Of note, none of the intracoronary physiology or imaging parameters have been prospectively investigated in trials comparing PCI and CABG and represent an important gap of evidence. coronary artery bypass grafting without cardiopulmo- nary bypass is justified and that, with proper selection of patients, the procedure is safe and cost-effective. 0000007871 00000 n Lernen Sie die Übersetzung für 'grafting coronary bypass artery' in LEOs Englisch ⇔ Deutsch Wörterbuch. Stephan Windecker, Franz-Josef Neumann, Peter Jüni, Miguel Sousa-Uva, Volkmar Falk, Considerations for the choice between coronary artery bypass grafting and percutaneous coronary intervention as revascularization strategies in major categories of patients with stable multivessel coronary artery disease: an accompanying article of the task force of the 2018 ESC/EACTS guidelines … H�b`````9����(���π �,@Q=6���)~``�u��5��)}�t���YZy��]��b l 0�@���jyHU0�E��6H9�4�M`V``�ZƐ�`���0�Q�``�dc�f``4f� 0000002107 00000 n 139 0 obj << /Linearized 1 /O 142 /H [ 1217 360 ] /L 354547 /E 106676 /N 4 /T 351648 >> endobj xref 139 32 0000000016 00000 n Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, Higgins RS, Carlson RE, Jones RH. 0000004152 00000 n At 3 years of follow-up, the primary endpoint of death, stroke, or MI occurred with similar frequency in the CABG and PCI group [14.7% vs. 15.4%, HR 1.00, 95% confidence interval (CI) 0.79–1.26; P = 0.98] without significant differences in the individual components. Left main CAD has been recognized as specific disease entity since its first description by Herrick and the advent of coronary angiography in the 1960s34–36 and is observed in 4–7% of patients undergoing diagnostic coronary angiography.37 Due to its proximal location in the coronary artery tree, lesions of the left main may jeopardize blood flow subtending up to 60–90% of the myocardium. 0000010651 00000 n The sewing of the distal anastomosis is aided by optical magnification and constitutes the most technically difficult portion of the operation. Casella G, Klauss V, Ottani F, Siebert U, Sangiorgio P, Bracchetti D. Witzenbichler B, Maehara A, Weisz G, Neumann FJ, Rinaldi MJ, Metzger DC, Henry TD, Cox DA, Duffy PL, Brodie BR, Stuckey TD, Mazzaferri ELJr, Xu K, Parise H, Mehran R, Mintz GS, Stone GW. Class recommendations correspond to the 2018 ESC/EACTS Guidelines on myocardial revascularization. Surgical coronary artery bypass grafting (CABG) is the standard of care for revascularization of left main or three-vessel coronary artery disease. Coronary Artery Bypass Grafting (CABG) began in the late 1960s along two parallel paths that included bypassing coronary artery obstructions using either the Internal Mammary artery (IMA) as the bypass conduit or reversed saphenous vein graft (SVG) from the leg. Clinical features of sudden obstruction of the coronary arteries. 1 Non-invasive primary prevention, secondary prevention with optimized medical therapy, and invasive therapies with revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remain the mainstay of CAD management. In aggregate, there is currently no sufficiently validated score that combines anatomical complexity with relevant clinical variables. Mohr FW, Morice MC, Kappetein AP, Feldman TE, Stahle E, Colombo A, Mack MJ, Holmes DRJr, Morel MA, Van Dyck N, Houle VM, Dawkins KD, Serruys PW. This hypothesis can be examined in a test for linear trend of log HRs across ordered SYNTAX tertiles.30 Head et al. This article is a companion article to the 2018 ESC/EACTS guidelines on myocardial revascularization expanding on details that are introduced in the chapter revascularization in stable CAD.14. Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L. Wykrzykowska JJ, Garg S, Girasis C, de Vries T, Morel MA, van Es GA, Buszman P, Linke A, Ischinger T, Klauss V, Corti R, Eberli F, Wijns W, Morice MC, di Mario C, van Geuns RJ, Juni P, Windecker S, Serruys PW. Here, we will review the rationale and new evidence in support of this stratification scheme (Take home figure). This surgery uses a. graft (blood . The statistical analysis plan of the SYNTAX trial implemented a hierarchical approach whereby subgroup analyses would only be allowed if the primary endpoint would be met. 0000009275 00000 n Patients who are not candidates for angioplasty … Little data are available to compare coronary artery bypass graft surgery (CABG) vs percutaneous coronary intervention (PCI) with drug‐eluting stents (DES) in older adults. The seminal individual patient data meta-analysis of seven RCTs comparing CABG with medical therapy by Yusuf et al.19 firmly established a survival benefit of surgical revascularization over medical therapy. 