Coronary artery bypass surgery revascularization to improve symptoms

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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]

Revascularization to Improve Symptoms (DO NOT EDIT)[1]

Class I
"1. CABG or PCI to improve symptoms is beneficial in patients with 1 or more significant (≥70% diameter) coronary artery stenoses amenable to revascularization and unacceptable angina despite GDMT.[2][3][4][5][6][7][8][9][10][11][12] (Level of Evidence: A)"
Class III: HARM
"1. CABG or PCI to improve symptoms should not be performed in patients who do not meet anatomic (≥50% left main or ≥70% non–left main stenosis) or physiological (eg, abnormal fractional flow reserve) criteria for revascularization. (Level of Evidence: C)"
Class IIa
"1. CABG or PCI to improve symptoms is reasonable in patients with 1 or more significant (≥70% diameter) coronary artery stenoses and unacceptable angina for whom GDMT cannot be implemented because of medication contraindications, adverse effects, or patient preferences. (Level of Evidence: C)"
"2. PCI to improve symptoms is reasonable in patients with previous CABG, 1 or more significant (≥70% diameter) coronary artery stenoses associated with ischemia, and unacceptable angina despite GDMT.[13][14][15] (Level of Evidence: C)"
"3. It is reasonable to choose CABG over PCI to improve symptoms in patients with complex 3-vessel CAD (eg, SYNTAX score >22), with or without involvement of the proximal LAD artery, who are good candidates for CABG.[16][17][18][19][20] (Level of Evidence: B)"
Class IIb
"1. CABG to improve symptoms might be reasonable for patients with previous CABG, 1 or more significant (≥70% diameter) coronary artery stenoses not amenable to PCI, and unacceptable angina despite GDMT.[21] (Level of Evidence: C)"
"2. Transmyocardial laser revascularization (TMR) performed as an adjunct to CABG to improve symptoms may be reasonable in patients with viable ischemic myocardium that is perfused by arteries that are not amenable to grafting.[22][23][24][25][26] (Level of Evidence: B)"

