Coronary artery bypass surgery in patients with valvular disease

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Coronary Artery Bypass Surgery Microchapters

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Patient Information

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]

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[1]

Concomitant Valvular Disease (DO NOT EDIT)[1]

Class I
"1. Patients undergoing CABG who have at least moderate aortic stenosis should have concomitant aortic valve replacement.[2][3][4][5] (Level of Evidence: B)"
"2. Patients undergoing CABG who have severe ischemic mitral valve regurgitation not likely to resolve with revascularization should have concomitant mitral valve repair or replacement at the time of CABG.[6][7][8][9][10][11] (Level of Evidence: B)"
Class IIa
"1. In patients undergoing CABG who have moderate ischemic mitral valve regurgitation not likely to resolve with revascularization, concomitant mitral valve repair or replacement at the time of CABG is reasonable.[6][7][8][9][10][11] (Level of Evidence: B)"
Class IIb
"1. Patients undergoing CABG who have mild aortic stenosis may be considered for concomitant aortic valve replacement when evidence (eg, moderate–severe leaflet calcification) suggests that progression of the aortic stenosis may be rapid and the risk of the combined procedure is acceptable. (Level of Evidence: C)"

Sources

  • 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. Filsoufi F, Aklog L, Adams DH, Byrne JG (2002). "Management of mild to moderate aortic stenosis at the time of coronary artery bypass grafting". The Journal of Heart Valve Disease. 11 Suppl 1: S45–9. PMID 11843520. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  3. Smith WT, Ferguson TB, Ryan T, Landolfo CK, Peterson ED (2004). "Should coronary artery bypass graft surgery patients with mild or moderate aortic stenosis undergo concomitant aortic valve replacement? A decision analysis approach to the surgical dilemma". Journal of the American College of Cardiology. 44 (6): 1241–7. doi:10.1016/j.jacc.2004.06.031. PMID 15364326. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  4. Pereira JJ, Balaban K, Lauer MS, Lytle B, Thomas JD, Garcia MJ (2005). "Aortic valve replacement in patients with mild or moderate aortic stenosis and coronary bypass surgery". The American Journal of Medicine. 118 (7): 735–42. doi:10.1016/j.amjmed.2005.01.072. PMID 15989907. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  5. Gillinov AM, Garcia MJ (2005). "When is concomitant aortic valve replacement indicated in patients with mild to moderate stenosis undergoing coronary revascularization?". Current Cardiology Reports. 7 (2): 101–4. PMID 15717955. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  6. 6.0 6.1 Gillinov AM, Wierup PN, Blackstone EH, Bishay ES, Cosgrove DM, White J, Lytle BW, McCarthy PM (2001). "Is repair preferable to replacement for ischemic mitral regurgitation?". The Journal of Thoracic and Cardiovascular Surgery. 122 (6): 1125–41. doi:10.1067/mtc.2001.116557. PMID 11726887. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  7. 7.0 7.1 Aklog L, Filsoufi F, Flores KQ, Chen RH, Cohn LH, Nathan NS, Byrne JG, Adams DH (2001). "Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation?". Circulation. 104 (12 Suppl 1): I68–75. PMID 11568033. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  8. 8.0 8.1 Trichon BH, Glower DD, Shaw LK, Cabell CH, Anstrom KJ, Felker GM, O'Connor CM (2003). "Survival after coronary revascularization, with and without mitral valve surgery, in patients with ischemic mitral regurgitation". Circulation. 108 Suppl 1: II103–10. doi:10.1161/01.cir.0000087656.10829.df. PMID 12970217. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  9. 9.0 9.1 Fattouch K, Guccione F, Sampognaro R, Panzarella G, Corrado E, Navarra E, Calvaruso D, Ruvolo G (2009). "POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: a randomized trial". The Journal of Thoracic and Cardiovascular Surgery. 138 (2): 278–85. doi:10.1016/j.jtcvs.2008.11.010. PMID 19619766. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  10. 10.0 10.1 Fattouch K, Sampognaro R, Speziale G, Salardino M, Novo G, Caruso M, Novo S, Ruvolo G (2010). "Impact of moderate ischemic mitral regurgitation after isolated coronary artery bypass grafting". The Annals of Thoracic Surgery. 90 (4): 1187–94. doi:10.1016/j.athoracsur.2010.03.103. PMID 20868812. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  11. 11.0 11.1 Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ (2003). "Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography". Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 16 (7): 777–802. doi:10.1016/S0894-7317(03)00335-3. PMID 12835667. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)

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