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医者仁心 一路相随 Withonary Arteries
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AHA Guideline for CABG Surgery
Left main coronary artery disease (LMCA) or significant disease
Bypass surgery can markedly reduce or relieve chest pain for most patients, and improve survival and minimize complications of cardiac ischemia
More than 300,000 patients undergo CABG surgery annually in the US
Long-term graft patency is excellent with internal thoracic artery and radial artery bypass grafts. Rates exceeding 90 percent at 5 to 10 years are common.
placement is not successful in opening
the blocked blood vessels
Survivors of sudden death who have coronary artery disease
Other high-risk patients such as those with severe ventricular dysfunction (i.e. low ejection fraction), or
diabetes mellitus.
CABG is superior to PCI for some patients with multivessel CAD
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CABG Contraindication
CABG is not recommended for patients who do not have adequate native vessels to use as graft. Patients with very small coronary arteries(< 1 mm or < 1.5 mm) and atherosclerosis of the aorta, heavily calcified, or located within the heart muscle rather than on the surface are challenges in CABG.
① Decreased graft patency due to problems with anastomoses
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Choice of Graft
①Internal thoracic arteries (also called internal mammary arteries)
Coronary Artery Bypass Grafting
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Definition Indication Contraindication CABG Types Graft choose Complications
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What is CABG?
Coronary artery bypass graft surgery (CABG) is a procedure that uses patient’s own veins (usually from the legs) or arteries to bypass narrowed areas and restore blood flow to heart muscle.
②Radial arteries ③Saphenous veins ④ Right gastroepiploic artery
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Saphenous vein graft patency declines significantly starting at the time of surgery. Rates below 90 percent are common at one year.
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Types of CABG
CABG
Traditional CABG Nontraditional CABG
Off Pump Coronary Artery Bypass Grafting
Minimally Invasive Direct Coronary Artery
Advantages:
① A decreased need for blood transfusion
② Less myocardial enzyme release
③ Less renal dysfunction ④ Less early neurological
dysfunction
Disadvantage:
Bypass Grafting
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Off Pump Coronary Artery Bypass Grafting
医者仁心 一路相随 With You All The Way
Off Pump Coronary Artery Bypass Grafting
of the LAD with another vessel involved or all three coronary arteries (LAD, LCX and RCA).
Diffuse disease not suitable to treatment with a PCI or stent