wikidoc - User contributions [en]

Coronary artery bypass surgery

2022-10-22T06:26:42Z

Anahita:

'''For the WikiPatient page for this topic, click [[{{PAGENAME}} (patient information)|here]]'''
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[User: Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{Anahita}}; {{CZ}}; {{VK}} {{PTD}}

'''''Synonyms and keywords:''''' Coronary artery bypass grafting, and colloquially heart bypass, bypass, bypass surgery, open heart surgery, or CABG (pronounced like cabbage), aortocoronary bypass (ACB). The term Coronary Artery Graft Surgery (CAGS) is often used outside the United States and should not be confused with [[Coronary angiography|Coronary Angiography (CAG)]]. OPCAB refers to [[Off-pump coronary artery bypass]], a procedure during which the patient is not placed on extracorporeal circulation ("the pump").

==[[Coronary artery bypass surgery overview|Overview]]==
[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is a [[surgery|surgical]] [[coronary revascularization|revascularization]] procedure that is used to circumvent or bypass blockages in the [[Epicardium|epicardial]] [[coronary arteries]] associated with [[acute coronary syndromes]] (including [[ST elevation MI]], [[non ST elevation MI]], [[unstable angina]]) and [[stable angina]]. The technique was pioneered by Argentine [[cardiac surgeon]] [[René Favaloro]] at the [[Cleveland Clinic]] in the late 1960s. As part of the procedure, [[artery|arteries]] or [[vein]]s from elsewhere in the [[patient]]'s body are [[medical grafting|grafted]] from the [[aorta]] to the [[coronary artery|coronary arteries]] to bypass [[atherosclerosis|atherosclerotic]] [[stenosis|narrowings]] and improve the [[blood]] supply to the [[coronary circulation]] supplying the [[myocardium]] ([[myocardium|heart muscle]]). This surgery is usually performed with the [[heart]] stopped, necessitating the usage of [[cardiopulmonary bypass]]. However, recent advances allow the procedure to be performed with the [[heart]] beating and through smaller [[incisions]]. Currently, about 500,000 [[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) are performed in the United States each year.

==Pathophysiology==
[[Coronary artery bypass surgery saphenous vein graft disease| Saphenous Vein Graft Disease]] | [[Coronary artery bypass surgery other non-atherosclerotic saphenous vein graft diseases|Other Non-Atherosclerotic Saphenous Vein Graft Diseases]]

==[[Coronary artery bypass surgery indications|Indications for CABG]]==
[[Coronary artery bypass surgery in patients with acute MI|CABG in Patients with Acute MI]] | [[Coronary artery bypass surgery in ventricular arrhythmias|CABG in Patients with Ventricular Arrhythmias]] | [[Coronary artery bypass surgery after failed PCI|Emergency CABG after Failed PCI]] | [[Coronary artery bypass surgery in association with other cardiac procedures|CABG in Association with Other Cardiac Procedures]] | [[Coronary artery bypass surgery heart team approach to revascularization decisions|Heart Team Approach to Revascularization Decisions]] | [[Coronary artery bypass surgery of left main CAD to improve survival|Revascularization of Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery of non–left main CAD to improve survival|Revascularization of Non-Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery revascularization to improve symptoms|Revascularization to Improve Symptoms]] | [[Coronary artery bypass surgery CABG in left ventricular dysfunction|CABG in Left Ventricular Dysfunction]]

==[[Coronary artery bypass surgery prognosis|Prognosis]]==

==Imaging in the patient undergoing CABG==
[[Coronary artery bypass surgery X-ray|Chest x-ray]] | [[Coronary artery bypass surgery angiography|Coronary Angiography]]
| [[Coronary artery bypass surgery CT angiography|CT Angiography]] | [[Coronary artery bypass surgery mri angiography|MRI Angiography]] | [[Coronary artery bypass surgery TEE|Trans-Esophageal Echocardiography]] | [[Coronary artery bypass surgery epiaortic ultrasound|Epiaortic Ultrasound]]

