, and appropriate patient selection have been rigorously tested in landmark clinical trials, some of which have resolved controversy and most of which have stoked further debate and trials. The evolution of CABG cannot be properly portrayed without presenting it in the context of the parallel development of percutaneous coronary intervention. In this Historical Perspective, we a provide a broad overview of the history of coronary revascularization with a focus on the foundations, evolution, best evidence, and future directions of CABG.

Percutaneous Coronary Revascularization: JACC Historical Breakthroughs in Perspective.

Over the last 4 decades, percutaneous coronary intervention has evolved dramatically and is now an acceptable treatment option for patients with advanced coronary artery disease. However, trialists have struggled to establish the respective roles for percutaneous coronary intervention and coronary artery bypass graft surgery, especially in patients with multivessel disease and unprotected left-main stem coronary artery disease. Several pivotal trials and meta-analyses comparing these 2 revascularization strategies have enabled the relative merits of each technique to be established with regard to the type of ischemic syndrome, the coronary anatomy, and the patient's overall comorbidity. Precision medicine with individualized prognosis is emerging as an important method of selecting treatment. However, the never-ending advancement of technology, in conjunction with the emergence of novel pharmacological agents, will in the future continue to force us to reconsider the evolving question: "Which treatment strategy is better and for which patient?"

Hybrid Coronary Revascularization: Perspective Current State After 25 Years of Start.

Hybrid coronary revascularization (HCR) represents a minimally invasive revascularization strategy in which the durability of the internal mammary artery to the left anterior descending artery graft is combined with percutaneous coronary intervention to treat remaining lesions. It first was introduced in the mid-1990s and aspired to bring together the "best of both worlds" - the excellent patency rates and survival benefits associated with the durable left internal mammary artery graft to the left anterior descending artery alongside the good patency rates of drug-eluting stents, which outlive saphenous vein grafts to non-left anterior descending vessels. Although in theory this is a very attractive revascularization strategy, several years later, only small randomized controlled trials comparing HCR with coronary artery bypass grafting has recently emerged in the medical literature, raising concerns regarding HCR's role. In the current review, we discuss HCR's rationale, the current evidence behind it, its limitations, and procedural challenges.

Intraaortic Balloon Pump Counterpulsation, Part I: History, Technical Aspects, Physiologic Effects, Contraindications, Medical Applications/Outcomes.

Intraaortic balloon pump counterpulsation is the most common form of mechanical circulatory support used in patients with myocardial ischemia and cardiogenic shock. The physiologic principles of counterpulsation include diastolic augmentation of aortic pressure and systolic reduction of left ventricular afterload, resulting in hemodynamic benefits through increased coronary perfusion pressure and improved myocardial oxygen balance in patients with myocardial ischemia. Major trials have failed to conclusively demonstrate improvements in morbidity and mortality with counterpulsation therapy for patients with acute myocardial infarction (MI), cardiogenic shock, and/or severe coronary artery disease undergoing revascularization therapy, and the debate over its applications continues. Part I of this review focuses on the history of the development of counterpulsation, technical considerations, and complications associated with its use, its physiologic effects, and evidence for its use in myocardial ischemia and cardiogenic shock.

Distal radial access for coronary angiography and percutaneous coronary intervention: A state-of-the-art review.

Since its introduction by Lucien Campeau three decades ago, percutaneous radial artery approach at the forearm has been shown to provide advantages over the femoral approach and has become the standard approach for coronary angiography and intervention. Though infrequent, vascular complications still remain, mainly radial artery occlusion. Therefore, a more distal radial approach at the snuffbox or at the dorsum of hand has been suggested, initially by anethesiologists for perioperative patient monitoring, and more recently by Babunashvili et al. for retrograde radial artery recanalization of radial artery occlusion and then for coronary angiography and intervention. This distal radial approach has been advocated to reduce the risk of radial artery occlusion at the forearm (which precludes reintervention through the same access site) and bleeding and vascular access site complications, as well as to improve operator and patient comfort, especially when using left radial approach. This review describes in detail the anatomy of the radial artery at the wrist and the hand, the history of distal radial access, the rationale underlying use of this technique, the results published by experienced operators, the technique, the limitations, and potential role of this approach. This journey from the very proximal to the very distal part of the radial artery was indeed initiated and conceptualized by Lucien Campeau himself.

Historical Milestones in the Management of Stable Coronary Artery Disease over the Last Half Century.

Coronary revascularization for coronary artery disease dates back to the introduction of coronary bypass by Favaloro in 1967 and coronary angioplasty by Gruentzig in 1977 (first published in 1968 and 1978, respectively). There have been many technical improvements over the ensuing 5 decades, studied in clinical trials. This article reviews the history of coronary revascularization (the development of optimal medical therapy) and points the way to the future of stable coronary artery disease management.

