Coronary artery bypass surgery prognosis

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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

Coronary artery bypass surgery prognosis On the Web

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powerpoint slides

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Risk calculators for Coronary artery bypass surgery prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Mohammed A. Sbeih, M.D. [3]

Overview

Prognosis following CABG depends on a variety of factors. In general, CABG improves the chances of survival of patients who are at high risk, such as those patients with left main disease. After approximately 5 years the difference in survival rate between those who have had surgery and those treated by drug therapy diminishes. Age at the time of CABG is critical to the prognosis; consequently younger patients with no complicating diseases have a high probability of greater longevity.

In a cohort of 1,388 patients who were 48.9 years at the time of their first surgery (young by today's standards) survival was as follows:

  • 5 years: 93.6%
  • 10 years: 81.1%
  • 15 years: 62.1%
  • 20 years: 46.7%
  • 23 years: 38.4%

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

Public Reporting of Cardiac Surgery Outcomes (DO NOT EDIT)[1]

Class I
"1. Public reporting of cardiac surgery outcomes should use risk-adjusted results based on clinical data.[2][3][4][5][6][7][8][9] (Level of Evidence: B)"

Use of Outcomes or Volume as CABG Quality Measures (DO NOT EDIT)[1]

Class I
"1. All cardiac surgery programs should participate in a state, regional, or national clinical data registry and should receive periodic reports of their risk-adjusted outcomes. (Level of Evidence: C)"
Class IIa
"1. When credible risk-adjusted outcomes data are not available, volume can be useful as a structural metric of CABG quality.[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] (Level of Evidence: B)"
Class IIb
"1. Affiliation with a high-volume tertiary center might be considered by cardiac surgery programs that perform fewer than 125 CABG procedures annually. (Level of Evidence: C)"