==[[Coronary artery bypass surgery goals of treatment|Goals of Treatment]]==

==[[Coronary artery bypass surgery perioperative management|Perioperative and Intraoperative Management]]==
[[Coronary artery bypass surgery aspirin and clopidogrel|Aspirin and Clopidogrel]] | [[Coronary artery bypass surgery use of beta-blockers|Beta-Blockers]] | [[Coronary artery bypass surgery use of ACE Inhibitors/ARBs|ACE Inhibitors/ARBs]] | [[Coronary artery bypass surgery management of hyperlipidemia|Management of Hyperlipidemia]] | [[Coronary artery bypass surgery management of perioperative infection|Management of Mediastinitis/Perioperative Infection]] | [[Coronary artery bypass surgery percutaneous coronary intervention (PCI) to treat saphenous vein graft failure|Percutaneous Coronary Intervention (PCI) To Treat Saphenous Vein Graft Failure]] | [[Coronary artery bypass surgery maintaining glucose level|Maintaining Glucose Level]] | [[Coronary artery bypass surgery bleeding/transfusion]] | [[Coronary artery bypass surgery management of dysrhythmias|Management of Dysrhythmias]] | [[Coronary artery bypass surgery smoking cessation|Smoking Cessation]] | [[Coronary artery bypass surgery perioperative management of myocardial dysfunction|Perioperative Management of Myocardial Dysfunction]] | [[Coronary artery bypass surgery perioperative carotid artery noninvasive screening|Perioperative Carotid Artery Noninvasive Screening]]

==[[Coronary artery bypass surgery perioperative monitoring|Perioperative and Intraoperative Monitoring]]==
[[Coronary artery bypass surgery electrocardiographic monitoring|Electrocardiographic Monitoring]] | [[Coronary artery bypass surgery pulmonary artery catheterization|Pulmonary Artery Catheterization]] | [[Coronary artery bypass surgery central nervous system monitoring|Central Nervous System Monitoring]]

==[[Coronary artery bypass surgery surgical procedure|Surgical Procedure]]==
[[Coronary artery bypass surgery anesthetic considerations|Anesthetic Considerations]] | [[Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified)| The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)]] | [[Coronary artery bypass surgery minimally invasive CABG| Minimally Invasive CABG]] | [[Coronary artery bypass surgery conduits used for bypass|Conduits Used for Bypass]] | [[Coronary artery bypass surgery videos on spahenous vein graft harvesting| Videos on Saphenous Vein-Graft Harvesting]] | [[Coronary artery bypass surgery videos on Coronary artery bypass surgery|Videos on Coronary Artery Bypass Surgery]] | [[Coronary artery bypass surgery cardiopulmonary bypass|Cardiopulmonary Bypass]]

==[[Coronary artery bypass surgery post-operative care and complications|Post-Operative Care and Complications]]==
[[Coronary artery bypass surgery postoperative antiplatelet therapy|Postoperative Antiplatelet Therapy]]
==Special Scenarios==
[[Coronary artery bypass surgery in anomalous coronary arteries|Anomalous Coronary Arteries]] | [[Coronary artery bypass surgery in patients with COPD/respiratory insufficiency|Chronic Obstructive Pulmonary Disease/Respiratory Insufficiency]] | [[Coronary artery bypass surgery in patients with existing renal disease|Existing Renal Disease]] | [[Coronary artery bypass surgery in patients with valvular disease|Concomitant Valvular Disease]] | [[Coronary artery bypass surgery in patients with previous cardiac surgery|Previous Cardiac Surgery]] | [[Coronary artery bypass surgery in patients with menopause|Menopause]] | [[Coronary artery bypass surgery carotid disease evaluation before surgery|Carotid Disease Evaluation Before Surgery]]

==Related Chapters==

* [[CABG]]
* [[Hybrid bypass]]
* [[Off-pump coronary artery bypass surgery|Off-Pump Coronary Artery Bypass Surgery (OPCAB)]]
* [[Minimally invasive direct coronary artery bypass surgery]] ([[MIDCAB]])
* [[Cardiothoracic surgery]]
* [[Dressler's syndrome]]
* [[Hybrid bypass]]

