Coronary artery bypass surgery perioperative management of myocardial dysfunction

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Overview

Pathophysiology

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

Indications for CABG

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Perioperative Management

Perioperative Monitoring

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Surgical Procedure

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Intervention in left main coronary artery disease
The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)
Minimally Invasive CABG
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Conduits Used for Bypass
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Post-Operative Care and Complications

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

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Anomalous Coronary Arteries
COPD/Respiratory Insufficiency
Existing Renal Disease
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Previous Cardiac Surgery
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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]

Perioperative Myocardial Dysfunction (DO NOT EDIT)[1]

Class IIa
"1. In the absence of severe, symptomatic aorto-iliac occlusive disease or peripheral artery disease, the insertion of an intra-aortic balloon is reasonable to reduce mortality rate in CABG patients who are considered to be at high risk (eg, those who are undergoing reoperation or have LVEF <30% or left main CAD).[2][3][4][5][6][7] (Level of Evidence: B)"
"2. Measurement of biomarkers of myonecrosis (eg, creatine kinase-MB, troponin) is reasonable in the first 24 hours after CABG.[8] (Level of Evidence: B)"

Transfusion (DO NOT EDIT)[1]

Class I
"1. Aggressive attempts at blood conservation are indicated to limit hemodilutional anemia and the need for intraoperative and perioperative allogeneic red blood cell transfusion in CABG patients.[9][10][11][12] (Level of Evidence: B)"

Preconditioning/Management of Myocardial Ischemia (DO NOT EDIT)[1]

Class I
"1. Management targeted at optimizing the determinants of coronary arterial perfusion (eg, heart rate, diastolic or mean arterial pressure, and right ventricular or LV end-diastolic pressure) is recommended to reduce the risk of perioperative myocardial ischemia and infarction.[13][14][15][16][17] (Level of Evidence: B)"
Class IIa
"1. Volatile-based anesthesia can be useful in reducing the risk of perioperative myocardial ischemia and infarction.[18][19][20][21] (Level of Evidence: A)"
Class IIb
"1. The effectiveness of prophylactic pharmacological therapies or controlled reperfusion strategies aimed at inducing preconditioning or attenuating the adverse consequences of myocardial reperfusion injury or surgically induced systemic inflammation is uncertain.[22][23][24][25][26][27][28][29] (Level of Evidence: A)"
2. Mechanical preconditioning might be considered to reduce the risk of perioperative myocardial ischemia and infarction in patients undergoing off-pump CABG.[30][31][32] (Level of Evidence: B)"
"3. Remote ischemic preconditioning strategies using peripheral-extremity occlusion/reperfusion might be considered to attenuate the adverse consequences of myocardial reperfusion injury.[33][34][35] (Level of Evidence: B)"
4. The effectiveness of postconditioning strategies to attenuate the adverse consequences of myocardial reperfusion injury is uncertain.[36][37] (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 1.3 1.4 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. Christenson JT, Cohen M, Ferguson JJ, Freedman RJ, Miller MF, Ohman EM; et al. (2002). "Trends in intraaortic balloon counterpulsation complications and outcomes in cardiac surgery". Ann Thorac Surg. 74 (4): 1086–90, discussion 1090-1. PMID 12400750.
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  18. Landoni G, Biondi-Zoccai GG, Zangrillo A, Bignami E, D'Avolio S, Marchetti C; et al. (2007). "Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials". J Cardiothorac Vasc Anesth. 21 (4): 502–11. doi:10.1053/j.jvca.2007.02.013. PMID 17678775.
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  21. Yu CH, Beattie WS (2006). "The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: a meta-analysis". Can J Anaesth. 53 (9): 906–18. doi:10.1007/BF03022834. PMID 16960269.
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