Makindo Medical Notes

Related Subjects: |Atherosclerosis |Ischaemic heart disease |Assessing Chest Pain |ACS - General |ACS - STEMI |ACS - NSTEMI |ACS - GRACE Score |ACS - ECG Changes |ACS -Cardiac Troponins |ACS - Post MI arrhythmias |ACS: Right Ventricular Infarction

As compared with the use of saphenous vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up

About

• Coronary Artery bypass grafting has been in use since the early 1960s to manage IHD
• Approximately 90% of patients have no angina postoperatively, with almost all patients experiencing a significant improvement.
• Originally using saphenous vein grafts but developments have included the use of the Internal Mammary artery which gives improved long term patency.
• The use of radial-artery grafts for coronary artery bypass grafting (CABG) may result in better postoperative outcomes than the use of saphenous vein grafts
• More recently minimally invasive techniques have been developed which include CABG without using cardiopulmonary bypass.
• The Internal mammary artery is also known as the internal thoracic artery and is usually remarkably free of atheroma, especially in patients younger than 65 years
• Usually Left Internal mammary bypasses the LAD and the Right internal mammary the RCA
• Reverse saphenous vein grafts are attached from the aorta to beyond distal obstruction
• CABG Relieves angina in 90% of those treated and With TVD or LMS stenosis evidence shows improved life expectancy

Indications for CABG

• Those with left main stem disease (LMS)
• Those with triple vessel disease (TVD)
• Two vessel disease with proximal LAD disease
• Improved outcome in those with moderately poor Left ventricular function
• Late complications include graft occlusion especially with veins
• Grafts can be treated with angioplasty and stented

Complications

• Sternal wound infections
• Pneumonia
• Thromboembolic phenomena
• Graft failure
• Atrial fibrillation
• Pulmonary hypertension
• Pericardial effusion
• Strokes
• Renal injury
• Gastrointestinal insults
• Haemodynamic instability

Other Issues

• Aspirin is usually continued for the procedure, but other antiplatelet drugs such as Clopidogrel are stopped up to 5 days in advance.
• During the procedure patients are Heparinised to prevent thrombosis on CPB.
• Antibiotic cover is provided using a broad-spectrum antibiotic to prevent bacteraemia.
• Operative mortality depends on many factors including age and concomitant disease, it usually varies from 1 to 5%.
• There is a similar, age-related risk of stroke.
  

References

• Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery
• Coronary artery bypass graft surgery complications: A review for emergency clinicians