==External Links==
*[http://www.texheartsurgeons.com/ Advances in Cardiovascular Surgery and Cardiothoracic Surgical Procedures]
*[http://www.ctsnet.org/residents/ctsn/ Cardiothoracic Surgery Notes] an online interactive review developed by residents in cardiothoracic surgery
*[http://www.enferpro.com/cirugia1.htm#DIRECCIONES Contenidos de Enfermería y Cirugía Cardiaca]
*[http://www.ctsnet.org/ CTSNet: The Cardiothoracic Surgery Network]
*[http://www.enferpro.com/cirugiacurso.htm Curso de Enfermería y Cirugía Cardiaca]
*[http://www.texheartsurgeons.com/AssistDvcs.htm Heart Assist Devices]
*[http://www1.cs.columbia.edu/robotics/projects/lvad/lvad_form.html LVAD Simulator]
*[http://perfline.com/index.htm Perfusion Line]
*[http://www.ctsnet.org/section/residents/ The CardioThoracic Surgery Network: Residents Section]
*[http://www.heartpioneers.com/ The Implantable Artificial Heart Project]
*[http://perfline.com/textbook/textbook.html The Virtual Textbook Of Extracorporeal Technology]
*[http://info.med.yale.edu/intmed/cardio/imaging/ Yale: Introduction to Cardiothoracic Imaging]

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

[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:mature chapter]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Overview complete]]
[[Category:Template complete]]

[[es:Bypass]]
[[fr:pontage aorto-coronarien]]
[[ja:冠動脈大動脈バイパス移植術]]
[[pl:CABG]]
[[pt:Cirurgia cardiovascular]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Coronary artery bypass surgery maintaining glucose level

2022-10-22T06:22:23Z

Anahita: /* Overview */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==
One of the recommended practices to decrease the likelihood of [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]] is [[Surgery|perioperative]] [[insulin]] [[infusion]] to control [[hyperglycemia]] and maintaining the [[blood sugar]] lower than 180 mg/dl. In addition to reducing the likelihood of [[infection]], the administration of continuous [[insulin]] [[infusion]] has been proven to lessens the likelihood of [[surgery|postoperative]] [[complications]], such as [[mediastinitis]], [[cardiac arrhythmias]], [[renal failure]], and lengthy [[hospital|hospitalization]].