References

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  2. Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS (2007). "Optimal medical therapy with or without PCI for stable coronary disease". The New England Journal of Medicine. 356 (15): 1503–16. doi:10.1056/NEJMoa070829. PMID 17387127. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  3. "Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial". Lancet. 358 (9286): 951–7. 2001. doi:10.1016/S0140-6736(01)06100-1. PMID 11583747. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
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  9. Pocock SJ, Henderson RA, Seed P, Treasure T, Hampton JR (1996). "Quality of life, employment status, and anginal symptoms after coronary angioplasty or bypass surgery. 3-year follow-up in the Randomized Intervention Treatment of Angina (RITA) Trial". Circulation. 94 (2): 135–42. PMID 8674171. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  10. Pocock SJ, Henderson RA, Clayton T, Lyman GH, Chamberlain DA (2000). "Quality of life after coronary angioplasty or continued medical treatment for angina: three-year follow-up in the RITA-2 trial. Randomized Intervention Treatment of Angina". Journal of the American College of Cardiology. 35 (4): 907–14. PMID 10732887. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  11. Weintraub WS, Spertus JA, Kolm P, Maron DJ, Zhang Z, Jurkovitz C, Zhang W, Hartigan PM, Lewis C, Veledar E, Bowen J, Dunbar SB, Deaton C, Kaufman S, O'Rourke RA, Goeree R, Barnett PG, Teo KK, Boden WE, Mancini GB (2008). "Effect of PCI on quality of life in patients with stable coronary disease". The New England Journal of Medicine. 359 (7): 677–87. doi:10.1056/NEJMoa072771. PMID 18703470. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  12. Wijeysundera HC, Nallamothu BK, Krumholz HM, Tu JV, Ko DT (2010). "Meta-analysis: effects of percutaneous coronary intervention versus medical therapy on angina relief". Annals of Internal Medicine. 152 (6): 370–9. doi:10.1059/0003-4819-152-6-201003160-00007. PMID 20231568. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  13. Gurfinkel EP, Perez de la Hoz R, Brito VM, Duronto E, Dabbous OH, Gore JM, Anderson FA (2007). "Invasive vs non-invasive treatment in acute coronary syndromes and prior bypass surgery". International Journal of Cardiology. 119 (1): 65–72. doi:10.1016/j.ijcard.2006.07.058. PMID 17045681. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  14. Pfautsch P, Frantz E, Ellmer A, Sauer HU, Fleck E (1999). "[Long-term outcome of therapy of recurrent myocardial ischemia after surgical revascularization]". Zeitschrift Für Kardiologie (in German). 88 (7): 489–97. PMID 10467648. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  15. Subramanian S, Sabik JF, Houghtaling PL, Nowicki ER, Blackstone EH, Lytle BW (2009). "Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending". The Annals of Thoracic Surgery. 87 (5): 1392–8, discussion 1400. doi:10.1016/j.athoracsur.2009.02.032. PMID 19379872. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  16. Hannan EL, Wu C, Walford G, Culliford AT, Gold JP, Smith CR, Higgins RS, Carlson RE, Jones RH (2008). "Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease". The New England Journal of Medicine. 358 (4): 331–41. doi:10.1056/NEJMoa071804. PMID 18216353. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  17. Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A (2011). "Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial". European Heart Journal. 32 (17): 2125–34. doi:10.1093/eurheartj/ehr213. PMID 21697170. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  18. Smith PK, Califf RM, Tuttle RH, Shaw LK, Lee KL, Delong ER, Lilly RE, Sketch MH, Peterson ED, Jones RH (2006). "Selection of surgical or percutaneous coronary intervention provides differential longevity benefit". The Annals of Thoracic Surgery. 82 (4): 1420–8, discussion 1428–9. doi:10.1016/j.athoracsur.2006.04.044. PMID 16996946. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  19. Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS (2004). "Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features". Circulation. 109 (19): 2290–5. doi:10.1161/01.CIR.0000126826.58526.14. PMID 15117846. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  20. Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, Culliford AT, Isom OW, Gold JP, Rose EA (2005). "Long-term outcomes of coronary-artery bypass grafting versus stent implantation". The New England Journal of Medicine. 352 (21): 2174–83. doi:10.1056/NEJMoa040316. PMID 15917382. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  21. Weintraub WS, Jones EL, Morris DC, King SB, Guyton RA, Craver JM (1997). "Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery". Circulation. 95 (4): 868–77. PMID 9054744. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  22. Schofield PM, Sharples LD, Caine N, Burns S, Tait S, Wistow T, Buxton M, Wallwork J (1999). "Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trial". Lancet. 353 (9152): 519–24. PMID 10028979. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  23. Aaberge L, Nordstrand K, Dragsund M, Saatvedt K, Endresen K, Golf S, Geiran O, Abdelnoor M, Forfang K (2000). "Transmyocardial revascularization with CO2 laser in patients with refractory angina pectoris. Clinical results from the Norwegian randomized trial". Journal of the American College of Cardiology. 35 (5): 1170–7. PMID 10758957. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  24. Burkhoff D, Schmidt S, Schulman SP, Myers J, Resar J, Becker LC, Weiss J, Jones JW (1999). "Transmyocardial laser revascularisation compared with continued medical therapy for treatment of refractory angina pectoris: a prospective randomised trial. ATLANTIC Investigators. Angina Treatments-Lasers and Normal Therapies in Comparison". Lancet. 354 (9182): 885–90. PMID 10489946. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  25. Allen KB, Dowling RD, DelRossi AJ, Realyvasques F, Lefrak EA, Pfeffer TA, Fudge TL, Mostovych M, Schuch D, Szentpetery S, Shaar CJ (2000). "Transmyocardial laser revascularization combined with coronary artery bypass grafting: a multicenter, blinded, prospective, randomized, controlled trial". The Journal of Thoracic and Cardiovascular Surgery. 119 (3): 540–9. PMID 10694615. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
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