Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified)

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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 Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Mohammed A. Sbeih, M.D. [3]

The Traditional coronary artery bypass grafting procedure (simplified)

  1. The patient is brought to the operating room and moved onto the operating table.
  2. An anesthetist places a variety of intravenous lines, often including a pulmonary artery catheter and injects an induction agent (usually propofol) to render the patient unconscious and to anesthetize the patient.
  3. An endotracheal tube is inserted and secured by the anesthetist or a respiratory therapist and mechanical ventilation is started.
  4. The chest is opened via a median sternotomy and the heart is examined by the surgeon.
  5. The grafts are harvested - frequent conduits are the internal thoracic arteries, radial arteries and saphenous veins.
  6. The surgeon stops the heart and initiates cardiopulmonary bypass; or in the case of "off-pump" surgery, places devices to stabilize the heart.
  7. One end of each graft is sewn onto the coronary arteries beyond the blockages and the other end is attached to the aorta.
  8. The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In some cases, the aorta is partially occluded by a C shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating. This reduces time spent on the heart lung machine.
  9. The sternum is wired together and the incisions are sutured closed.
  10. The patient is moved to the intensive care unit (ICU) to recover. After awakening and stabilizing in the ICU (approximately 1 day), the patient is transferred to the cardiac surgery unit until ready to go home (approximately 4 days).



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