==Maintaining Glucose Level in CABG==
*Even though the rate of [[Sternum|sternal]] [[wound]] [[infection]] has decreased among [[patients]] undergoing [[CABG]], its strong relation to death is not neglectable.<ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid25060372">{{cite journal| author=Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD | display-authors=etal| title=Management practices and major infections after cardiac surgery. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 4 | pages= 372-81 | pmid=25060372 | doi=10.1016/j.jacc.2014.04.052 | pmc=4222509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25060372 }} </ref>
*[[Surgery|Perioperative]] [[insulin]] [[infusion]] to control [[hyperglycemia]] and maintaining the [[blood sugar]] lower than 180 mg/dl can prevent the likelihood of [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] with known [[diabetes]] and in those with [[stress hyperglycemia]].<ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid24799638">{{cite journal| author=Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L | display-authors=etal| title=Strategies to prevent surgical site infections in acute care hospitals: 2014 update. | journal=Infect Control Hosp Epidemiol | year= 2014 | volume= 35 | issue= 6 | pages= 605-27 | pmid=24799638 | doi=10.1086/676022 | pmc=4267723 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24799638 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref>
*Usage of continuous [[intravenous]] [[insulin]] after [[CABG]] lessens the likelihood of [[surgery|postoperative]] [[complications]], such as [[mediastinitis]], deep [[sternum|sternal]] [[wound]] [[infections]], [[cardiac arrhythmias]], [[renal failure]], and lengthy [[hospital|hospitalization]].<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
*The following table represents some of the strategies proposed as best practices to reduce the risk of [[sternum|sternal]] [[wound]] [[infection]].<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref><ref name="pmid21106051">{{cite journal| author=Vestergaard RF, Jensen H, Vind-Kezunovic S, Jakobsen T, Søballe K, Hasenkam JM| title=Bone healing after median sternotomy: a comparison of two hemostatic devices. | journal=J Cardiothorac Surg | year= 2010 | volume= 5 | issue= | pages= 117 | pmid=21106051 | doi=10.1186/1749-8090-5-117 | pmc=3001423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106051 }} </ref><ref name="pmid28161384">{{cite journal| author=Cardona S, Pasquel FJ, Fayfman M, Peng L, Jacobs S, Vellanki P | display-authors=etal| title=Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy. | journal=J Diabetes Complications | year= 2017 | volume= 31 | issue= 4 | pages= 742-747 | pmid=28161384 | doi=10.1016/j.jdiacomp.2017.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28161384 }} </ref><ref name="pmid22064600">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG | display-authors=etal| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 23 | pages= 2610-42 | pmid=22064600 | doi=10.1161/CIR.0b013e31823b5fee | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064600 }} </ref>
{| class="wikitable" style="background-color:#dae8fc;"
|-
| [[Prophylactic]] [[antibiotics]] is recommended, nevertheless it should not be continued beyond 48 hours. The [[dose]] of [[prophylactic]] [[antibiotics]] must be tailored for lengthy [[surgery|procedures]] (more than two [[half-lives]]) or for those who lost excessive amount of [[blood]] during [[CABG]].
|- style="background-color:#ecf4ff;"
| [[nose|Nasal]] [[Cotton swab|swab]] [[test]] for [[Staphylococcus aureus]] is recommended.
|- style="background-color:#dae8fc;"
| For known carriers of [[Staphylococcus aureus]], [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#ecf4ff;"
| For those with unknown [[nose|nasal]] [[culture]] or [[PCR]], [[surgery|preoperative]] [[nose|intranasal]] [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#dae8fc;"
| It is recommended to measure [[HbA1c]] before [[CABG]]
|- style="background-color:#ecf4ff;"
| If it is a nonemergent [[surgery|surgical]] [[coronary revascularization]], all [[Chest|extrathoracic]] [[infections]] must be [[treatment|treated]] before the [[surgery]].
|- style="background-color:#dae8fc;"
| Guide [[patients]] to [[smoking cessation]] before [[elective]] [[CABG]]
|- style="background-color:#ecf4ff;"
| For [[surgery|procedures]] involving a [[median sternotomy]], it is recommended to apply [[topical]] [[antibiotics]] ([[vancomycin]]) to the cut edges of the [[sternum]] on opening and before closing.
|- style="background-color:#dae8fc;"
| In BIMA [[grafting]], it is recommended to use a skeletonized harvest of [[IMA]].
|}
*The target [[blood glucose]] level in order to improve the outcome of [[CABG]] is controversial. One study compared the outcome among those with a target [[glucose]] level of 100 to 140 mg/dL with [[glucose]] level of 141 mg/dL to 180 mg/dL in the [[intensive care unit]]. The result did not report reduced [[surgery|perioperative]] [[complications]] among the two different groups.<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
*Based on a [[randomized controlled trial]] and numerous [[observational studies]], continuous [[intravenous]] [[insulin]] [[infusion]] is superior to [[subcutaneous]] [[insulin]] in [[diabetes|diabetic]] [[patients]] who undergo [[CABG]]. These studies revealed that continuous [[intravenous]] [[insulin]] [[infusion]] is associated with a more stable [[blood glucose]] concentration, shorter [[hospital|hospitalization]], fewer [[ischemia|ischemic events]], [[wound]] [[complications]], and an overall better outcome.<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref><ref name="pmid21623155">{{cite journal| author=Abelev Z, Seth A, Patel R, Goldstein S, Bogun M, Paliou M | display-authors=etal| title=Continuous insulin infusion is associated with a reduced post-surgical length of stay, but not with the complication rate, in patients with diabetes mellitus undergoing coronary artery bypass graft. | journal=J Endocrinol Invest | year= 2011 | volume= 34 | issue= 10 | pages= 770-4 | pmid=21623155 | doi=10.3275/7760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21623155 }} </ref><ref name="pmid25825261">{{cite journal| author=Ogawa S, Okawa Y, Sawada K, Goto Y, Yamamoto M, Koyama Y | display-authors=etal| title=Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: a propensity-matched analysis. | journal=Eur J Cardiothorac Surg | year= 2016 | volume= 49 | issue= 2 | pages= 420-6 | pmid=25825261 | doi=10.1093/ejcts/ezv106 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25825261 }} </ref>

===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
|-
| bgcolor="LightGreen"| 1. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]] an [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] should be initiated with the goal to keep [[blood sugar]] lower than 180 mg/dL.
2. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]], an [[surgery|postoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] is recommended with the goal to keep an early [[surgery|postoperative]] [[blood sugar]] lower than 180 mg/dL.
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid19932261">{{cite journal| author=Steingrímsson S, Gustafsson R, Gudbjartsson T, Mokhtari A, Ingemansson R, Sjögren J| title=Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up. | journal=Ann Thorac Surg | year= 2009 | volume= 88 | issue= 6 | pages= 1910-5 | pmid=19932261 | doi=10.1016/j.athoracsur.2009.07.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19932261 }} </ref><ref name="pmid24613159">{{cite journal| author=Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I| title=Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 5 | pages= 1887-95 | pmid=24613159 | doi=10.1016/j.jtcvs.2014.02.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24613159 }} </ref>
|-
| bgcolor="Yellow"| A comprehensive approach to decrease the risk of [[Sternum|sternal]] [[wound]] [[infection]] is recommended in [[patients]] undergoing [[CABG]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
|-
| bgcolor="Lightblue"| The effectiveness of [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] with the goal to keep [[blood sugar]] lower than 140 mg/dL in [[patients]] undergoing [[CABG]] is not certain.
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery maintaining glucose level

