Coronary artery bypass surgery in patients with acute MI

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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]

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

CABG in Patients With Acute Myocardial Infarction (DO NOT EDIT)[1]

Class I
"1. Emergency CABG is recommended in patients with acute myocardial infarction (MI) in whom 1) primary PCI has failed or cannot be performed, 2) coronary anatomy is suitable for CABG, and 3) persistent ischemia of a significant area of myocardium at rest and/or hemodynamic instability refractory to nonsurgical therapy is present.[2][3][4][5][6] (Level of Evidence: B)"
"2. Emergency CABG is recommended in patients undergoing surgical repair of a postinfarction mechanical complication of MI, such as ventricular septal rupture, mitral valve insufficiency because of papillary muscle infarction and/or rupture, or free wall rupture.[7][8][9][10][11] (Level of Evidence: B)"
"3. Emergency CABG is recommended in patients with cardiogenic shock and who are suitable for CABG irrespective of the time interval from MI to onset of shock and time from MI to CABG.[12][5][13][14] (Level of Evidence: B)"
"4. Emergency CABG is recommended in patients with life-threatening ventricular arrhythmias (believed to be ischemic in origin) in the presence of left main stenosis greater than or equal to 50% and/or 3-vessel CAD.[15] (Level of Evidence: C)"
Class III: HARM
"1. Emergency CABG should not be performed in patients with persistent angina and a small area of viable myocardium who are stable hemodynamically. (Level of Evidence: C)"
"2. Emergency CABG should not be performed in patients with noreflow (successful epicardial reperfusion with unsuccessful microvascular reperfusion). (Level of Evidence: C)"
Class IIa
"1. The use of CABG is reasonable as a revascularization strategy in patients with multivessel CAD with recurrent angina or MI within the first 48 hours of STEMI presentation as an alternative to a more delayed strategy.[2][4][6][16] (Level of Evidence: B)"
"2. Early revascularization with PCI or CABG is reasonable for selected patients greater than 75 years of age with ST-segment elevation or left bundle branch block who are suitable for revascularization irrespective of the time interval from MI to onset of shock.[17][18][19][20][21] (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. 124 (23): e652–735. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  2. 2.0 2.1 Alexiou K, Kappert U, Staroske A, Joskowiak D, Wilbring M, Matschke K, Tugtekin SM (2008). "Coronary surgery for acute coronary syndrome: which determinants of outcome remain?". Clinical Research in Cardiology : Official Journal of the German Cardiac Society. 97 (9): 601–8. doi:10.1007/s00392-008-0657-6. PMID 18379855. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  3. Chiu FC, Chang SN, Lin JW, Hwang JJ, Chen YS (2009). "Coronary artery bypass graft surgery provides better survival in patients with acute coronary syndrome or ST-segment elevation myocardial infarction experiencing cardiogenic shock after percutaneous coronary intervention: a propensity score analysis". The Journal of Thoracic and Cardiovascular Surgery. 138 (6): 1326–30. doi:10.1016/j.jtcvs.2009.03.038. PMID 19660378. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 DeWood MA, Spores J, Berg R, Kendall RW, Grunwald RP, Selinger SL, Hensley GR, Sutherland KI, Sheilds JP (1983). "Acute myocardial infarction: a decade of experience with surgical reperfusion in 701 patients". Circulation. 68 (3 Pt 2): II8–16. PMID 6872200. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  5. 5.0 5.1 Donatelli F, Benussi S, Triggiani M, Guarracino F, Marchetto G, Grossi A (1997). "Surgical treatment for life-threatening acute myocardial infarction: a prospective protocol". European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 11 (2): 228–33. PMID 9080148. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  6. 6.0 6.1 Filizcan U, Kurc E, Cetemen S, Soylu O, Aydogan H, Bayserke O, Yilmaz M, Uyarel H, Ergelen M, Orhan G, Ugurlucan M, Eren E, Yekeler I (2011). "Mortality predictors in ST-elevated myocardial infarction patients undergoing coronary artery bypass grafting". Angiology. 62 (1): 68–73. doi:10.1177/0003319710369103. PMID 20462895. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  7. Chevalier P, Burri H, Fahrat F, Cucherat M, Jegaden O, Obadia JF, Kirkorian G, Touboul P (2004). "Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation". European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 26 (2): 330–5. doi:10.1016/j.ejcts.2004.04.027. PMID 15296892. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  8. Lemery R, Smith HC, Giuliani ER, Gersh BJ (1992). "Prognosis in rupture of the ventricular septum after acute myocardial infarction and role of early surgical intervention". The American Journal of Cardiology. 70 (2): 147–51. PMID 1626498. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  9. Russo A, Suri RM, Grigioni F, Roger VL, Oh JK, Mahoney DW, Schaff HV, Enriquez-Sarano M (2008). "Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture". Circulation. 118 (15): 1528–34. doi:10.1161/CIRCULATIONAHA.107.747949. PMID 18809799. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  10. Shamshad F, Kenchaiah S, Finn PV, Soler-Soler J, McMurray JJ, Velazquez EJ, Maggioni AP, Califf RM, Swedberg K, Kober L, Belenkov Y, Varshavsky S, Pfeffer MA, Solomon SD (2010). "Fatal myocardial rupture after acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALsartan In Acute myocardial iNfarcTion Trial (VALIANT)". American Heart Journal. 160 (1): 145–51. doi:10.1016/j.ahj.2010.02.037. PMID 20598985. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  11. Tavakoli R, Weber A, Brunner-La Rocca H, Bettex D, Vogt P, Pretre R, Jenni R, Turina M (2002). "Results of surgery for irreversible moderate to severe mitral valve regurgitation secondary to myocardial infarction". European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 21 (5): 818–24. PMID 12062269. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  12. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH (1999). "Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock". The New England Journal of Medicine. 341 (9): 625–34. doi:10.1056/NEJM199908263410901. PMID 10460813. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  13. Mehta RH, Lopes RD, Ballotta A, Frigiola A, Sketch MH, Bossone E, Bates ER (2010). "Percutaneous coronary intervention or coronary artery bypass surgery for cardiogenic shock and multivessel coronary artery disease?". American Heart Journal. 159 (1): 141–7. doi:10.1016/j.ahj.2009.10.035. PMID 20102880. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  14. White HD, Assmann SF, Sanborn TA, Jacobs AK, Webb JG, Sleeper LA, Wong CK, Stewart JT, Aylward PE, Wong SC, Hochman JS (2005). "Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock: results from the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial". Circulation. 112 (13): 1992–2001. doi:10.1161/CIRCULATIONAHA.105.540948. PMID 16186436. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  15. Ngaage DL, Cale AR, Cowen ME, Griffin S, Guvendik L (2008). "Early and late survival after surgical revascularization for ischemic ventricular fibrillation/tachycardia". The Annals of Thoracic Surgery. 85 (4): 1278–81. doi:10.1016/j.athoracsur.2007.12.035. PMID 18355509. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  16. Parikh SV, de Lemos JA, Jessen ME, Brilakis ES, Ohman EM, Chen AY, Wang TY, Peterson ED, Roe MT, Holper EM (2010). "Timing of in-hospital coronary artery bypass graft surgery for non-ST-segment elevation myocardial infarction patients results from the National Cardiovascular Data Registry ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines)". JACC. Cardiovascular Interventions. 3 (4): 419–27. doi:10.1016/j.jcin.2010.01.012. PMID 20398870. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  17. Lim HS, Farouque O, Andrianopoulos N, Yan BP, Lim CC, Brennan AL, Reid CM, Freeman M, Charter K, Black A, New G, Ajani AE, Duffy SJ, Clark DJ (2009). "Survival of elderly patients undergoing percutaneous coronary intervention for acute myocardial infarction complicated by cardiogenic shock". JACC. Cardiovascular Interventions. 2 (2): 146–52. doi:10.1016/j.jcin.2008.11.006. PMID 19463417. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  18. Amin AP, Nathan S, Prodduturi P, D'Silva O, Gupta A, Kumar A, Senter S, Mamtani M, Kulkarni H, Klein LW, Kelly RF (2009). "Survival benefit from early revascularization in elderly patients with cardiogenic shock after acute myocardial infarction: a cohort study". The Journal of Invasive Cardiology. 21 (7): 305–12. PMID 19571337. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  19. Migliorini A, Moschi G, Valenti R, Parodi G, Dovellini EV, Carrabba N, Buonamici P, Antoniucci D (2006). "Routine percutaneous coronary intervention in elderly patients with cardiogenic shock complicating acute myocardial infarction". American Heart Journal. 152 (5): 903–8. doi:10.1016/j.ahj.2005.12.030. PMID 17070154. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)
  20. Hochman JS, Buller CE, Sleeper LA, Boland J, Dzavik V, Sanborn TA, Godfrey E, White HD, Lim J, LeJemtel T (2000). "Cardiogenic shock complicating acute myocardial infarction--etiologies, management and outcome: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?". Journal of the American College of Cardiology. 36 (3 Suppl A): 1063–70. PMID 10985706. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  21. Dzavik V, Sleeper LA, Cocke TP, Moscucci M, Saucedo J, Hosat S, Jiang X, Slater J, LeJemtel T, Hochman JS (2003). "Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock: a report from the SHOCK Trial Registry". European Heart Journal. 24 (9): 828–37. PMID 12727150. Retrieved 2011-12-09. Unknown parameter |month= ignored (help)

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