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Difference between revisions of "Coronary artery bypass grafts"
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Coronary artery bypass grafts (view source)
Revision as of 14:25, 3 September 2012
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==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. | ||
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Notes: | 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> | *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=== | ===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: | All grafts should be identified: | ||
*Proximal anastomosis - if applicable. | *Proximal anastomosis - if applicable. | ||
**Usu. non-existent in ITA grafts. | |||
**Generally, found several centimetres above the coronary ostia. | |||
*Distal anastomosis. | *Distal anastomosis. | ||
**Classic site of failure, esp. in arterial grafts. | |||
* | |||
* | |||
==See also== | ==See also== | ||
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==References== | ==References== | ||
{{Reflist| | {{Reflist|2}} | ||
[[Category:Clinical]] | [[Category:Clinical]] | ||