2022-10-22T06:22:14Z

Anahita: /* Maintaining Glucose Level in CABG */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==

==Maintaining Glucose Level in CABG==
*Even though the rate of [[Sternum|sternal]] [[wound]] [[infection]] has decreased among [[patients]] undergoing [[CABG]], its strong relation to death is not neglectable.<ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid25060372">{{cite journal| author=Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD | display-authors=etal| title=Management practices and major infections after cardiac surgery. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 4 | pages= 372-81 | pmid=25060372 | doi=10.1016/j.jacc.2014.04.052 | pmc=4222509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25060372 }} </ref>
*[[Surgery|Perioperative]] [[insulin]] [[infusion]] to control [[hyperglycemia]] and maintaining the [[blood sugar]] lower than 180 mg/dl can prevent the likelihood of [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] with known [[diabetes]] and in those with [[stress hyperglycemia]].<ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid24799638">{{cite journal| author=Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L | display-authors=etal| title=Strategies to prevent surgical site infections in acute care hospitals: 2014 update. | journal=Infect Control Hosp Epidemiol | year= 2014 | volume= 35 | issue= 6 | pages= 605-27 | pmid=24799638 | doi=10.1086/676022 | pmc=4267723 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24799638 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref>
*Usage of continuous [[intravenous]] [[insulin]] after [[CABG]] lessens the likelihood of [[surgery|postoperative]] [[complications]], such as [[mediastinitis]], deep [[sternum|sternal]] [[wound]] [[infections]], [[cardiac arrhythmias]], [[renal failure]], and lengthy [[hospital|hospitalization]].<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
*The following table represents some of the strategies proposed as best practices to reduce the risk of [[sternum|sternal]] [[wound]] [[infection]].<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref><ref name="pmid21106051">{{cite journal| author=Vestergaard RF, Jensen H, Vind-Kezunovic S, Jakobsen T, Søballe K, Hasenkam JM| title=Bone healing after median sternotomy: a comparison of two hemostatic devices. | journal=J Cardiothorac Surg | year= 2010 | volume= 5 | issue= | pages= 117 | pmid=21106051 | doi=10.1186/1749-8090-5-117 | pmc=3001423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106051 }} </ref><ref name="pmid28161384">{{cite journal| author=Cardona S, Pasquel FJ, Fayfman M, Peng L, Jacobs S, Vellanki P | display-authors=etal| title=Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy. | journal=J Diabetes Complications | year= 2017 | volume= 31 | issue= 4 | pages= 742-747 | pmid=28161384 | doi=10.1016/j.jdiacomp.2017.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28161384 }} </ref><ref name="pmid22064600">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG | display-authors=etal| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 23 | pages= 2610-42 | pmid=22064600 | doi=10.1161/CIR.0b013e31823b5fee | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064600 }} </ref>
{| class="wikitable" style="background-color:#dae8fc;"
|-
| [[Prophylactic]] [[antibiotics]] is recommended, nevertheless it should not be continued beyond 48 hours. The [[dose]] of [[prophylactic]] [[antibiotics]] must be tailored for lengthy [[surgery|procedures]] (more than two [[half-lives]]) or for those who lost excessive amount of [[blood]] during [[CABG]].
|- style="background-color:#ecf4ff;"
| [[nose|Nasal]] [[Cotton swab|swab]] [[test]] for [[Staphylococcus aureus]] is recommended.
|- style="background-color:#dae8fc;"
| For known carriers of [[Staphylococcus aureus]], [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#ecf4ff;"
| For those with unknown [[nose|nasal]] [[culture]] or [[PCR]], [[surgery|preoperative]] [[nose|intranasal]] [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#dae8fc;"
| It is recommended to measure [[HbA1c]] before [[CABG]]
|- style="background-color:#ecf4ff;"
| If it is a nonemergent [[surgery|surgical]] [[coronary revascularization]], all [[Chest|extrathoracic]] [[infections]] must be [[treatment|treated]] before the [[surgery]].
|- style="background-color:#dae8fc;"
| Guide [[patients]] to [[smoking cessation]] before [[elective]] [[CABG]]
|- style="background-color:#ecf4ff;"
| For [[surgery|procedures]] involving a [[median sternotomy]], it is recommended to apply [[topical]] [[antibiotics]] ([[vancomycin]]) to the cut edges of the [[sternum]] on opening and before closing.
|- style="background-color:#dae8fc;"
| In BIMA [[grafting]], it is recommended to use a skeletonized harvest of [[IMA]].
|}
*The target [[blood glucose]] level in order to improve the outcome of [[CABG]] is controversial. One study compared the outcome among those with a target [[glucose]] level of 100 to 140 mg/dL with [[glucose]] level of 141 mg/dL to 180 mg/dL in the [[intensive care unit]]. The result did not report reduced [[surgery|perioperative]] [[complications]] among the two different groups.<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
*Based on a [[randomized controlled trial]] and numerous [[observational studies]], continuous [[intravenous]] [[insulin]] [[infusion]] is superior to [[subcutaneous]] [[insulin]] in [[diabetes|diabetic]] [[patients]] who undergo [[CABG]]. These studies revealed that continuous [[intravenous]] [[insulin]] [[infusion]] is associated with a more stable [[blood glucose]] concentration, shorter [[hospital|hospitalization]], fewer [[ischemia|ischemic events]], [[wound]] [[complications]], and an overall better outcome.<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref><ref name="pmid21623155">{{cite journal| author=Abelev Z, Seth A, Patel R, Goldstein S, Bogun M, Paliou M | display-authors=etal| title=Continuous insulin infusion is associated with a reduced post-surgical length of stay, but not with the complication rate, in patients with diabetes mellitus undergoing coronary artery bypass graft. | journal=J Endocrinol Invest | year= 2011 | volume= 34 | issue= 10 | pages= 770-4 | pmid=21623155 | doi=10.3275/7760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21623155 }} </ref><ref name="pmid25825261">{{cite journal| author=Ogawa S, Okawa Y, Sawada K, Goto Y, Yamamoto M, Koyama Y | display-authors=etal| title=Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: a propensity-matched analysis. | journal=Eur J Cardiothorac Surg | year= 2016 | volume= 49 | issue= 2 | pages= 420-6 | pmid=25825261 | doi=10.1093/ejcts/ezv106 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25825261 }} </ref>

