Upcoming expert opinions on adult coronary surgery

Central MessageIn upcoming issues of the Journal, readers will have access to a number high-impact Invited Expert Opinion articles on important topics in coronary surgery. In This year, surgery ranging from continued debate surrounding multiple arterial grating (MAG) optimal use graft flow measurement. this era rapidly evolving evidence across field artery bypass grafting (CABG), experts guide clinicians everyday management and intraoperative decision making with goal improving patient care through an evidence-based approach. MAG has seen recent renaissance cardiac Recently published randomized demonstrated superior long-term outcomes associated MAG.1Gaudino M. Benedetto U. Fremes S. Ballman K. Biondi-Zoccai G. Sedrakyan A. et al.Association radial vs saphenous vein cardiovascular among patients undergoing grafting: systematic review meta-analysis.JAMA. 2020; 324: 179-187Crossref PubMed Scopus (36) Google Scholar,2Buxton B.F. Hayward P.A. Raman J. Moten S.C. Rosalion Gordon I. al.Long-term results RAPCO trials.Circulation. 142: 1330-1338Crossref (27) Scholar Few contributed more evolution than Stephen Sunnybrook Health Sciences Centre Ontario, Canada. JTCVS Open, colleagues3Gillmore T. Rocha R.V. S.E. Evidence-based selection second third conduit.J Thorac Cardiovasc Surg Open. 2021; 5C: 66-69Google expertly summarize supporting MAG, particularly long life expectancy. Despite wave promising evidence, remains suboptimal.4Gaudino Rahouma Habib R.H. Hameed Robinson N.B. Farrington W.J. al.Surgeons' practice patterns United States.J Am Coll Cardiol. 76: 1714-1715Crossref (6) Gaudino, Kurlansky, Fremes5Gaudio Kurlansky P. The for improves outcomes: now what?.J Surg. November 10, ([Epub ahead print])Google discuss ways which health systems may disincentivize surgeons' by focusing short-term rather outcomes. another article, Vallely colleagues6Vallely M.P. Ramponi F. Seco Royse Multiarterial why is it so hard convince masses benefits?.J 161: 1832-1836Abstract Full Text PDF (3) directly address 3 major concerns related MAG; namely, lack supportive given neutral Arterial Revascularization Trial, potential increased morbidity mortality, perceived technical complexity. Furthermore, Kurlansky7Kurlansky answer that question.J 1828-1831Abstract (2) maintain “should I MAG?” resounding yes as he explains further research needed. As continues develop, special concern been turned toward specific populations who would benefit most strategy, such older individuals, female patients, comorbid conditions like diabetes. Patients diabetes, particular, present unique challenge surgeons. their Akhrass Bakaeen8Akhrass R. Bakaeen advantage surgical revascularization diabetics multivessel disease: conduits, benefit.J February 27, print])Abstract (4) pathophysiology anatomy disease delve into literature appropriate discusses role MAG. Four leaders distill recently International Study Comparative Effectiveness With Medical Invasive Approaches (ISCHEMIA) trial9Maron D.J. Hochman J.S. Reynolds H.R. Bangalore O'Brien S.M. Boden W.E. al.Initial invasive or conservative strategy stable disease.N Engl J Med. 382: 1395-1407Crossref (599) its implications myocardial article.10Ruel Sun L.Y. Farkouh M.E. Gaudino M.F. Implications ISCHEMIA trial revascularization.J September 9, trial, was designed compare initial ischemic heart disease, found similar both groups at median 3.2 years follow-up. authors explain how these findings do not negate value CABG but highlight importance including medical therapy expert alongside surgeons interventionalists team discussions.10Ruel Brophy11Gaudino Brophy J.M. controversy treatment left main disease.J (0) help critically evaluate trials meta-analyses severe disease. They differences study design led discordant merit percutaneous intervention (PCI) versus CABG, using Evaluation XIENCE Versus Coronary Artery Bypass Surgery Left Main (EXCEL) Percutaneous Angioplasty Grafting Treatment Unprotected Stenosis (NOBLE) low- medium-complexity examples. Based totality current they conclude should be standard care. chronic syndromes unclear. Doenst Sigusch12Doenst Sigusch H. Surgical collateralization: hidden mechanism prognosis syndromes.J argue compared PCI, confers greater benefits only revascularizing myocardium also preventing new infarctions “surgical collateralization” nonflow-limiting lesions. These are identified 85% subsequent infarctions, typically addressed during PCI.12Doenst explanation relates modern well fractional reserve (FFR). FFR, fact, limited CABG. Glineur colleagues13Glineur D. Chong A.Y. Grau What measurement grafting?.J 74-79Google Ottawa Heart Institute summary FFR clear showing superiority angiographic-guided revascularization. applicability aimed addressing acute ischemia, future events. utility determining type (ie, venous).13Glineur Graft patency paramount importance. Microvesicles circulation play thrombosis. Moore Harken14Moore Harken Managing microvesicles Virchow's vicissitude.J suggest increase tissue factor expression etiology thrombosis certain patients. pathway offer specific, targeted therapies prevent occlusion; however, investigation needed before clinical implementation.14Moore Looking forward, Ryan colleagues15Ryan C. Patel V. Rosengart T.K. Clinical angiogenic cellular reprogramming.J March 18, Baylor College Medicine thoughtful therapeutic angiogenesis direct reprogramming. can gap options exist no-option refractory angina failure due Their offers compelling statement state preclinical arena, high translation. Finally, 2 reviews Techniques insight strategies (RA) patency. Most data reintroduction RA attributed James Tatoulis colleagues Melbourne. harvesting preservation strategies, colleagues16Tatoulis artery: component multiarterial considerations harvest.J Tech. 5: 46-55Google pragmatic approach make even unfamiliar surgeon comfortable Additionally, verification becomes common, Bakaeen17Akhrass F.G. Intraoperative validation: friend foe?.J January 05, encourage routine judicious interpretation avoid unnecessary revision. We grateful all contributions no doubt our expertise. Opinions were solicited widely internationally evidence-based, informed decisions improve reported conflicts interest. Journal policy requires editors reviewers disclose interest decline handling reviewing manuscripts conflict article