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. Geraci JM, Johnson ML, Gordon HS, Petersen NJ, Shroyer AL, Grover FL; et al. (2005). "Mortality after cardiac bypass surgery: prediction from administrative versus clinical data". Med Care. 43 (2): 149–58. PMID 15655428.
  3. Hannan EL, Kilburn H, Lindsey ML, Lewis R (1992). "Clinical versus administrative data bases for CABG surgery. Does it matter?". Med Care. 30 (10): 892–907. PMID 1405795.
  4. Hannan EL, Racz MJ, Jollis JG, Peterson ED (1997). "Using Medicare claims data to assess provider quality for CABG surgery: does it work well enough?". Health Serv Res. 31 (6): 659–78. PMC 1070152. PMID 9018210.
  5. Hartz AJ, Kuhn EM (1994). "Comparing hospitals that perform coronary artery bypass surgery: the effect of outcome measures and data sources". Am J Public Health. 84 (10): 1609–14. PMC 1615096. PMID 7943479.
  6. Jones RH, Hannan EL, Hammermeister KE, Delong ER, O'Connor GT, Luepker RV; et al. (1996). "Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery. The Working Group Panel on the Cooperative CABG Database Project". J Am Coll Cardiol. 28 (6): 1478–87. PMID 8917261.
  7. Mack MJ, Herbert M, Prince S, Dewey TM, Magee MJ, Edgerton JR (2005). "Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes?". J Thorac Cardiovasc Surg. 129 (6): 1309–17. doi:10.1016/j.jtcvs.2004.10.036. PMID 15942571.
  8. Shahian DM, Silverstein T, Lovett AF, Wolf RE, Normand SL (2007). "Comparison of clinical and administrative data sources for hospital coronary artery bypass graft surgery report cards". Circulation. 115 (12): 1518–27. doi:10.1161/CIRCULATIONAHA.106.633008. PMID 17353447.
  9. Tu JV, Sykora K, Naylor CD (1997). "Assessing the outcomes of coronary artery bypass graft surgery: how many risk factors are enough? Steering Committee of the Cardiac Care Network of Ontario". J Am Coll Cardiol. 30 (5): 1317–23. PMID 9350934.
  10. Clark RE (1996). "Outcome as a function of annual coronary artery bypass graft volume. The Ad Hoc Committee on Cardiac Surgery Credentialing of The Society of Thoracic Surgeons". Ann Thorac Surg. 61 (1): 21–6. PMID 8561556.
  11. Grumbach K, Anderson GM, Luft HS, Roos LL, Brook R (1995). "Regionalization of cardiac surgery in the United States and Canada. Geographic access, choice, and outcomes". JAMA. 274 (16): 1282–8. PMID 7563533.
  12. Hannan EL, Kilburn H, Bernard H, O'Donnell JF, Lukacik G, Shields EP (1991). "Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors". Med Care. 29 (11): 1094–107. PMID 1943270.
  13. Hannan EL, Siu AL, Kumar D, Kilburn H, Chassin MR (1995). "The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume". JAMA. 273 (3): 209–13. PMID 7807659.
  14. Hannan EL, Wu C, Ryan TJ, Bennett E, Culliford AT, Gold JP; et al. (2003). "Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates?". Circulation. 108 (7): 795–801. doi:10.1161/01.CIR.0000084551.52010.3B. PMID 12885743.
  15. Kalant N, Shrier I (2004). "Volume and outcome of coronary artery bypass graft surgery: are more and less the same?". Can J Cardiol. 20 (1): 81–6. PMID 14968146.
  16. Nallamothu BK, Saint S, Ramsey SD, Hofer TP, Vijan S, Eagle KA (2001). "The role of hospital volume in coronary artery bypass grafting: is more always better?". J Am Coll Cardiol. 38 (7): 1923–30. PMID 11738295.
  17. Peterson ED, Coombs LP, DeLong ER, Haan CK, Ferguson TB (2004). "Procedural volume as a marker of quality for CABG surgery". JAMA. 291 (2): 195–201. doi:10.1001/jama.291.2.195. PMID 14722145.
  18. Rathore SS, Epstein AJ, Volpp KG, Krumholz HM (2004). "Hospital coronary artery bypass graft surgery volume and patient mortality, 1998-2000". Ann Surg. 239 (1): 110–7. doi:10.1097/01.sla.0000103066.22732.b8. PMC 1356200. PMID 14685108.
  19. Shahian DM, O'Brien SM, Normand SL, Peterson ED, Edwards FH (2010). "Association of hospital coronary artery bypass volume with processes of care, mortality, morbidity, and the Society of Thoracic Surgeons composite quality score". J Thorac Cardiovasc Surg. 139 (2): 273–82. doi:10.1016/j.jtcvs.2009.09.007. PMID 20022608.
  20. Showstack JA, Rosenfeld KE, Garnick DW, Luft HS, Schaffarzick RW, Fowles J (1987). "Association of volume with outcome of coronary artery bypass graft surgery. Scheduled vs nonscheduled operations". JAMA. 257 (6): 785–9. PMID 3492614.
  21. Shroyer AL, Marshall G, Warner BA, Johnson RR, Guo W, Grover FL; et al. (1996). "No continuous relationship between Veterans Affairs hospital coronary artery bypass grafting surgical volume and operative mortality". Ann Thorac Surg. 61 (1): 17–20. doi:10.1016/0003-4975(95)00830-6. PMID 8561546.
  22. Sowden AJ, Deeks JJ, Sheldon TA (1995). "Volume and outcome in coronary artery bypass graft surgery: true association or artefact?". BMJ. 311 (6998): 151–5. PMC 2550219. PMID 7613425.
  23. Welke KF, Barnett MJ, Sarrazin MS, Rosenthal GE (2005). "Limitations of hospital volume as a measure of quality of care for coronary artery bypass graft surgery". Ann Thorac Surg. 80 (6): 2114–9. doi:10.1016/j.athoracsur.2005.05.017. PMID 16305854.
  24. Wu C, Hannan EL, Ryan TJ, Bennett E, Culliford AT, Gold JP; et al. (2004). "Is the impact of hospital and surgeon volumes on the in-hospital mortality rate for coronary artery bypass graft surgery limited to patients at high risk?". Circulation. 110 (7): 784–9. doi:10.1161/01.CIR.0000138744.13516.B5. PMID 15302792.



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