Difference between revisions of "Coronary artery bypass grafts"

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Coronary artery bypass grafts (view source)

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'''Coronary artery bypass surgery''', also '''coronary artery bypass grafting''' (abbreviated '''CABG'''), is a procedure to treatment [[atherosclerotic coronary artery disease]] (ACAD). It is encountered by [[pathologist]]s at [[autopsy]].
'''Coronary artery bypass grafts''' are a treatment for [[atherosclerotic heart disease]] (ASHD).  They are created in a procedure called '''coronary artery bypass surgery''', also '''coronary artery bypass grafting''', abbreviated '''CABG'''. CABGs are encountered by [[pathologist]]s at [[autopsy]].


The other treatments for ACAD are medical management, and percutaneous coronary intervention (PCI).
The other treatments for ASHD are medical management, and percutaneous coronary intervention (PCI).


==Indications==
==Indications==
Indications for CABG:<ref>{{Cite journal  | last1 = Serruys | first1 = PW. | last2 = Morice | first2 = MC. | last3 = Kappetein | first3 = AP. | last4 = Colombo | first4 = A. | last5 = Holmes | first5 = DR. | last6 = Mack | first6 = MJ. | last7 = Ståhle | first7 = E. | last8 = Feldman | first8 = TE. | last9 = van den Brand | first9 = M. | title = Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. | journal = N Engl J Med | volume = 360 | issue = 10 | pages = 961-72 | month = Mar | year = 2009 | doi = 10.1056/NEJMoa0804626 | PMID = 19228612 }}</ref>
Indications for CABG:<ref name=pmid19228612>{{Cite journal  | last1 = Serruys | first1 = PW. | last2 = Morice | first2 = MC. | last3 = Kappetein | first3 = AP. | last4 = Colombo | first4 = A. | last5 = Holmes | first5 = DR. | last6 = Mack | first6 = MJ. | last7 = Ståhle | first7 = E. | last8 = Feldman | first8 = TE. | last9 = van den Brand | first9 = M. | title = Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. | journal = N Engl J Med | volume = 360 | issue = 10 | pages = 961-72 | month = Mar | year = 2009 | doi = 10.1056/NEJMoa0804626 | PMID = 19228612 }}</ref>
*Left main coronary artery disease.
*Left main coronary artery disease.
*Triple vessel disease.
*Triple vessel disease.
**Disease involving the left anterior descending (coronary artery), left circumflex coronary artery and right coronary artery.  
**Disease involving the left anterior descending (coronary artery), left circumflex coronary artery and right coronary artery.  
Others:
*Disease that cannot be treated with percutaneous coronary intervention (PCI).
==Complications==
*[[Cholesterol embolism]] - may go anywhere.
**Kidney -> [[renal failure]].
**Cerebral vessels -> [[stroke]].
*[[Aortic dissection]].
*[[Myocardial infarction]].
*Others.


==Gross==
==Gross==
#All grafts should be identified.
[[Image:Heart_saphenous_coronary_grafts.jpg|right|thumb|Heart with three bypass grafts. (WC)]]
#*Proximal anastomosis.
===Types of grafts===
#*Distal anastomosis.
*Arterial - usually ''internal thoracic artery''.
*Venous - saphenous vein.
 
Notes:
*Arterial grafts, generally, are much longer lived ~90% patency at 10 years verus ~57% for saphenous vein grafts.<ref name=pmid15680832>{{Cite journal  | last1 = Sabik | first1 = JF. | last2 = Lytle | first2 = BW. | last3 = Blackstone | first3 = EH. | last4 = Houghtaling | first4 = PL. | last5 = Cosgrove | first5 = DM. | title = Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal = Ann Thorac Surg | volume = 79 | issue = 2 | pages = 544-51; discussion 544-51 | month = Feb | year = 2005 | doi = 10.1016/j.athoracsur.2004.07.047 | PMID = 15680832 }}</ref>
 
====Common configurations====
Arterial:
*Left internal thoracic artery (LITA) - almost always to the distal LAD.
Venous:
*Aorta to posterior interventricular branch of RCA.
**Typically pass around the right side of the heart.
*Aorta to left circumflex coronary artery.
**Typically pass around the left side of the heart.
*Aorta to first or second diagonal branch of the LAD.
 
===Identification===
*Know the common configurations.
*Get the OR note - '''important'''.
**Clinical notes are notoriously unreliable.
*Trace the grafts from proximal to distal ''or'' distal to proximal.
*Look for the sutures... where there is a suture there is often a graft.
**The aorta usu. has one extra suture for the (arterial) cannulation site -- where the bypass machine returns the blood to the body.
**The right atrium usu. has a suture for the (venous) cannulation site -- where the bypass machine receives the blood from the body.
 
All grafts should be identified:
*Proximal anastomosis - if applicable.
**Usu. non-existent in ITA grafts.
**Generally, found several centimetres above the coronary ostia.
*Distal anastomosis.
**Classic site of failure, esp. in arterial grafts.


==See also==
==See also==
*[[Autopsy]].
*[[Autopsy]].
*[[Heart]].
*[[Heart]].
*[[Heart anatomy]].


==References==
==References==
{{Reflist|1}}
{{Reflist|2}}


[[Category:Clinical]]
[[Category:Clinical]]
Michael
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