Coronary artery bypass surgery of left main CAD to improve survival

Jump to navigation Jump to search

Coronary Artery Bypass Surgery Microchapters

Home

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

Pharmacotherapy in patients undergoing CABG 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 of left main CAD to improve survival On the Web

Most recent articles

Most cited articles

Review articles

CME programs

powerpoint slides

Images

Ongoing trials at clinical trials.gov

US National guidelines clearinghouse

NICE guidance

FDA on Coronary artery bypass surgery of left main CAD to improve survival

CDC on Coronary artery bypass surgery of left main CAD to improve survival

Coronary artery bypass surgery of left main CAD to improve survival in the news

Blogs on Coronary artery bypass surgery of left main CAD to improve survival|-

Directions to Hospitals Performing Coronary artery bypass surgery of left main CAD to improve survival

Risk calculators for Coronary artery bypass surgery of left main CAD to improve survival

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

Coronary artery bypass surgery is more effective for treating left main disease than percutaneous coronary intervention.[1]

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[2]

Left Main CAD Revascularization to Improve Survival (DO NOT EDIT)[2]

Class I
"1. CABG to improve survival is recommended for patients with significant (≥50% diameter stenosis) left main coronary artery stenosis.[3][4][5][6][7][8][9] (Level of Evidence: B)"
Class III: HARM
"1. PCI to improve survival should not be performed in stable patients with significant (≥50% diameter stenosis) unprotected left main CAD who have unfavorable anatomy for PCI and who are good candidates for CABG.[10][11][12][3][4][5][6] (Level of Evidence: B)"
Class IIa
"1. PCI to improve survival is reasonable as an alternative to CABG in selected stable patients with significant (≥50% diameter stenosis) unprotected left main CAD with: 1) anatomic conditions associated with a low risk of PCI procedural complications and a high likelihood of good long-term outcome (eg, a low SYNTAX score [≤22], ostial or trunk left main CAD); and 2) clinical characteristics that predict a significantly increased risk of adverse surgical outcomes (eg, STS-predicted risk of operative mortality ≥5%).[10][11][12][13][14][15][16][17][18][19][20][21][22] (Level of Evidence: B)"
"2. PCI to improve survival is reasonable in patients with UA/NSTEMI when an unprotected left main coronary artery is the culprit lesion and the patient is not a candidate for CABG.[10][17][18][23][24][25][21][22][26][27] (Level of Evidence: B)"
"3. PCI to improve survival is reasonable in patients with acute STEMI when an unprotected left main coronary artery is the culprit lesion, distal coronary flow is less than Thrombolysis In Myocardial Infarction grade 3, and PCI can be performed more rapidly and safely than CABG.[28][29][30] (Level of Evidence: C)"
Class IIb
"1. PCI to improve survival may be reasonable as an alternative to CABG in selected stable patients with significant (≥50% diameter stenosis) unprotected left main CAD with: 1) anatomic conditions associated with a low to intermediate risk of PCI procedural complications and an intermediate to high likelihood of good long-term outcome (eg, low–intermediate SYNTAX score of <33, bifurcation left main CAD); and 2) clinical characteristics that predict an increased risk of adverse surgical outcomes (eg, moderate–severe chronic obstructive pulmonary disease, disability from previous stroke, or previous cardiac surgery; STS-predicted risk of operative mortality >2%).[10][11][12][13][31][15][16][17][18][19][20][21][22][32] (Level of Evidence: B)"

