Coronary artery bypass surgery perioperative carotid artery noninvasive screening

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Coronary Artery Bypass Surgery Microchapters

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Overview

Pathophysiology

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

Indications for CABG

Prognosis

Diagnosis

Imaging in the Patient Undergoing CABG

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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
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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

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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]

The Role of Preoperative Carotid Artery Noninvasive Screening in CABG Patients (DO NOT EDIT)[1]

Class I
"1. A multidisciplinary team approach (consisting of a cardiologist, cardiac surgeon, vascular surgeon, and neurologist) is recommended for patients with clinically significant carotid artery disease for whom CABG is planned. (Level of Evidence: C)"
Class IIa
"1. Carotid artery duplex scanning is reasonable in selected patients who are considered to have high-risk features (ie, age >65 years, left main coronary stenosis, peripheral artery disease, history of cerebrovascular disease [transient ischemic attack, stroke, etc.], hypertension, smoking, and diabetes mellitus).[2][3] (Level of Evidence: C)"
"2. In the CABG patient with a previous transient ischemic attack or stroke and a significant (50% to 99%) carotid artery stenosis, it is reasonable to consider carotid revascularization in conjunction with CABG. In such an individual, the sequence and timing (simultaneous or staged) of carotid intervention and CABG should be determined by the patient's relative magnitudes of cerebral and myocardial dysfunction. (Level of Evidence: C)"
Class IIb
"1. In the patient scheduled to undergo CABG who has no history of transient ischemic attack or stroke, carotid revascularization may be considered in the presence of bilateral severe (70% to 99%) carotid stenoses or a unilateral severe carotid stenosis with a contralateral occlusion. (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 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. Durand DJ, Perler BA, Roseborough GS, Grega MA, Borowicz LM, Baumgartner WA; et al. (2004). "Mandatory versus selective preoperative carotid screening: a retrospective analysis". Ann Thorac Surg. 78 (1): 159–66, discussion 159-66. doi:10.1016/j.athoracsur.2004.02.024. PMID 15223422.
  3. Sheiman RG, Janne d'Othée B, d'Othée BJ (2007). "Screening carotid sonography before elective coronary artery bypass graft surgery: who needs it". AJR Am J Roentgenol. 188 (5): W475–9. doi:10.2214/AJR.06.1024. PMID 17449747.

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