Coronary artery bypass surgery angiography

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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

Recommendation for Duration of DAPT in Patients With ACS Treated With 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-in-Chief: Mathew Southard

Coronary angiography

Prior to coronary artery bypass grafting

It is often recommended that the first procedure performed on the diagnostic coronary angiography is the RAO caudal, to determine and to assess the stenosis in the circumflex, the left anterior descending, and distal targets. These are assessed in case the patient becomes critically ill following the initial injection in the left main. If the patient is not critically ill, then angiography should be performed in an adequate number of views to identify all blockages that should be bypassed as well as the size, calcification, and disease extent of target vessels. Angiography should continue for a sufficient duration of time to assess the presence and quality of distal vessels that may be collateralized and may need to be bypassed. Although left ventriculography is helpful in the assessment of left ventricular function, it can also be assessed on echocardiography to minimize the dye load and the potential for hemodynamic collapse with excess contrast agent.

Following coronary artery bypass grafting

Use of radio-opaque saphenous vein graft markers has been associated with the following in non-randomized observational studies:

  1. Reduced volume of contrast injections
  2. Shorter cardiac catheterization procedure times
  3. Greater rates of identification of occluded SVGs (90.7% vs 72.1%, p < 0.001)[1]
  4. No increase in the risk of SVG failure [1]
  5. An unexplained increase in the risk of perioperative MI in non-randomized analyses [1]
  6. No increase in the risk of death or MI by 12-18 months of follow-up.

References

  1. 1.0 1.1 1.2 Olenchock SA, Karmpaliotis D, Gibson WJ, Murphy SA, Southard MC, Ciaglo L, Buros J, Mack MJ, Alexander JH, Harrington RA, Califf RM, Kouchoukos NT, Ferguson TB, Gibson CM (2008). "Impact of saphenous vein graft radiographic markers on clinical events and angiographic parameters". The Annals of Thoracic Surgery. 85 (2): 520–4. doi:10.1016/j.athoracsur.2007.10.061. PMID 18222256. Retrieved 2010-07-13. Unknown parameter |month= ignored (help)



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