===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
|-
| bgcolor="LightGreen"| 1. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]] an [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] should be initiated with the goal to keep [[blood sugar]] lower than 180 mg/dL.
2. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]], an [[surgery|postoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] is recommended with the goal to keep an early [[surgery|postoperative]] [[blood sugar]] lower than 180 mg/dL.
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid19932261">{{cite journal| author=Steingrímsson S, Gustafsson R, Gudbjartsson T, Mokhtari A, Ingemansson R, Sjögren J| title=Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up. | journal=Ann Thorac Surg | year= 2009 | volume= 88 | issue= 6 | pages= 1910-5 | pmid=19932261 | doi=10.1016/j.athoracsur.2009.07.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19932261 }} </ref><ref name="pmid24613159">{{cite journal| author=Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I| title=Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 5 | pages= 1887-95 | pmid=24613159 | doi=10.1016/j.jtcvs.2014.02.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24613159 }} </ref>
|-
| bgcolor="Yellow"| A comprehensive approach to decrease the risk of [[Sternum|sternal]] [[wound]] [[infection]] is recommended in [[patients]] undergoing [[CABG]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
|-
| bgcolor="Lightblue"| The effectiveness of [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] with the goal to keep [[blood sugar]] lower than 140 mg/dL in [[patients]] undergoing [[CABG]] is not certain.
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery maintaining glucose level

2022-10-22T06:15:55Z

Anahita: /* Maintaining Glucose Level in CABG */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==

