Coronary artery bypass surgery
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Coronary Artery Bypass Surgery Microchapters | |
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Pathophysiology | |
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Diagnosis | |
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Perioperative Monitoring | |
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Surgical Procedure | |
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Coronary artery bypass surgery On the Web | |
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Directions to Hospitals Performing 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
- Based on ACC 2021 revascularization guideline, STS risk score is recommended to predict the prognosis of CABG.[1]
- This score system can predict the adverse outcomes of CABG such as death, permanent stroke, renal failure, repeated surgery, deep sternal wound infection, prolonged mechanical ventilation, and hospitalization.[1]
- Compared to EuroSCORE II (the European System for Cardiac Operative Risk Evaluation), STS risk score is more accurate in predicting CABG outcomes, especially at mortality rates higher than 5%.[1]
- STS risk score is limited in evaluating the effect of conditions such as cirrhosis, malnutrition, and frailty on CABG's outcome. Therefore, for patients who are candidates for CABG and have those conditions other tools should be used.
- STS risk score is derived from the United States' data on patients who had CABG.[1] The following table shows last updated STS risk score (2018) for patients who had only CABG or CABG with a heart value surgery.[2]
| 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
- CABG
- Hybrid bypass
- Off-Pump Coronary Artery Bypass Surgery (OPCAB)
- Minimally invasive direct coronary artery bypass surgery (MIDCAB)
- Cardiothoracic surgery
- Dressler's syndrome
- Hybrid bypass
External Links
- Advances in Cardiovascular Surgery and Cardiothoracic Surgical Procedures
- Cardiothoracic Surgery Notes an online interactive review developed by residents in cardiothoracic surgery
- Contenidos de Enfermería y Cirugía Cardiaca
- CTSNet: The Cardiothoracic Surgery Network
- Curso de Enfermería y Cirugía Cardiaca
- Heart Assist Devices
- LVAD Simulator
- Perfusion Line
- The CardioThoracic Surgery Network: Residents Section
- The Implantable Artificial Heart Project
- The Virtual Textbook Of Extracorporeal Technology
- Yale: Introduction to Cardiothoracic Imaging
- ↑ 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). - ↑ 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.