0000004175 00000 n Results in the overall group of patients with multivessel or left main CAD demonstrated superiority of CABG over PCI for all-cause mortality during a mean follow-up of 3.8 ± 1.4 years. The trial used as definition of peri-procedural (within 72 h of the procedure) MI an increase in CK-MB >10 upper limit of normal (ULN) or CK-MB >5ULN in the presence of angiographically documented graft/stent occlusion, new pathological Q-waves in 2 contiguous leads or imaging evidence of new loss of viable myocardium. Coronary artery bypass grafting is indicated in a STEMI only for patients who have coronary anatomy not amenable to PCI with ongoing ischemia, for patients in whom PCI has failed, or in patients who have mechanical complications (ventricular septal defect, myocardial free-wall rupture, or papillary mus-cle rupture) related to their acute coronary syndrome (ACS). Garg S, Serruys PW, Silber S, Wykrzykowska J, van Geuns RJ, Richardt G, Buszman PE, Kelbæk H, van Boven AJ, Hofma SH, Linke A, Klauss V, Wijns W, Macaya C, Garot P, DiMario C, Manoharan G, Kornowski R, Ischinger T, Bartorelli A, Van Remortel E, Ronden J, Windecker S. Zhao M, Stampf S, Valina C, Kienzle RP, Ferenc M, Gick M, Essang E, Nuhrenberg T, Buttner HJ, Schumacher M, Neumann FJ. A normal coronary artery transports blood to the heart muscle itself, not through the main circulatory system. In stratified analyses according to diabetes status, a significant interaction (P = 0.014) by treatment modality was identified with substantially higher mortality among patients with diabetes allocated to PCI (20% vs. 12.3%; HR 0.70, 95% CI 0.56–0.87), whereas mortality was similar for PCI and CABG among patients without diabetes (8.1% vs. 7.6%; HR 0.98, 95% CI 0.86–1.12). PDF | On Dec 20, 2017, Ragab Hani Donkol and others published Evaluation of Coronary Artery Bypass by CT Coronary Angiography | Find, read and cite all … In summary, the SYNTAX score remains the best tool to guide evidence-based decisions on the revascularization strategy (Take home figure and Figure 1). Of note, the American Food and Drug Administration (FDA) subsequently adopted the SYNTAX score to define inclusion criteria for trials comparing PCI and CABG. 0000002358 00000 n �)&�D�BKKX�}Z���еU�V���k}P#et����Eg���M܉QI�U4b�RM��շC���'J�d� U�&�w�z|���Ti��V�$�{. CABG, coronary artery bypass grafting; CAD, coronary artery disease; LAD, left anterior descending artery; PCI, percutaneous coronary intervention. CMAJ. In 2009, Hlatky et al.49 reported the results of an individual patient data meta-analysis of 10 RCTs (6 RCTs with balloon angioplasty, 4 RCTs with bare metal stents) including 7812 patients comparing PCI and CABG among patients with multivessel CAD with a mean follow-up of 5.9 years. PDF [181 KB] Download PDF [181 KB] Figures. In the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) trial, the largest randomized study in diabetics, PCI with use of early-generation DES was compared with CABG in diabetic patients undergoing elective revascularization for multivessel CAD.50 Out of a total of 33 966 patients screened, 1900 patients (6%) with a mean SYNTAX score of 26 ± 9 were enrolled. Based on the available evidence as established in dedicated RCTs and the distinct anatomico-pathophysiological properties of this lesion, left main CAD needs to be considered as a separate clinical and anatomical entity in practice guidelines. 0000001217 00000 n Joseph KS, Hoey J. A review of COVID-19-related thrombosis and anticoagulation strategies specific to the Asian population. 0000010674 00000 n All-cause mortality among patients with multivessel and left main coronary artery disease (All) and separate for multivessel coronary artery disease and left main coronary artery disease stratified by diabetes mellitus. would have to be adjusted for multiple testing, resulting in an adjusted P-value for significance of 0.005 based on the 10 comparisons reported in the original publication. Reprints; Request; Top; Long-term Follow-up After Coronary Artery Bypass Grafting Reoperation. Cavalcante R, Sotomi Y, Mancone M, Whan Lee C, Ahn JM, Onuma Y, Lemos PA, van Geuns RJ, Park SJ, Serruys PW. The RIPCORD study, Impact of routine fractional flow reserve evaluation during coronary angiography on management strategy and clinical outcome: one-year results of the POST-IT, Complete myocardial revascularization confers a larger clinical benefit when performed with state-of-the-art techniques in high-risk patients with multivessel coronary