Coronary artery bypass surgery heart team approach to revascularization decisions

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Coronary Artery Bypass Surgery Microchapters

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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(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

Overview

In patients with unprotected left main disease or complex CAD, a Heart Team approach is recommended.Calculation of the STS and SYNTAX score is also reasonable in these patients.

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[1]

Heart Team Approach to Revascularization Decisions (DO NOT EDIT)[1]

Class I
"1. A Heart Team approach to revascularization is recommended in patients with unprotected left main or complex CAD.[2][3][4] (Level of Evidence: C)"
Class IIa
"1. Calculation of the STS and SYNTAX scores (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) is reasonable in patients with unprotected left main and complex CAD.[5][2][6][7][8][9][10][11] (Level of Evidence: B)"

References

  1. 1.0 1.1 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. 2.0 2.1 Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Ståhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW (2009). "Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease". The New England Journal of Medicine. 360 (10): 961–72. doi:10.1056/NEJMoa0804626. PMID 19228612. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  3. Feit F, Brooks MM, Sopko G, Keller NM, Rosen A, Krone R, Berger PB, Shemin R, Attubato MJ, Williams DO, Frye R, Detre KM (2000). "Long-term clinical outcome in the Bypass Angioplasty Revascularization Investigation Registry: comparison with the randomized trial. BARI Investigators". Circulation. 101 (24): 2795–802. PMID 10859284. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  4. King SB, Barnhart HX, Kosinski AS, Weintraub WS, Lembo NJ, Petersen JY, Douglas JS, Jones EL, Craver JM, Guyton RA, Morris DC, Liberman HA (1997). "Angioplasty or surgery for multivessel coronary artery disease: comparison of eligible registry and randomized patients in the EAST trial and influence of treatment selection on outcomes. Emory Angioplasty versus Surgery Trial Investigators". The American Journal of Cardiology. 79 (11): 1453–9. PMID 9185632. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  5. Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A, Mack MJ, Holmes DR, Torracca L, van Es GA, Leadley K, Dawkins KD, Mohr F (2010). "Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial". Circulation. 121 (24): 2645–53. doi:10.1161/CIRCULATIONAHA.109.899211. PMID 20530001. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  6. Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J, Mirocha JM, Fontana G, Forrester JS, Makkar R (2011). "Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization". The American Journal of Cardiology. 107 (3): 360–6. doi:10.1016/j.amjcard.2010.09.029. PMID 21256999. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  7. Grover FL, Shroyer AL, Hammermeister K, Edwards FH, Ferguson TB, Dziuban SW, Cleveland JC, Clark RE, McDonald G (2001). "A decade's experience with quality improvement in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national databases". Annals of Surgery. 234 (4): 464–72, discussion 472–4. PMC 1422070. PMID 11573040. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  8. Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ (2010). "Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization". JACC. Cardiovascular Interventions. 3 (6): 612–23. doi:10.1016/j.jcin.2010.04.004. PMID 20630454. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  9. Shahian DM, O'Brien SM, Filardo G, Ferraris VA, Haan CK, Rich JB, Normand SL, DeLong ER, Shewan CM, Dokholyan RS, Peterson ED, Edwards FH, Anderson RP (2009). "The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery". The Annals of Thoracic Surgery. 88 (1 Suppl): S2–22. doi:10.1016/j.athoracsur.2009.05.053. PMID 19559822. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  10. Shahian DM, O'Brien SM, Normand SL, Peterson ED, Edwards FH (2010). "Association of hospital coronary artery bypass volume with processes of care, mortality, morbidity, and the Society of Thoracic Surgeons composite quality score". The Journal of Thoracic and Cardiovascular Surgery. 139 (2): 273–82. doi:10.1016/j.jtcvs.2009.09.007. PMID 20022608. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)
  11. Welke KF, Peterson ED, Vaughan-Sarrazin MS, O'Brien SM, Rosenthal GE, Shook GJ, Dokholyan RS, Haan CK, Ferguson TB (2007). "Comparison of cardiac surgery volumes and mortality rates between the Society of Thoracic Surgeons and Medicare databases from 1993 through 2001". The Annals of Thoracic Surgery. 84 (5): 1538–46. doi:10.1016/j.athoracsur.2007.06.022. PMID 17954059. Retrieved 2011-12-13. Unknown parameter |month= ignored (help)

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