Coronary artery bypass surgery indications: Difference between revisions
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==Overview== | ==Overview== | ||
[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is the preferred [[treatment]] with: | *[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is the preferred [[treatment]] with: | ||
**[[Disease]] of the [[left main coronary artery]] ([[Left main coronary artery|LMCA]]). [[LMCA]] [[disease]] is associated with [[sudden death]]; therefore, lesions of the [[Left main coronary artery|LMCA]] are sometimes referred to as widow makers. | |||
*[[Disease]] of the [[left main coronary artery]] ([[Left main coronary artery|LMCA]]). [[LMCA]] [[disease]] is associated with [[sudden death]]; therefore, lesions of the [[Left main coronary artery|LMCA]] are sometimes referred to as widow makers. | **[[Disease]] of all three coronary vessels ([[Left anterior descending artery|LAD]], [[Left circumflex artery|LCX]] and [[Right coronary artery|RCA]]). | ||
*[[Disease]] of all three coronary vessels ([[Left anterior descending artery|LAD]], [[Left circumflex artery|LCX]] and [[Right coronary artery|RCA]]). | **Diffuse [[disease]] not amenable to [[treatment]] with [[Percutaneous coronary intervention|PCI]]. | ||
*Diffuse [[disease]] not amenable to [[treatment]] with [[Percutaneous coronary intervention|PCI]]. | **[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is likely the preferred [[treatment]] with other high-risk [[patients]] such as those with [[severe ventricular dysfunction]] (i.e. low [[ejection fraction]]), or [[diabetes mellitus]] [[patients]], particularly those with [[disease]] involving the [[left anterior descending artery]]. | ||
*[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is likely the preferred [[treatment]] with other high-risk [[patients]] such as those with [[severe ventricular dysfunction]] (i.e. low [[ejection fraction]]), or [[diabetes mellitus]] [[patients]], particularly those with [[disease]] involving the [[left anterior descending artery]]. | *Alternative [[treatments]] for [[coronary artery disease]] include: | ||
**Medical management ([[statins]], [[antihypertensives]], [[smoking cessation]], and tight [[Diabetes management|blood sugar control]] in [[diabetics]]). | |||
Alternative [[treatments]] for [[coronary artery disease]] include: | **Both [[Percutaneous coronary intervention]] ([[PCI]]) and [[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) are more effective than medical management at relieving [[symptoms]], (e.g. [[angina]], [[dyspnea]], [[fatigue]]), but repeated procedures are required more frequently after [[PCI]]. | ||
*Medical management ([[statins]], [[antihypertensives]], [[smoking cessation]], and tight [[Diabetes management|blood sugar control]] in [[diabetics]]). | *When optimal [[treatment]] strategy is unclear for a [[patient]], it is recommended to have a multidisciplinary Heart Team approach.<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | ||
*Both [[Percutaneous coronary intervention]] ([[PCI]]) and [[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) are more effective than medical management at relieving [[symptoms]], (e.g. [[angina]], [[dyspnea]], [[fatigue]]), but repeated procedures are required more frequently after [[PCI]]. | *Decision regarding the [[treatment]] should be [[patient]] centered.<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | ||
When optimal [[treatment]] strategy is unclear for a [[patient]], it is recommended to have a multidisciplinary Heart Team approach.<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | |||
Decision regarding the [[treatment]] should be [[patient]] centered.<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | |||
==Surgery Indications== | ==Surgery Indications== | ||
Latest revision as of 20:01, 11 February 2022
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Coronary Artery Bypass Surgery Microchapters | |
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Pathophysiology | |
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Diagnosis | |
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Treatment | |
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Perioperative Monitoring | |
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Surgical Procedure | |
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Special Scenarios | |
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Coronary artery bypass surgery indications On the Web | |
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Directions to Hospitals Performing Coronary artery bypass surgery indications | |
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Risk calculators for Coronary artery bypass surgery indications | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Mohammed A. Sbeih, M.D. [3] Anahita Deylamsalehi, M.D.[4]
Overview
- Coronary artery bypass surgery (CABG) is the preferred treatment with:
- Disease of the left main coronary artery (LMCA). LMCA disease is associated with sudden death; therefore, lesions of the LMCA are sometimes referred to as widow makers.
- Disease of all three coronary vessels (LAD, LCX and RCA).
- Diffuse disease not amenable to treatment with PCI.
- Coronary artery bypass surgery (CABG) is likely the preferred treatment with other high-risk patients such as those with severe ventricular dysfunction (i.e. low ejection fraction), or diabetes mellitus patients, particularly those with disease involving the left anterior descending artery.
- Alternative treatments for coronary artery disease include:
- Medical management (statins, antihypertensives, smoking cessation, and tight blood sugar control in diabetics).
- Both Percutaneous coronary intervention (PCI) and Coronary artery bypass surgery (CABG) are more effective than medical management at relieving symptoms, (e.g. angina, dyspnea, fatigue), but repeated procedures are required more frequently after PCI.
- When optimal treatment strategy is unclear for a patient, it is recommended to have a multidisciplinary Heart Team approach.[1]
- Decision regarding the treatment should be patient centered.[1]
Surgery Indications
- You can read in greater detail about each of the indications for CABG below in greater detail by clicking on the link.
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
- ↑ 1.0 1.1 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).