==Maintaining Glucose Level in CABG==
*Even though the rate of [[Sternum|sternal]] [[wound]] [[infection]] has decreased among [[patients]] undergoing [[CABG]], its strong relation to death is not neglectable.<ref name="pmid25855820">{{cite journal| author=| title=Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. doi: 10.1002/ cncr.28811. | journal=Cancer | year= 2015 | volume= 121 | issue= 5 | pages= 800 | pmid=25855820 | doi=10.1002/cncr.29118 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855820 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid25060372">{{cite journal| author=Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD | display-authors=etal| title=Management practices and major infections after cardiac surgery. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 4 | pages= 372-81 | pmid=25060372 | doi=10.1016/j.jacc.2014.04.052 | pmc=4222509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25060372 }} </ref>
*[[Surgery|Perioperative]] [[insulin]] [[infusion]] to control [[hyperglycemia]] and maintaining the blood sugar lower than 180 mg/dl can prevent the likelihood of [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] with known [[diabetes]] and in those with [[stress hyperglycemia]].<ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid24799638">{{cite journal| author=Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L | display-authors=etal| title=Strategies to prevent surgical site infections in acute care hospitals: 2014 update. | journal=Infect Control Hosp Epidemiol | year= 2014 | volume= 35 | issue= 6 | pages= 605-27 | pmid=24799638 | doi=10.1086/676022 | pmc=4267723 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24799638 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref>
*Usage of continuous [[intravenous]] [[insulin]] after [[CABG]] lessens the likelihood of [[surgery|postoperative]] [[complications]], such as [[mediastinitis]], deep [[sternum|sternal]] [[wound]] [[infections]], [[cardiac arrhythmias]], [[renal failure]], and length of [[hospital|hospitalization]].<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
*The following table represents some of the strategies proposed as best practices to reduce the risk of [[sternum|sternal]] [[wound]] [[infection]].<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref><ref name="pmid21106051">{{cite journal| author=Vestergaard RF, Jensen H, Vind-Kezunovic S, Jakobsen T, Søballe K, Hasenkam JM| title=Bone healing after median sternotomy: a comparison of two hemostatic devices. | journal=J Cardiothorac Surg | year= 2010 | volume= 5 | issue= | pages= 117 | pmid=21106051 | doi=10.1186/1749-8090-5-117 | pmc=3001423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106051 }} </ref><ref name="pmid28161384">{{cite journal| author=Cardona S, Pasquel FJ, Fayfman M, Peng L, Jacobs S, Vellanki P | display-authors=etal| title=Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy. | journal=J Diabetes Complications | year= 2017 | volume= 31 | issue= 4 | pages= 742-747 | pmid=28161384 | doi=10.1016/j.jdiacomp.2017.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28161384 }} </ref><ref name="pmid22064600">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG | display-authors=etal| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 23 | pages= 2610-42 | pmid=22064600 | doi=10.1161/CIR.0b013e31823b5fee | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064600 }} </ref>
{| class="wikitable" style="background-color:#dae8fc;"
|-
| [[Prophylactic]] [[antibiotics]] is recommended, nevertheless it should not be continued beyond 48 hours. The [[dose]] of [[prophylactic]] [[antibiotics]] must be tailored for lengthy [[surgery|procedures]] (more than two [[half-lives]]) or for those who lost excessive amount of [[blood]] during [[CABG]].
|- style="background-color:#ecf4ff;"
| [[nose|Nasal]] [[Cotton swab|swab]] [[test]] for [[Staphylococcus aureus]] is recommended.
|- style="background-color:#dae8fc;"
| For known carriers of [[Staphylococcus aureus]], [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#ecf4ff;"
| For those with unknown [[nose|nasal]] [[culture]] or [[PCR]], [[surgery|preoperative]] [[nose|intranasal]] [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#dae8fc;"
| It is recommended to measure [[HbA1c]] before [[CABG]]
|- style="background-color:#ecf4ff;"
| If it is a nonemergent [[surgery|surgical]] [[coronary revascularization]], all [[Chest|extrathoracic]] [[infections]] must be [[treatment|treated]] before the [[surgery]].
|- style="background-color:#dae8fc;"
| Guide [[patients]] to [[smoking cessation]] before [[elective]] [[CABG]]
|- style="background-color:#ecf4ff;"
| For [[surgery|procedures]] involving a [[median sternotomy]], it is recommended to apply [[topical]] [[antibiotics]] ([[vancomycin]]) to the cut edges of the [[sternum]] on opening and before closing.
|- style="background-color:#dae8fc;"
| In BIMA [[grafting]], it is recommended to use a skeletonized harvest of [[IMA]].
|}
*The target [[blood glucose]] level in order to improve the outcome of [[CABG]] is controversial. One study compared the outcome among those with a target [[glucose]] level of 100 to 140 mg/dL with [[glucose]] level of 141 mg/dL to 180 mg/dL in the [[intensive care unit]]. The result did not report reduced [[surgery|perioperative]] [[complications]] among the two different groups.<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
*Based on a [[randomized controlled trial]] and numerous [[observational studies]], continuous [[intravenous]] [[insulin]] [[infusion]] is superior to [[subcutaneous]] [[insulin]] in [[diabetes|diabetic]] [[patients]] who undergo [[CABG]]. These studies revealed that continuous [[intravenous]] [[insulin]] [[infusion]] is associated with a more stable [[blood glucose]] concentration, shorter [[hospital|hospitalization]], fewer [[ischemia|ischemic events]], [[wound]] [[complications]], and an overall better outcome.<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref><ref name="pmid21623155">{{cite journal| author=Abelev Z, Seth A, Patel R, Goldstein S, Bogun M, Paliou M | display-authors=etal| title=Continuous insulin infusion is associated with a reduced post-surgical length of stay, but not with the complication rate, in patients with diabetes mellitus undergoing coronary artery bypass graft. | journal=J Endocrinol Invest | year= 2011 | volume= 34 | issue= 10 | pages= 770-4 | pmid=21623155 | doi=10.3275/7760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21623155 }} </ref><ref name="pmid25825261">{{cite journal| author=Ogawa S, Okawa Y, Sawada K, Goto Y, Yamamoto M, Koyama Y | display-authors=etal| title=Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: a propensity-matched analysis. | journal=Eur J Cardiothorac Surg | year= 2016 | volume= 49 | issue= 2 | pages= 420-6 | pmid=25825261 | doi=10.1093/ejcts/ezv106 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25825261 }} </ref>