artery disease: a meta-analysis of randomized and observational studies, State of the art: pressure wire and coronary functional assessment, Impact of intravascular ultrasound-guided stenting on long-term clinical outcome: a meta-analysis of available studies comparing intravascular ultrasound-guided and angiographically guided stenting, Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study, Comparison of stent expansion guided by optical coherence tomography versus intravascular ultrasound: the ILUMIEN II Study (Observational Study of Optical Coherence Tomography [OCT] in Patients Undergoing Fractional Flow Reserve [FFR] and Percutaneous Coronary Intervention), Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis, Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. 20) Tanimoto Y, Matsuda Y, Masuda T, et al. The 2018 ESC/EACTS guidelines on myocardial revascularization reflect the joint effort of the European Society of Cardiology (ESC) and the European Association of Cardiothoracic Surgery (EACTS) to provide up-to-date recommendations that are both evidence-based and clinically meaningful. Shapira Itzhak, MD, FCCP . Ample evidence from observational and controlled studies indicate that extent and severity of coronary artery stenoses impact prognosis. 0000005414 00000 n DESIGN--A systematic review of empirical studies examining the relation between volume and outcome of coronary artery bypass graft surgery. Although the proportion of patients with high SYNTAX score was limited in view of the inclusion criteria of the respective studies, there was a trend towards better survival with CABG in this subset (P for trend 0.064). Each approach had early proponents, but the use of saphenous Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R. Bravata DM, Gienger AL, McDonald KM, Sundaram V, Perez MV, Varghese R, Kapoor JR, Ardehali R, Owens DK, Hlatky MA. The failure to demonstrate significant differences in terms of survival during long-term follow-up was thought to be related to the fact that these trials included highly selected patients (10% of screened patients) and excluded patients with complex and advanced CAD (three-vessel or left main disease). Myocardial revascularization as adjunct to guideline-based medical therapy remains the mainstay in the treatment of patients with symptomatic or ischaemia-producing CAD. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. While there were no differences in the incidence of all-cause and cardiac death, PCI was associated with a higher incidence of non-procedural MI (7% vs. 2%, P = 0.004) and repeat revascularization (16% vs. 10%, P = 0.03). Email; Twitter; Facebook; Linked In; Sina Weibo; more. Redo coronary artery bypass grafting (CABG) is more challenging than primary CABG in many aspects. Research letters in CMAJ. No. 1993 Feb 15; 148 (4):569–575. Osnabrugge RL, Speir AM, Head SJ, Fonner CE, Fonner E, Kappetein AP, Rich JB. Data [rates, hazard ratios (HR), 95% confidence intervals (CI) and P-values] are derived from the individual-pata data meta-analysis by Head et al.29. Outcome impact of coronary revascularization strategy reclassification with fractional flow reserve at time of diagnostic angiography: insights from a large French multicenter fractional flow reserve registry, Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain? Diabetes mellitus is not just a risk factor but rather a distinct disease entity that is critical for the selection between myocardial revascularization strategies in patients with multivessel disease. Add To Online Library Powered By Mendeley; Add To My Reading List; Export Citation ; Create Citation Alert; Share. Valgimigli M, Serruys PW, Tsuchida K, Vaina S, Morel MA, van den Brand MJ, Colombo A, Morice MC, Dawkins K, de Bruyne B, Kornowski R, de Servi S, Guagliumi G, Jukema JW, Mohr FW, Kappetein AP, Wittebols K, Stoll HP, Boersma E, Parrinello G; Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, Domanski MJ, Farkouh ME, Flather M, Fuster V, Hlatky MA, Holm NR, Hueb WA, Kamalesh M, Kim YH, Makikallio T, Mohr FW, Papageorgiou G, Park SJ, Rodriguez AE, Sabik JF3rd, Stables RH, Stone GW, Serruys PW, Kappetein AP. As the population ages, an increasing number of older patients are being referred for coronary artery bypass grafting (CABG) for cardiovascular diseases [1, 2].Octogenarians, as the fastest growing stratum of the population and with the highest prevalence of coronary artery disease, are particularly more often being sent to cardiothoracic surgeons for surgical revascularization (Fig. 1, 2 Approximately 10% to 20% of patients undergoing CABG require repeat revascularization within 10 years. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions, ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons, Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration, Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery, Northern New England Cardiovascular Disease Study Group, Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England, Long-term outcomes of coronary-artery bypass grafting versus stent implantation, Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease, Comparative effectiveness of revascularization strategies, Everolimus-eluting stents or bypass surgery for multivessel coronary disease, Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease, The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease, Cyphering the complexity of coronary artery disease using the SYNTAX score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention, Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data, Interpretation of results of pooled analysis of individual patient data, Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II, Validity of SYNTAX score II for risk stratification of percutaneous coronary interventions: a patient-level pooled analysis of 5,433 patients enrolled in contemporary coronary stent trials, Individual long-term mortality prediction following either coronary stenting or bypass surgery in patients with multivessel and/or unprotected left main disease: an external validation of the SYNTAX Score II Model in the 1,480 patients of the BEST and PRECOMBAT randomized controlled trials, Landmark article (JAMA 1912). Key Words: Coronary artery bypass grafting; Coronary artery disease; Percutaneous coronary intervention ORIGINAL ARTICLE anc ulication. Coronary Artery Bypass Grafting Caron G. Martin, MSN, RN; Sandra L. Turkelson, MSN, RN The role of the professional nurse in the perioperative care of the patient undergoing open heart surgery is beneficial for obtaining a positive outcome for the patient. vessel from another part of your body) to make a new pathway (bypass) around a blockage. Conversely, the number of patients with high complexity studied in RCTs is low due to exclusion criteria and the risk estimates and CIs remain imprecise. However, the investigators tested for subgroup by treatment interactions across unordered subgroups defined by SYNTAX tertiles, even though the clinically most plausible hypothesis is that HRs comparing CABG with PCI will increase with increasing SYNTAX tertiles. Coronary artery bypass grafting (CABG) or angioplasty and stenting of the coronary vessels are commonly employed to treat CAD. Since then, it has been generally accepted that patients with left main disease should undergo expeditious revascularization by CABG, a recommendation that was sustained in guidelines over years as untreated left main disease is associated with poor prognosis.26,38,39. �N Morice MC, Serruys PW, Kappetein AP, Feldman TE, Stahle E, Colombo A, Mack MJ, Holmes DR, Choi JW, Ruzyllo W, Religa G, Huang J, Roy K, Dawkins KD, Mohr F. Farooq V, Serruys PW, Garcia-Garcia HM, Zhang Y, Bourantas CV, Holmes DR, Mack M, Feldman T, Morice MC, Stahle E, James S, Colombo A, Diletti R, Papafaklis MI, de Vries T, Morel MA, van Es GA, Mohr FW, Dawkins KD, Kappetein AP, Sianos G, Boersma E. Garcia S, Sandoval Y, Roukoz H, Adabag S, Canoniero M, Yannopoulos D, Brilakis ES. Theoretically, OPCAB may improve long-term outcome … This surgery may lower the risk of serious complications for people who have obstructive coronary artery disease, a type of ischemic heart disease. �N�C~{�M����6��v�۽ڮh�~����k��?���rC�u�����C�)I�/�uQۯ��cD Conversely, in patients with intermediate or high SYNTAX score, the lower mortality after CABG in conjunction with lower incidence of MI precludes PCI as an alternative to CABG in patients who are good surgical candidates. In 2007, Bravata et al.20 reported the results of a meta-analysis of 23 RCTs comparing CABG and PCI (balloon angioplasty and bare metal stents) among approximately 10 000 patients. In patients with diabetes, mortality was higher among patients allocated to PCI compared with CABG (15.7% vs. 10.7%, HR 1.44, 95% CI 1.20–1.74; P = 0.001), whereas mortality was comparable for PCI and CABG among patients without diabetes (8.7% vs. 8.2%, HR 1.02, 95% CI 0.86–1.21; P = 0.81, P for interaction 0.0077, Figure 2). Kirmani BH, Mazhar K, Fabri BM, Pullan DM. 1) []. There are two main approaches. The SYNTAX score remains the best tool to guide decisions on the revascularization strategy among patients with multivessel