Chest pain surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3]
Overview
Common causes of acute chest pain in the months after CABG include musculoskeletal pain from sternotomy, myocardial ischemia from acute graft stenosis or occlusion, pericarditis, pulmonary embolism, sternal wound infection, nonunion. Post-sternotomy pain syndrome is defined as discomfort after thoracic surgery, persisting for at least 2 months, and without apparent cause. The incidence of post-sternotomy pain syndrome is varied 7%-66% with a higher prevalence in women compared with men within the first 3 months of thoracic surgery but, after 3 months, postoperative sex difference in prevalence was not seen. Causes of Graft failure within the first year post-CABG are using saphenous venous grafts, intimal hyperplasia, thrombosis. Internal mammary artery graft failure within the first-year post-CABG is most commonly cause asscociated with the anastomotic site of the graft. Causes of acute chest pain several years after CABG include graft stenosis, occlusion or progression of disease in a non-bypassed vessel. One year after CABG, about 10%-20% of saphenous vein grafts fail. By 10 years, about half of saphenous vein grafts are patent. The patency rates of internal mammary artery is 90% to 95%, 10 to 15 years after CABG. The use of radial artery grafts for CABG has a higher patency rate at 5 years of follow-up, compared with the use of saphenous vein grafts.
Surgery
Common causes of acute chest pain in the months after CABG include:[1]
- Musculoskeletal pain from sternotomy: the most common cause
- Myocardial ischemia from acute graft stenosis or occlusion
- Pericarditis
- Pulmonary embolism
- Sternal wound infection
- Nonunion
- Post-sternotomy pain syndrome is defined as discomfort after thoracic surgery, persisting for at least 2 months, and without apparent cause.
- The incidence of post-sternotomy pain syndrome is varied 7%-66% with a higher prevalence in women compared with men within the first 3 months of thoracic surgery but, after 3 months, postoperative sex difference in prevalence was not seen.
- Causes of Graft failure within the first year post-CABG using saphenous venous grafts are:
- Technical issues
- Intimal hyperplasia
- Thrombosis
- Internal mammary artery graft failure within the first-year post-CABG is most commonly associated with the anastomotic site of the graft.
- Causes of acute chest pain several years after CABG including:
- One year after CABG, about 10%-20% of saphenous vein grafts fail.
- By 10 years, about half of saphenous vein grafts are patent.
- The internal mammary artery has patency rates of 90% to 95% 10 to 15 years after CABG.
- The use of radial artery grafts for CABG has a higher patency rate at 5 years of follow-up, compared with the use of saphenous vein grafts.
- For patients with aortic dissections, emergent surgery may be required
- Although often fatal, aortic dissection is an indication for urgent surgical therapy.
References
- ↑ Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ (November 2021). "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. PMID 34709879 Check
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