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Medicina
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New Insights into Coronary Artery Bypass
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New Insights into Coronary Artery Bypass

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 20 November 2026 | Viewed by 1831

Special Issue Editors

Dr. Augusto D'Onofrio

E-Mail Website
Guest Editor
Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy
Interests: TAVI; arch repair; valve sparing; total arterial bypass
Dr. Dario Buioni

E-Mail Website
Guest Editor Assistant
Cardiac Surgery Division, Tor Vergata University Hospital, 00133 Rome, Italy
Interests: coronary artery bypass grafting; cardiac surgery; frailty; vascular aging; age related syndrome; sarcopenia; malnutrition

Special Issue Information

Dear Colleagues,

Background and history of this topic: Coronary artery bypass grafting (CABG) remains the main choice in multivessel disease, providing good long-term results with low complication rates. Currently, the profiles of patients undergoing coronary artery bypass grafting suggest that they are at higher risk than patients in the past. Multiple arterial bypass grafting, especially when associated with anaortic techniques, may lead to the best long-term results. A higher emphasis is being placed on flowmetry in the operating room. An increasing number of cases are being treated with minimally invasive and/or robotic techniques. Therefore, it is necessary to develop a personalized surgical approach based on the clinical and anatomical characteristics of the patient and the experience of the team to achieve the best results.

Aim and scope of the Special Issue: We welcome submissions on the best surgical technical approaches, patient selection, indications, graft selection, the results of minimally invasive procedures, the growth of the robotic approach, and strategies for patients with heart failure in order to optimize outcomes in patients treated with CABG.

Cutting-edge research: We invite colleagues around the world to report their clinical experience in coronary artery bypass for this Special Issue of Medicina in order to provide guidance in this fundamental area of the daily life of hospital workers.

What kind of papers we are soliciting: We welcome research articles, reviews and other types.

Dr. Augusto D'Onofrio
Guest Editor

Dr. Dario Buioni
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardioplegia
  • minithoracotomy
  • off pump
  • total arterial bypass
  • robotic approach
  • hybrid coronary revascularization
  • artificial intelligence

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Published Papers (3 papers)

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Research

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10 pages, 1179 KB  
Article
Incidence, Clinical Characteristics and Outcomes of Severe Prosthesis–Patient Mismatch in Patients Undergoing TAVI with Large Aortic Annuli
by Mohamed Ali, Muntaser Omari, Debbie Stewart, Sarah Lamb, Timothy Cartlidge, Rajiv Das, Richard Edwards, Azfar Zaman, Mohamed Farag and Mohammad Alkhalil
Medicina 2026, 62(5), 892; https://doi.org/10.3390/medicina62050892 - 6 May 2026
Viewed by 249
Abstract
Background and Objectives: Recent studies have focused on evaluating the hemodynamic results in patients undergoing transcatheter aortic valve implantation (TAVI) with small aortic annuli. There is limited data on the incidence, clinical characteristics, and mortality of prosthesis–patient mismatch (PPM) in patients undergoing [...] Read more.
Background and Objectives: Recent studies have focused on evaluating the hemodynamic results in patients undergoing transcatheter aortic valve implantation (TAVI) with small aortic annuli. There is limited data on the incidence, clinical characteristics, and mortality of prosthesis–patient mismatch (PPM) in patients undergoing TAVI with large aortic annuli. Materials and Methods: This is a retrospective analysis of consecutive patients with severe aortic stenosis and large annuli who underwent TAVI at a single UK center. PPM was defined according to the Valve Academic Research Consortium (VARC-3) criteria and identified using echocardiography within 4–6 weeks following TAVI. Measurements were analyzed by an experienced operator who was blinded to the type of valve platform and clinical outcomes. Results: A total of 447 patients were screened, of whom 353 patients were included in the analysis. The incidence of any PPM or severe PPM was 38% and 15% of patients, respectively. Patients with severe PPM were younger, had larger body surface area, and were more likely to receive a balloon-expandable valve (BEV). At a mean follow-up of 35 months, mortality was numerically higher in patients with severe PPM (46% vs. 36%, p = 0.20) but this did not reach statistical significance. Similar mortality rates were observed among patients with or without severe PPM in those who received SEV as well as BEV. There was a differential role of body surface area in mortality in patients who developed severe PPM versus non-severe PPM. Conclusions: Severe PPM was evident in patients with large aortic annuli undergoing TAVI, particularly those who received BEV. Nonetheless, severe PPM did not impact mortality rate at three-year follow-up. Longer-term follow-up may be required to assess the impact of severe PPM on mortality. Full article
(This article belongs to the Special Issue New Insights into Coronary Artery Bypass)
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16 pages, 530 KB  
Article
Impact of Periprocedural Risk Predictors on Long-Term Outcomes in Patients with Diabetes Undergoing Coronary Artery Bypass Grafting
by Aleksander Dokollari, Serge Sicouri, Basel Ramlawi, MaryAnn Wertan and Francis P. Sutter
Medicina 2026, 62(1), 71; https://doi.org/10.3390/medicina62010071 - 29 Dec 2025
Viewed by 583
Abstract
Background and Objectives: In this study, we aim to analyze the impact of risk predictors on long-term outcomes in patients with diabetes undergoing isolated coronary artery bypass grafting (CABG). Materials and Methods: All consecutive patients undergoing isolated CABG between May 2005 and June [...] Read more.
Background and Objectives: In this study, we aim to analyze the impact of risk predictors on long-term outcomes in patients with diabetes undergoing isolated coronary artery bypass grafting (CABG). Materials and Methods: All consecutive patients undergoing isolated CABG between May 2005 and June 2021 were included in the study. Patients with and without diabetes were compared for baseline demographics and pre-operative characteristics. A propensity-matched analysis was used to compare the two groups. The primary outcome was long-term incidence of all-cause death. Results: Of a total of 4871 patients, propensity matching identified 1589 pairs of patients with and without diabetes that were included in the current study. Median follow-up was 5.8 years. All-cause death was recorded in 215/1589 (13.5%) vs. 169/1589 (10.6%) patients with and without diabetes, respectively (HR 1.3, p = 0.013). MACCE was also significantly higher in diabetic patients (HR 1.3, p = 0.049). Diabetes mellitus was identified as one of the independent predictors for all-cause mortality (HR 1.4, CI 1.2, 1.7) and MACCE (HR 1.2, CI 1.0, 1.3). Chronic obstructive pulmonary disease, peripheral vascular disease, and serum creatinine levels >2.0 mg/dL were found to be the only predictors of all-cause mortality in both diabetic and non-diabetic patient groups, when individually analyzed. Conclusions: Patients with diabetes undergoing isolated CABG had a significantly higher incidence of late all-cause death and MACCE compared to those without diabetes. The presence of diabetes mellitus predicts poorer long-term outcomes following CABG. Full article
(This article belongs to the Special Issue New Insights into Coronary Artery Bypass)
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Review