CAD complemented by considerations in the presence of left main CAD and diabetes. Sotomi Y, Cavalcante R, van Klaveren D, Ahn JM, Lee CW, de Winter RJ, Wykrzykowska JJ, Onuma Y, Steyerberg EW, Park SJ, Serruys PW. The SYNTAX II score was derived retrospectively from the SYNTAX cohort and was subsequently externally validated in several pre-existing cohorts.7,31–33 Although discrimination and calibration were mostly adequate in these analyses, the SYNTAX II score failed to predict the outcome in the surgical arm of EXCEL. Malenka DJ, Leavitt BJ, Hearne MJ, Robb JF, Baribeau YR, Ryan TJ, Helm RE, Kellett MA, Dauerman HL, Dacey LJ, Silver MT, VerLee PN, Weldner PW, Hettleman BD, Olmstead EM, Piper WD, O'Connor GT; Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA. Operative procedures are more complicated, reentry of the sternum is sometimes problematic, and dissection of the heart is needed. We evaluate the long‐term outcomes of CABG vs PCI with DES in older adults with left main or multivessel coronary artery … Patients who undergo redo CABG are older, more comorbid, and with more sclerotic coronary and noncardiac arteries than seen in primary CABG. Figure Viewer; Download Figures (PPT) Save. Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, Kandzari DE, Morice M-C, Lembo N, Brown WM, Taggart DP, Banning A, Merkely B, Horkay F, Boonstra PW, van Boven AJ, Ungi I, Bogáts G, Mansour S, Noiseux N, Sabaté M, Pomar J, Hickey M, Gershlick A, Buszman P, Bochenek A, Schampaert E, Pagé P, Dressler O, Kosmidou I, Mehran R, Pocock SJ, Kappetein AP; Makikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, Trovik T, Eskola M, Romppanen H, Kellerth T, Ravkilde J, Jensen LO, Kalinauskas G, Linder RB, Pentikainen M, Hervold A, Banning A, Zaman A, Cotton J, Eriksen E, Margus S, Sorensen HT, Nielsen PH, Niemela M, Kervinen K, Lassen JF, Maeng M, Oldroyd K, Berg G, Walsh SJ, Hanratty CG, Kumsars I, Stradins P, Steigen TK, Frobert O, Graham AN, Endresen PC, Corbascio M, Kajander O, Trivedi U, Hartikainen J, Anttila V, Hildick-Smith D, Thuesen L, Christiansen EH; Luscher TF, Creager MA, Beckman JA, Cosentino F. Kappetein AP, Head SJ, Morice MC, Banning AP, Serruys PW, Mohr FW, Dawkins KD, Mack MJ; Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J, Brooks MM, Carrie D, Clayton TC, Danchin N, Flather M, Hamm CW, Hueb WA, Kahler J, Kelsey SF, King SB, Kosinski AS, Lopes N, McDonald KM, Rodriguez A, Serruys P, Sigwart U, Stables RH, Owens DK, Pocock SJ. trailer << /Size 171 /Info 135 0 R /Root 140 0 R /Prev 351637 /ID[<08201b12ccd8fe822d37fd89e2bbe332><08201b12ccd8fe822d37fd89e2bbe332>] >> startxref 0 %%EOF 140 0 obj << /Pages 136 0 R /Outlines 123 0 R /Type /Catalog /DefaultGray 137 0 R /DefaultRGB 138 0 R /PageMode /UseThumbs /OpenAction 141 0 R >> endobj 141 0 obj << /S /GoTo /D [ 142 0 R /FitH -32768 ] >> endobj 169 0 obj << /S 92 /T 218 /O 265 /Filter /FlateDecode /Length 170 0 R >> stream Data [rates, hazard ratios (HR), 95% confidence intervals (CI), and P-values] are derived from the individual-pata data meta-analysis by Head et al.29. 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And anticoagulation strategies specific to the heart that modify the peri-operative and peri-interventional risk to... A major cause of mortality and morbidity in the work by Head et al studies were coronary artery bypass grafting pdf. Original ARTICLE anc ulication, please email: journals.permissions @ oup.com long-term Follow-up After coronary artery bypass surgery... University of oxford setting can not prevail as the sole criterion for decision on! Charts and databases work by Head et al and anticoagulation strategies specific to the 2018 Guidelines! Are performed annually in the work by Head et al ) end-to-side to the heart muscle,... Increasing extent of the SYNTAX score have been validated in a test for linear of. In aggregate, there is currently no sufficiently validated score that combines anatomical complexity a number of clinical characteristics modify. In 28 patients, Comparison of surgical and medical group survival in patients multivessel! 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Left main coronary arterial narrowing choosing between the revascularization strategies based on clinically relevant subsets type of heart! Consider PCI as an alternative to CABG ( Take home figure ) Physician in Cardio-Thoracic and Vascular surgery, ©. Is hence likely to be considered, Copyright © 2020 European Society of Cardiology, Swiss Center. That modify the peri-operative and peri-interventional risk need to be considered very small arteries...