References

  1. Mäkikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB; et al. (2016). "Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial". Lancet. 388 (10061): 2743–2752. doi:10.1016/S0140-6736(16)32052-9. PMID 27810312.
  2. 2.0 2.1 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.
  3. 3.0 3.1 Caracciolo EA, Davis KB, Sopko G, Kaiser GC, Corley SD, Schaff H, Taylor HA, Chaitman BR (1995). "Comparison of surgical and medical group survival in patients with left main coronary artery disease. Long-term CASS experience". Circulation. 91 (9): 2325–34. PMID 7729018. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 Chaitman BR, Fisher LD, Bourassa MG, Davis K, Rogers WJ, Maynard C, Tyras DH, Berger RL, Judkins MP, Ringqvist I, Mock MB, Killip T (1981). "Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the Collaborative Study in Coronary Artery Surgery (CASS)". The American Journal of Cardiology. 48 (4): 765–77. PMID 7025604. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  5. 5.0 5.1 Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD, Galbraith PD, Hui W, Faris P, Knudtson ML (2001). "Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators". American Heart Journal. 142 (1): 119–26. doi:10.1067/mhj.2001.116072. PMID 11431667. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  6. 6.0 6.1 Takaro T, Hultgren HN, Lipton MJ, Detre KM (1976). "The VA cooperative randomized study of surgery for coronary arterial occlusive disease II. Subgroup with significant left main lesions". Circulation. 54 (6 Suppl): III107–17. PMID 791537. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  7. Takaro T, Peduzzi P, Detre KM, Hultgren HN, Murphy ML, van der Bel-Kahn J, Thomsen J, Meadows WR (1982). "Survival in subgroups of patients with left main coronary artery disease. Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease". Circulation. 66 (1): 14–22. PMID 6979435. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  8. Taylor HA, Deumite NJ, Chaitman BR, Davis KB, Killip T, Rogers WJ (1989). "Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry". Circulation. 79 (6): 1171–9. PMID 2785870. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  9. Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R (1994). "Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration". Lancet. 344 (8922): 563–70. PMID 7914958. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  10. 10.0 10.1 10.2 10.3 Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A, Mack MJ, Holmes DR, Torracca L, van Es GA, Leadley K, Dawkins KD, Mohr F (2010). "Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial". Circulation. 121 (24): 2645–53. doi:10.1161/CIRCULATIONAHA.109.899211. PMID 20530001. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  11. 11.0 11.1 11.2 Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J, Mirocha JM, Fontana G, Forrester JS, Makkar R (2011). "Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization". The American Journal of Cardiology. 107 (3): 360–6. doi:10.1016/j.amjcard.2010.09.029. PMID 21256999. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  12. 12.0 12.1 12.2 Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ (2010). "Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization". JACC. Cardiovascular Interventions. 3 (6): 612–23. doi:10.1016/j.jcin.2010.04.004. PMID 20630454. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  13. 13.0 13.1 Buszman PE, Kiesz SR, Bochenek A, Peszek-Przybyla E, Szkrobka I, Debinski M, Bialkowska B, Dudek D, Gruszka A, Zurakowski A, Milewski K, Wilczynski M, Rzeszutko L, Buszman P, Szymszal J, Martin JL, Tendera M (2008). "Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization". Journal of the American College of Cardiology. 51 (5): 538–45. doi:10.1016/j.jacc.2007.09.054. PMID 18237682. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  14. Capodanno D, Caggegi A, Miano M; et al. (2011). "Global Risk Classification and Clinical SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) Score in Patients Undergoing Percutaneous or Surgical Left Main Revascularization". Journal of the American College of Cardiology. 4: 287–297. doi:10.1016/j.jcin.2010.10.013. Retrieved 2011-12-13.
  15. 15.0 15.1 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 2011-12-13. Unknown parameter |month= ignored (help)
  16. 16.0 16.1 Biondi-Zoccai GG, Lotrionte M, Moretti C, Meliga E, Agostoni P, Valgimigli M, Migliorini A, Antoniucci D, Carrié D, Sangiorgi G, Chieffo A, Colombo A, Price MJ, Teirstein PS, Christiansen EH, Abbate A, Testa L, Gunn JP, Burzotta F, Laudito A, Trevi GP, Sheiban I (2008). "A collaborative systematic review and meta-analysis on 1278 patients undergoing percutaneous drug-eluting stenting for unprotected left main coronary artery disease". American Heart Journal. 155 (2): 274–83. doi:10.1016/j.ahj.2007.10.009. PMID 18215597. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  17. 17.0 17.1 17.2 Brener SJ, Galla JM, Bryant R, Sabik JF, Ellis SG (2008). "Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients". The American Journal of Cardiology. 101 (2): 169–72. doi:10.1016/j.amjcard.2007.08.054. PMID 18178401. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  18. 18.0 18.1 18.2 Chieffo A, Morici N, Maisano F, Bonizzoni E, Cosgrave J, Montorfano M, Airoldi F, Carlino M, Michev I, Melzi G, Sangiorgi G, Alfieri O, Colombo A (2006). "Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience". Circulation. 113 (21): 2542–7. doi:10.1161/CIRCULATIONAHA.105.595694. PMID 16717151. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  19. 19.0 19.1 Mäkikallio TH, Niemelä M, Kervinen K, Jokinen V, Laukkanen J, Ylitalo I, Tulppo MP, Juvonen J, Huikuri HV (2008). "Coronary angioplasty in drug eluting stent era for the treatment of unprotected left main stenosis compared to coronary artery bypass grafting". Annals of Medicine. 40 (6): 437–43. doi:10.1080/07853890701879790. PMID 18608116. Retrieved 2011-12-13.