A decade of genome-wide association studies for coronary artery disease: the challenges ahead.

In this review, we summarize current knowledge on the genetics of coronary artery disease, based on 10 years of genome-wide association studies. The discoveries began with individual studies using 200K single nucleotide polymorphism arrays and progressed to large-scale collaborative efforts, involving more than a 100 000 people and up to 40 Mio genetic variants. We discuss the challenges ahead, including those involved in identifying causal genes and deciphering the links between risk variants and disease pathology. We also describe novel insights into disease biology based on the findings of genome-wide association studies. Moreover, we discuss the potential for discovery of novel treatment targets through the integration of different layers of 'omics' data and the application of systems genetics approaches. Finally, we provide a brief outlook on the potential for precision medicine to be enhanced by genome-wide association study findings in the cardiovascular field.

Intervenção percutânea e revascularização miocárdica no paciente com dm - elementos que devem ser considerados / Percutaneous intervention and myocardial revascularization in patients with dm - elements that should be considered

A doença arterial coronariana (DAC) é a principal causa de mortalidade e morbidade entre os portadores de diabetes mellitus (DM). O DM aumenta o risco de DAC e é um preditor independente dos piores resultados após qualquer método de revascularização coronária: intervenção coronária percutânea (ICP) ou cirurgia de revascularização miocárdica (CRM). O tratamento da DAC em diabéticos possui características importantes e sua respectiva presença deve ser utilizada na escolha do método de intervenção, especialmente nos pacientes multiarteriais e/ou com lesão de tronco de coronária esquerda. Além da terapia medicamentosa rigorosa ser um dos pilares fundamentais, a decisão sobre a estratégia de revascularização deve ser tomada por uma equipe multiprofissional e multidisciplinar ("Heart Team"), baseando-se em elementos do quadro clínico, da anatomia coronária, carga isquêmica, função ventricular esquerda, risco cirúrgico hospitalar e do próprio paciente.

Coronary artery disease (CAD) is the leading cause of mortality and morbidity among patients with Diabetes Mellitus (DM). DM increases the risk of CAD and is an independent predictor of poorer outcomes after any method of coronary revascularization: percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The treatment of CAD in diabetics has important characteristics, and its presence should not be used in the choice of intervention method, especially in multiarterial patients and/or patients with unprotected left main stem disease. In addition to rigorous drug therapy being one of the fundamental pillars, the decision on the type of revascularization strategy should be made by a multiprofessional and multidisciplinary team ("Heart Team"), based on the clinical presentation, coronary anatomy, ischemic burden, left ventricular function, in-hospital surgical risk and individual patient risk.

Charcot and vascular Parkinsonism.

Jean-Martin Charcot (1825-1893), recognized as the founder of Neurology and the first formal teacher of nervous system diseases, died on August 16, 1893, from acute pulmonary edema secondary to myocardial infarction. In his last years, there were several descriptions of his gait and posture disorders, suggesting the diagnosis of "lower-half parkinsonism" due to cerebrovascular disease.

Charcot and vascular Parkinsonism / O parkinsonismo vascular de Charcot

ABSTRACT Jean-Martin Charcot (1825-1893), recognized as the founder of Neurology and the first formal teacher of nervous system diseases, died on August 16, 1893, from acute pulmonary edema secondary to myocardial infarction. In his last years, there were several descriptions of his gait and posture disorders, suggesting the diagnosis of “lower-half parkinsonism” due to cerebrovascular disease.

RESUMO Jean-Martin Charcot (1825-1893) pode ser reconhecido como o fundador da Neurologia, bem como o primeiro professor de doenças do sistema nervoso. Ele morreu no dia 16 de Agosto de 1893, em decorrência de edema agudo de pulmão, secundário a infarto agudo do miocárdio. Nos últimos anos da vida de Charcot, ocorreram várias descrições de anormalidades da sua marcha e da sua postura, sugerindo o diagnóstico de parkinsonismo vascular.

50 años de cirugía de bypass coronario, meditar el pasado, enfrentar el presente y forjar el futuro / Fifty years of coronary artery surgery

Al cumplirse este año 50 años de la cirugía de bypass coronario, introducida y desarrollada por René Favaloro en la Cleveland Clinic, es conveniente meditar el camino seguido previamente por la cirugía para tratar la enfermedad coronaria, analizar cómo la cirugía enfrenta en la actualidad esta grave y frecuente enfermedad, y, si es posible, predecir el rol que ésta jugará en el futuro en el tratamiento de la enfermedad coronaria.

This year is the 50th anniversary of Coronary Artery Bypass Graft surgery, introduced and developed by René Favaloro at The Cleveland Clinic. The occasion calls for meditation about the path followed by surgery to treat coronary artery disease in the past, to analyze how surgery currently faces this serious and frequent disease and, if possible, to predict the role that surgery will play in the future in the treatment of coronary artery disease.