Coronary artery bypass surgery perioperative management of myocardial dysfunction

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Saphenous Vein Graft Disease
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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]

Perioperative Myocardial Dysfunction (DO NOT EDIT)[1]

Class IIa
"1. In the absence of severe, symptomatic aorto-iliac occlusive disease or peripheral artery disease, the insertion of an intra-aortic balloon is reasonable to reduce mortality rate in CABG patients who are considered to be at high risk (eg, those who are undergoing reoperation or have LVEF <30% or left main CAD).[2][3][4][5][6][7] (Level of Evidence: B)"
"2. Measurement of biomarkers of myonecrosis (eg, creatine kinase-MB, troponin) is reasonable in the first 24 hours after CABG.[8] (Level of Evidence: B)"

Transfusion (DO NOT EDIT)[1]

Class I
"1. Aggressive attempts at blood conservation are indicated to limit hemodilutional anemia and the need for intraoperative and perioperative allogeneic red blood cell transfusion in CABG patients.[9][10][11][12] (Level of Evidence: B)"

Preconditioning/Management of Myocardial Ischemia (DO NOT EDIT)[1]

Class I
"1. Management targeted at optimizing the determinants of coronary arterial perfusion (eg, heart rate, diastolic or mean arterial pressure, and right ventricular or LV end-diastolic pressure) is recommended to reduce the risk of perioperative myocardial ischemia and infarction.[13][14][15][16][17] (Level of Evidence: B)"
Class IIa
"1. Volatile-based anesthesia can be useful in reducing the risk of perioperative myocardial ischemia and infarction.[18][19][20][21] (Level of Evidence: A)"
Class IIb
"1. The effectiveness of prophylactic pharmacological therapies or controlled reperfusion strategies aimed at inducing preconditioning or attenuating the adverse consequences of myocardial reperfusion injury or surgically induced systemic inflammation is uncertain.[22][23][24][25][26][27][28][29] (Level of Evidence: A)"
”2. Mechanical preconditioning might be considered to reduce the risk of perioperative myocardial ischemia and infarction in patients undergoing off-pump CABG.[30][31][32] (Level of Evidence: B)"
"3. Remote ischemic preconditioning strategies using peripheral-extremity occlusion/reperfusion might be considered to attenuate the adverse consequences of myocardial reperfusion injury.[33][34][35] (Level of Evidence: B)"
”4. The effectiveness of postconditioning strategies to attenuate the adverse consequences of myocardial reperfusion injury is uncertain.[36][37] (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 1.3 1.4 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. ↑ Christenson JT, Cohen M, Ferguson JJ, Freedman RJ, Miller MF, Ohman EM; et al. (2002). "Trends in intraaortic balloon counterpulsation complications and outcomes in cardiac surgery". Ann Thorac Surg. 74 (4): 1086–90, discussion 1090-1. PMID 12400750.
  3. ↑ Christenson JT, Simonet F, Badel P, Schmuziger M (1999). "Optimal timing of preoperative intraaortic balloon pump support in high-risk coronary patients". Ann Thorac Surg. 68 (3): 934–9. PMID 10509987.
  4. ↑ Christenson JT, Licker M, Kalangos A (2003). "The role of intra-aortic counterpulsation in high-risk OPCAB surgery: a prospective randomized study". J Card Surg. 18 (4): 286–94. PMID 12869172.
  5. ↑ Christenson JT, Schmuziger M, Simonet F (2001). "Effective surgical management of high-risk coronary patients using preoperative intra-aortic balloon counterpulsation therapy". Cardiovasc Surg. 9 (4): 383–90. PMID 11420164.
  6. ↑ Urban PM, Freedman RJ, Ohman EM, Stone GW, Christenson JT, Cohen M; et al. (2004). "In-hospital mortality associated with the use of intra-aortic balloon counterpulsation". Am J Cardiol. 94 (2): 181–5. doi:10.1016/j.amjcard.2004.03.058. PMID 15246896.
  7. ↑ Santa-Cruz RA, Cohen MG, Ohman EM (2006). "Aortic counterpulsation: a review of the hemodynamic effects and indications for use". Catheter Cardiovasc Interv. 67 (1): 68–77. doi:10.1002/ccd.20552. PMID 16342217.
