Coronary artery bypass surgery

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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

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 On the Web

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Most cited articles

Review articles

CME programs

powerpoint slides

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Ongoing trials at clinical trials.gov

US National guidelines clearinghouse

NICE guidance

FDA on Coronary artery bypass surgery

CDC on Coronary artery bypass surgery

Coronary artery bypass surgery in the news

Blogs on Coronary artery bypass surgery|-

Directions to Hospitals Performing Coronary artery bypass surgery

Risk calculators for Coronary artery bypass surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Mohammed A. Sbeih, M.D. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Varun Kumar, M.B.B.S. [4] Prince Tano Djan, BSc, MBChB [5]

Synonyms and keywords: Coronary artery bypass grafting, and colloquially heart bypass, bypass, bypass surgery, open heart surgery, or CABG (pronounced like cabbage), aortocoronary bypass (ACB). The term Coronary Artery Graft Surgery (CAGS) is often used outside the United States and should not be confused with Coronary Angiography (CAG). OPCAB refers to Off-pump coronary artery bypass, a procedure during which the patient is not placed on extracorporeal circulation ("the pump").

Overview

Coronary artery bypass surgery (CABG) is a surgical revascularization procedure that is used to circumvent or bypass blockages in the epicardial coronary arteries associated with acute coronary syndromes (including ST elevation MI, non ST elevation MI, unstable angina) and stable angina. The technique was pioneered by Argentine cardiac surgeon René Favaloro at the Cleveland Clinic in the late 1960s. As part of the procedure, arteries or veins from elsewhere in the patient's body are grafted from the aorta to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass. However, recent advances allow the procedure to be performed with the heart beating and through smaller incisions. Currently, about 500,000 Coronary artery bypass surgery (CABG) are performed in the United States each year.

Pathophysiology

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

Indications for CABG

CABG in Patients with Acute MI | CABG in Patients with Ventricular Arrhythmias | Emergency CABG after Failed PCI | CABG in Association with Other Cardiac Procedures | Heart Team Approach to Revascularization Decisions | Revascularization of Left Main CAD to Improve Survival | Revascularization of Non-Left Main CAD to Improve Survival | Revascularization to Improve Symptoms | CABG in Left Ventricular Dysfunction

Prognosis

Society of Thoracic Surgery (STS) Risk Score

Adverse Outcomes CABG CABG and heart value surgery
Mortality rate 0.804 0.761
Permanent stroke 0.697 0.632
Renal failure 0.826 0.759
Prolonged mechanical ventilation 0.772 0.744
Repeated surgery 0.621 0.588
Composite morbidity and mortality 0.738 0.712
Prolonged post operation hospitalization 0.777 0.739
Deep sternal wound infection/Mediastinitis 0.681 0.659

Imaging in the patient undergoing CABG

Chest x-ray | Coronary Angiography | CT Angiography | MRI Angiography | Trans-Esophageal Echocardiography

Goals of Treatment

Perioperative Management

Aspirin and Clopidogrel | Beta-Blockers | ACE Inhibitors/ARBs | Management of Hyperlipidemia | Management of Mediastinitis/Perioperative Infection | Percutaneous Coronary Intervention (PCI) To Treat Saphenous Vein Graft Failure | Postoperative Antiplatelet Therapy | Maintaining Glucose Level | Coronary artery bypass surgery bleeding/transfusion | Management of Dysrhythmias | Smoking Cessation | Perioperative Management of Myocardial Dysfunction | Perioperative Carotid Artery Noninvasive Screening

Perioperative Monitoring

Electrocardiographic Monitoring | Pulmonary Artery Catheterization | Central Nervous System Monitoring

Surgical Procedure

Anesthetic Considerations | The Traditional Coronary Artery Bypass Grafting Procedure (Simplified) | Minimally Invasive CABG | Conduits Used for Bypass | Videos on Spahenous Vein Graft Harvesting | Videos on Coronary Artery Bypass Surgery

Post-Operative Care and Complications

Special Scenarios

Anomalous Coronary Arteries | Chronic Obstructive Pulmonary Disease/Respiratory Insufficiency | Existing Renal Disease | Concomitant Valvular Disease | Previous Cardiac Surgery | Menopause | Carotid Disease Evaluation Before Surgery

Related Chapters

External Links


Template:WikiDoc Sources

  1. 1.0 1.1 1.2 1.3 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
  2. O'Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V; et al. (2018). "The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 2-Statistical Methods and Results". Ann Thorac Surg. 105 (5): 1419–1428. doi:10.1016/j.athoracsur.2018.03.003. PMID 29577924.