Coronary artery bypass surgery in patients with end stage existing renal disease

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Overview

Pathophysiology

Saphenous Vein Graft Disease
Other Non-Atherosclerotic Saphenous Vein Graft Diseases

Indications for CABG

Prognosis

Diagnosis

Imaging in the Patient Undergoing CABG

Chest X Ray

Angiography

CT Angiography
MRI Angiography

Trans-Esophageal Echocardiography

Treatment

Goals of Treatment

Perioperative Management

Perioperative Monitoring

Electrocardiographic Monitoring
Pulmonary Artery Catheterization
Central Nervous System Monitoring

Surgical Procedure

Anesthetic Considerations
Intervention in left main coronary artery disease
The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)
Minimally Invasive CABG
Hybrid coronary revascularization
Conduits Used for Bypass
Videos on Spahenous Vein Graft Harvesting
Videos on Coronary Artery Bypass Surgery

Post-Operative Care and Complications

Recommendation for Duration of DAPT in Patients With ACS Treated With CABG

Special Scenarios

Anomalous Coronary Arteries
COPD/Respiratory Insufficiency
Existing Renal Disease
Concomitant Valvular Disease
Previous Cardiac Surgery
Menopause
Carotid Disease evaluation before surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

ACCF/AHA Guidelines for Patients with Renal Dysfunction[1]

Class IIb

"1. In patients with preoperative renal dysfunction (creatinine clearance <60 mL/min), off-pump CABG may be reasonable to reduce the risk of acute kidney injury (AKI).[2][3][4][5][6] (Level of Evidence: B)"

"2. In patients with preexisting renal dysfunction undergoing on-pump CABG, maintenance of a perioperative hematocrit greater than 19% and mean arterial pressure greater than 60 mm Hg may be reasonable. (Level of Evidence: C)"

"3. In patients with preexisting renal dysfunction, a delay of surgery after coronary angiography may be reasonable until the effect of radiographic contrast material on renal function is assessed.[7][8][9] (Level of Evidence: B)"

"4. The effectiveness of pharmacological agents to provide renal protection during cardiac surgery is uncertain.[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] (Level of Evidence: B)"

ACCF/AHA Guidelines for CABG in Patients with End Stage Renal Disease[1]

Class III: HARM

"1. CABG should not be performed in patients with end-stage renal disease whose life expectancy is limited by noncardiac issues. (Level of Evidence: C)"

Class IIb

"1. CABG to improve survival rate may be reasonable in patients with end stage renal disease undergoing CABG for left main coronary artery stenosis of greater than or equal to 50%.[32] (Level of Evidence: C)"

"2. CABG to improve survival rate or to relieve angina despite GDMT may be reasonable for patients with end-stage renal disease with significant stenoses (≥70%) in 3 major vessels or in the proximal LAD artery plus 1 other major vessel, regardless of LV systolic function.[33] (Level of Evidence: B)"

Guidelines Resources

  • 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[1]

References

  1. 1.0 1.1 1.2 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  2. Ascione R, Nason G, Al-Ruzzeh S, Ko C, Ciulli F, Angelini GD (2001). "Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency". The Annals of Thoracic Surgery. 72 (6): 2020–5. PMID 11789787. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  3. Chukwuemeka A, Weisel A, Maganti M, Nette AF, Wijeysundera DN, Beattie WS, Borger MA (2005). "Renal dysfunction in high-risk patients after on-pump and off-pump coronary artery bypass surgery: a propensity score analysis". The Annals of Thoracic Surgery. 80 (6): 2148–53. doi:10.1016/j.athoracsur.2005.06.015. PMID 16305860. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  4. Di Mauro M, Gagliardi M, Iacò AL, Contini M, Bivona A, Bosco P, Gallina S, Calafiore AM (2007). "Does off-pump coronary surgery reduce postoperative acute renal failure? The importance of preoperative renal function". The Annals of Thoracic Surgery. 84 (5): 1496–502. doi:10.1016/j.athoracsur.2007.05.054. PMID 17954051. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  5. Nigwekar SU, Kandula P, Hix JK, Thakar CV (2009). "Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized and observational studies". American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 54 (3): 413–23. doi:10.1053/j.ajkd.2009.01.267. PMID 19406542. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
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  18. Haase M, Haase-Fielitz A, Bagshaw SM, Reade MC, Morgera S, Seevenayagam S, Matalanis G, Buxton B, Doolan L, Bellomo R (2007). "Phase II, randomized, controlled trial of high-dose N-acetylcysteine in high-risk cardiac surgery patients". Critical Care Medicine. 35 (5): 1324–31. doi:10.1097/01.CCM.0000261887.69976.12. PMID 17414730. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  19. Ip-Yam PC, Murphy S, Baines M, Fox MA, Desmond MJ, Innes PA (1994). "Renal function and proteinuria after cardiopulmonary bypass: the effects of temperature and mannitol". Anesthesia and Analgesia. 78 (5): 842–7. PMID 8160980. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
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