  8. ↑ Yau JM, Alexander JH, Hafley G, Mahaffey KW, Mack MJ, Kouchoukos N; et al. (2008). "Impact of perioperative myocardial infarction on angiographic and clinical outcomes following coronary artery bypass grafting (from PRoject of Ex-vivo Vein graft ENgineering via Transfection [PREVENT] IV)". Am J Cardiol. 102 (5): 546–51. doi:10.1016/j.amjcard.2008.04.069. PMID 18721510.
  9. ↑ Koch CG, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr NJ; et al. (2006). "Transfusion in coronary artery bypass grafting is associated with reduced long-term survival". Ann Thorac Surg. 81 (5): 1650–7. doi:10.1016/j.athoracsur.2005.12.037. PMID 16631651.
  10. ↑ Surgenor SD, DeFoe GR, Fillinger MP, Likosky DS, Groom RC, Clark C; et al. (2006). "Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure". Circulation. 114 (1 Suppl): I43–8. doi:10.1161/CIRCULATIONAHA.105.001271. PMID 16820613.
  11. ↑ van Straten AH, Bekker MW, Soliman Hamad MA, van Zundert AA, Martens EJ, Schönberger JP; et al. (2010). "Transfusion of red blood cells: the impact on short-term and long-term survival after coronary artery bypass grafting, a ten-year follow-up". Interact Cardiovasc Thorac Surg. 10 (1): 37–42. doi:10.1510/icvts.2009.214551. PMID 19815567.
  12. ↑ van Straten AH, Kats S, Bekker MW, Verstappen F, ter Woorst JF, van Zundert AJ; et al. (2010). "Risk factors for red blood cell transfusion after coronary artery bypass graft surgery". J Cardiothorac Vasc Anesth. 24 (3): 413–7. doi:10.1053/j.jvca.2010.01.001. PMID 20231104.
  13. ↑ Dyub AM, Whitlock RP, Abouzahr LL, Cinà CS (2008). "Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery: a systematic review and meta-analysis". J Card Surg. 23 (1): 79–86. doi:10.1111/j.1540-8191.2007.00499.x. PMID 18290898.
  14. ↑ Heusch G (2008). "Heart rate in the pathophysiology of coronary blood flow and myocardial ischaemia: benefit from selective bradycardic agents". Br J Pharmacol. 153 (8): 1589–601. doi:10.1038/sj.bjp.0707673. PMC 2438254. PMID 18223669.
  15. ↑ Slogoff S, Keats AS (1985). "Does perioperative myocardial ischemia lead to postoperative myocardial infarction?". Anesthesiology. 62 (2): 107–14. PMID 3970360.
  16. ↑ Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF; et al. (2002). "ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines)". J Am Coll Cardiol. 40 (8): 1531–40. PMID 12392846.
  17. ↑ Lavana JD, Fraser JF, Smith SE, Drake L, Tesar P, Mullany DV (2010). "Influence of timing of intraaortic balloon placement in cardiac surgical patients". J Thorac Cardiovasc Surg. 140 (1): 80–5. doi:10.1016/j.jtcvs.2009.09.033. PMID 19909993.
  18. ↑ Landoni G, Biondi-Zoccai GG, Zangrillo A, Bignami E, D'Avolio S, Marchetti C; et al. (2007). "Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials". J Cardiothorac Vasc Anesth. 21 (4): 502–11. doi:10.1053/j.jvca.2007.02.013. PMID 17678775.
  19. ↑ Lucchinetti E, Hofer C, Bestmann L, Hersberger M, Feng J, Zhu M; et al. (2007). "Gene regulatory control of myocardial energy metabolism predicts postoperative cardiac function in patients undergoing off-pump coronary artery bypass graft surgery: inhalational versus intravenous anesthetics". Anesthesiology. 106 (3): 444–57. PMID 17325502.
  20. ↑ Yao YT, Li LH (2009). "Sevoflurane versus propofol for myocardial protection in patients undergoing coronary artery bypass grafting surgery: a meta-analysis of randomized controlled trials". Chin Med Sci J. 24 (3): 133–41. PMID 19848312.
  21. ↑ Yu CH, Beattie WS (2006). "The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: a meta-analysis". Can J Anaesth. 53 (9): 906–18. doi:10.1007/BF03022834. PMID 16960269.
  22. ↑ Rabi D, Clement F, McAlister F, Majumdar S, Sauve R, Johnson J; et al. (2010). "Effect of perioperative glucose-insulin-potassium infusions on mortality and atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis". Can J Cardiol. 26 (6): 178–84. PMC 2903988. PMID 20548978.
  23. ↑ Buckberg GD (2010). "Controlled reperfusion after ischemia may be the unifying recovery denominator". J Thorac Cardiovasc Surg. 140 (1): 12–8, 18.e1–2. doi:10.1016/j.jtcvs.2010.02.014. PMID 20416890.