  20. 20.0 20.1 Palmerini T, Marzocchi A, Marrozzini C, Ortolani P, Saia F, Savini C, Bacchi-Reggiani L, Gianstefani S, Virzì S, Manara F, Kiros Weldeab M, Marinelli G, Di Bartolomeo R, Branzi A (2006). "Comparison between coronary angioplasty and coronary artery bypass surgery for the treatment of unprotected left main coronary artery stenosis (the Bologna Registry)". The American Journal of Cardiology. 98 (1): 54–9. doi:10.1016/j.amjcard.2006.01.070. PMID 16784920. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  21. 21.0 21.1 21.2 Sanmartín M, Baz JA, Claro R, Asorey V, Durán D, Pradas G, Iñiguez A (2007). "Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease". The American Journal of Cardiology. 100 (6): 970–3. doi:10.1016/j.amjcard.2007.04.037. PMID 17826380. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  22. 22.0 22.1 22.2 Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK, Park SW, Yun SC, Gwon HC, Jeong MH, Jang Y, Kim HS, Kim PJ, Seong IW, Park HS, Ahn T, Chae IH, Tahk SJ, Chung WS, Park SJ (2008). "Stents versus coronary-artery bypass grafting for left main coronary artery disease". The New England Journal of Medicine. 358 (17): 1781–92. doi:10.1056/NEJMoa0801441. PMID 18378517. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  23. Chieffo A, Magni V, Latib A, Maisano F, Ielasi A, Montorfano M, Carlino M, Godino C, Ferraro M, Calori G, Alfieri O, Colombo A (2010). "5-year outcomes following percutaneous coronary intervention with drug-eluting stent implantation versus coronary artery bypass graft for unprotected left main coronary artery lesions the Milan experience". JACC. Cardiovascular Interventions. 3 (6): 595–601. doi:10.1016/j.jcin.2010.03.014. PMID 20630452. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  24. Lee MS, Kapoor N, Jamal F, Czer L, Aragon J, Forrester J, Kar S, Dohad S, Kass R, Eigler N, Trento A, Shah PK, Makkar RR (2006). "Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease". Journal of the American College of Cardiology. 47 (4): 864–70. doi:10.1016/j.jacc.2005.09.072. PMID 16487857. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  25. Rodés-Cabau J, Deblois J, Bertrand OF, Mohammadi S, Courtis J, Larose E, Dagenais F, Déry JP, Mathieu P, Rousseau M, Barbeau G, Baillot R, Gleeton O, Perron J, Nguyen CM, Roy L, Doyle D, De Larochellière R, Bogaty P, Voisine P (2008). "Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians". Circulation. 118 (23): 2374–81. doi:10.1161/CIRCULATIONAHA.107.727099. PMID 19029471. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  26. White AJ, Kedia G, Mirocha JM, Lee MS, Forrester JS, Morales WC, Dohad S, Kar S, Czer LS, Fontana GP, Trento A, Shah PK, Makkar RR (2008). "Comparison of coronary artery bypass surgery and percutaneous drug-eluting stent implantation for treatment of left main coronary artery stenosis". JACC. Cardiovascular Interventions. 1 (3): 236–45. doi:10.1016/j.jcin.2008.02.007. PMID 19463306. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  27. Montalescot G, Brieger D, Eagle KA, Anderson FA, FitzGerald G, Lee MS, Steg PG, Avezum A, Goodman SG, Gore JM (2009). "Unprotected left main revascularization in patients with acute coronary syndromes". European Heart Journal. 30 (19): 2308–17. doi:10.1093/eurheartj/ehp353. PMC 2755115. PMID 19720640. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  28. Ellis SG, Tamai H, Nobuyoshi M, Kosuga K, Colombo A, Holmes DR, Macaya C, Grines CL, Whitlow PL, White HJ, Moses J, Teirstein PS, Serruys PW, Bittl JA, Mooney MR, Shimshak TM, Block PC, Erbel R (1997). "Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multicenter registry analysis 1994-1996". Circulation. 96 (11): 3867–72. PMID 9403609. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  29. Lee MS, Tseng CH, Barker CM, Menon V, Steckman D, Shemin R, Hochman JS (2008). "Outcome after surgery and percutaneous intervention for cardiogenic shock and left main disease". The Annals of Thoracic Surgery. 86 (1): 29–34. doi:10.1016/j.athoracsur.2008.03.019. PMID 18573394. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  30. Lee MS, Bokhoor P, Park SJ, Kim YH, Stone GW, Sheiban I, Biondi-Zoccai G, Sillano D, Tobis J, Kandzari DE (2010). "Unprotected left main coronary disease and ST-segment elevation myocardial infarction: a contemporary review and argument for percutaneous coronary intervention". JACC. Cardiovascular Interventions. 3 (8): 791–5. doi:10.1016/j.jcin.2010.06.005. PMID 20723848. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  31. Capodanno D, Caggegi A, Miano M; et al. (2011). "Global Risk Classification and Clinical SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) Score in Patients Undergoing Percutaneous or Surgical Left Main Revascularization". Journal of the American College of Cardiology. 4: 287–297. doi:10.1016/j.jcin.2010.10.013. Retrieved 2011-12-13. line feed character in |author= at position 14 (help)
  32. Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG, Lee JY, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, Chung CH, Lee JW, Lim DS, Rha SW, Lee SG, Gwon HC, Kim HS, Chae IH, Jang Y, Jeong MH, Tahk SJ, Seung KB (2011). "Randomized trial of stents versus bypass surgery for left main coronary artery disease". The New England Journal of Medicine. 364 (18): 1718–27. doi:10.1056/NEJMoa1100452. PMID 21463149. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)

Template:WH Template:WS