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17 pages, 752 KB  
Review
Mechanical Circulatory Support on Coronary Artery Bypass Grafting for Advanced Ischemic Cardiomyopathy: State of the Art
by Erik J. Orozco-Hernandez, James E. Davies, Sasha Anne Still, Kyle W. Eudailey, Venkateswaran Rajamiyer, Panos N. Vardas, Clifton T. Lewis and William Holman
Medicina 2026, 62(4), 638; https://doi.org/10.3390/medicina62040638 - 27 Mar 2026
Viewed by 571
Abstract
Ischemic cardiomyopathy is defined as coronary artery disease accompanied by left ventricular dysfunction with an ejection fraction equal to or less than 40%. The substrate of ischemic cardiomyopathy is heterogeneous, characterized by the coexistence of normal, stunned, hibernating, and scarred myocardium within the [...] Read more.
Ischemic cardiomyopathy is defined as coronary artery disease accompanied by left ventricular dysfunction with an ejection fraction equal to or less than 40%. The substrate of ischemic cardiomyopathy is heterogeneous, characterized by the coexistence of normal, stunned, hibernating, and scarred myocardium within the same myocardial region. Altogether, these components may represent different phases of a single pathological process. It is well-established that the assessment of isolated myocardial viability and ischemia alone has failed to reliably guide the indication for coronary artery bypass grafting (CABG). CABG in patients with low ejection fraction carries a significant risk of perioperative mortality and morbidity, largely related to the development of postcardiotomy shock. Preoperative optimization with pharmacologic or mechanical circulatory support (MCS) is often essential; the decision requires integrating multiple complex factors, including clinical presentation, response to optimization therapy, myocardial viability, the presence of hibernating or scarred myocardium, left ventricular end-systolic volume index, coronary angiography findings, hemodynamic assessment, and the Pulmonary Arterial Pressure Index score. A preoperative evaluation that incorporates anatomical, morphological, functional, and hemodynamic domains enables more precise selection and timing of MCS. Preemptive left ventricular unloading mitigates the physiological impact of cardiopulmonary bypass, preserves end-organ perfusion, and reduces the need for high-dose vasopressors. However, the risk–benefit ratio remains uncertain and may be associated with serious complications. Careful judgment regarding the indications for MCS has the potential to enhance the safety of CABG in high-risk patients, but robust, long-term, prospective studies are needed to determine its true impact on clinical outcomes. In this review, we will examine the indications and criteria for the use of MCS in patients with advanced ischemic cardiomyopathy, as well as the various devices available for preoperative or intraoperative support, including technical considerations, advantages and disadvantages, and associated complications. Full article
(This article belongs to the Special Issue New Insights into Coronary Artery Bypass)
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