  24. ↑ MEND-CABG II Investigators. Alexander JH, Emery RW, Carrier M, Ellis SJ, Mehta RH; et al. (2008). "Efficacy and safety of pyridoxal 5'-phosphate (MC-1) in high-risk patients undergoing coronary artery bypass graft surgery: the MEND-CABG II randomized clinical trial". JAMA. 299 (15): 1777–87. doi:10.1001/jama.299.15.joc80027. PMID 18381567.
  25. ↑ Mangano DT (1997). "Effects of acadesine on myocardial infarction, stroke, and death following surgery. A meta-analysis of the 5 international randomized trials. The Multicenter Study of Perioperative Ischemia (McSPI) Research Group". JAMA. 277 (4): 325–32. PMID 9002496.
  26. ↑ Mangano DT, Miao Y, Tudor IC, Dietzel C, Investigators of the Multicenter Study of Perioperative Ischemia (McSPI) Research Group. Ischemia Research and Education Foundation (IREF) (2006). "Post-reperfusion myocardial infarction: long-term survival improvement using adenosine regulation with acadesine". J Am Coll Cardiol. 48 (1): 206–14. doi:10.1016/j.jacc.2006.04.044. PMID 16814669.
  27. ↑ Shernan SK, Fitch JC, Nussmeier NA, Chen JC, Rollins SA, Mojcik CF; et al. (2004). "Impact of pexelizumab, an anti-C5 complement antibody, on total mortality and adverse cardiovascular outcomes in cardiac surgical patients undergoing cardiopulmonary bypass". Ann Thorac Surg. 77 (3): 942–9, discussion 949-50. doi:10.1016/j.athoracsur.2003.08.054. PMID 14992903.
  28. ↑ Smith PK, Shernan SK, Chen JC, Carrier M, Verrier ED, Adams PX; et al. (2011). "Effects of C5 complement inhibitor pexelizumab on outcome in high-risk coronary artery bypass grafting: combined results from the PRIMO-CABG I and II trials". J Thorac Cardiovasc Surg. 142 (1): 89–98. doi:10.1016/j.jtcvs.2010.08.035. PMID 20880552.
  29. ↑ Testa L, Van Gaal WJ, Bhindi R, Biondi-Zoccai GG, Abbate A, Agostoni P; et al. (2008). "Pexelizumab in ischemic heart disease: a systematic review and meta-analysis on 15,196 patients". J Thorac Cardiovasc Surg. 136 (4): 884–93. doi:10.1016/j.jtcvs.2007.12.062. PMID 18954626.
  30. ↑ Laurikka J, Wu ZK, Iisalo P, Kaukinen L, Honkonen EL, Kaukinen S; et al. (2002). "Regional ischemic preconditioning enhances myocardial performance in off-pump coronary artery bypass grafting". Chest. 121 (4): 1183–9. PMID 11948051.
  31. ↑ Penttilä HJ, Lepojärvi MV, Kaukoranta PK, Kiviluoma KT, Ylitalo KV, Peuhkurinen KJ (2003). "Ischemic preconditioning does not improve myocardial preservation during off-pump multivessel coronary operation". Ann Thorac Surg. 75 (4): 1246–52, discussion 1252-3. PMID 12683571.
  32. ↑ Walsh SR, Tang TY, Kullar P, Jenkins DP, Dutka DP, Gaunt ME (2008). "Ischaemic preconditioning during cardiac surgery: systematic review and meta-analysis of perioperative outcomes in randomised clinical trials". Eur J Cardiothorac Surg. 34 (5): 985–94. doi:10.1016/j.ejcts.2008.07.062. PMID 18783958.
  33. ↑ Hausenloy DJ, Mwamure PK, Venugopal V, Harris J, Barnard M, Grundy E; et al. (2007). "Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: a randomised controlled trial". Lancet. 370 (9587): 575–9. doi:10.1016/S0140-6736(07)61296-3. PMID 17707752.
  34. ↑ Rahman IA, Mascaro JG, Steeds RP, Frenneaux MP, Nightingale P, Gosling P; et al. (2010). "Remote ischemic preconditioning in human coronary artery bypass surgery: from promise to disappointment?". Circulation. 122 (11 Suppl): S53–9. doi:10.1161/CIRCULATIONAHA.109.926667. PMID 20837926.
  35. ↑ Venugopal V, Hausenloy DJ, Ludman A, Di Salvo C, Kolvekar S, Yap J; et al. (2009). "Remote ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold-blood cardioplegia: a randomised controlled trial". Heart. 95 (19): 1567–71. doi:10.1136/hrt.2008.155770. PMID 19508973.
  36. ↑ Luo W, Li B, Chen R, Huang R, Lin G (2008). "Effect of ischemic postconditioning in adult valve replacement". Eur J Cardiothorac Surg. 33 (2): 203–8. doi:10.1016/j.ejcts.2007.11.010. PMID 18078762.
  37. ↑ Ovize M, Baxter GF, Di Lisa F, Ferdinandy P, Garcia-Dorado D, Hausenloy DJ; et al. (2010). "Postconditioning and protection from reperfusion injury: where do we stand? Position paper from the Working Group of Cellular Biology of the Heart of the European Society of Cardiology". Cardiovasc Res. 87 (3): 406–23. doi:10.1093/cvr/cvq129. PMID 20448097.
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