===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
|-
| bgcolor="LightGreen"| 1. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]] an [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] should be initiated with the goal to keep [[blood sugar]] lower than 180 mg/dL.
2. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]], an [[surgery|postoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] is recommended with the goal to keep an early [[surgery|postoperative]] [[blood sugar]] lower than 180 mg/dL.
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid19932261">{{cite journal| author=Steingrímsson S, Gustafsson R, Gudbjartsson T, Mokhtari A, Ingemansson R, Sjögren J| title=Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up. | journal=Ann Thorac Surg | year= 2009 | volume= 88 | issue= 6 | pages= 1910-5 | pmid=19932261 | doi=10.1016/j.athoracsur.2009.07.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19932261 }} </ref><ref name="pmid24613159">{{cite journal| author=Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I| title=Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 5 | pages= 1887-95 | pmid=24613159 | doi=10.1016/j.jtcvs.2014.02.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24613159 }} </ref>
|-
| bgcolor="Yellow"| A comprehensive approach to decrease the risk of [[Sternum|sternal]] [[wound]] [[infection]] is recommended in [[patients]] undergoing [[CABG]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
|-
| bgcolor="Lightblue"| The effectiveness of [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] with the goal to keep [[blood sugar]] lower than 140 mg/dL in [[patients]] undergoing [[CABG]] is not certain.
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery maintaining glucose level

2022-10-22T06:07:37Z

Anahita: /* Maintaining Glucose Level in CABG */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==

==Maintaining Glucose Level in CABG==
*Even though the rate of [[Sternum|sternal]] [[wound]] [[infection]] has decreased among [[patients]] undergoing [[CABG]], its strong relation to death is not neglectable.<ref name="pmid25855820">{{cite journal| author=| title=Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. doi: 10.1002/ cncr.28811. | journal=Cancer | year= 2015 | volume= 121 | issue= 5 | pages= 800 | pmid=25855820 | doi=10.1002/cncr.29118 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855820 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid25060372">{{cite journal| author=Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD | display-authors=etal| title=Management practices and major infections after cardiac surgery. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 4 | pages= 372-81 | pmid=25060372 | doi=10.1016/j.jacc.2014.04.052 | pmc=4222509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25060372 }} </ref>
*[[Surgery|Perioperative]] [[insulin]] [[infusion]] to control [[hyperglycemia]] and maintaining the blood sugar lower than 180 mg/dl can prevent the likelihood of [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] with known [[diabetes]] and in those with [[stress hyperglycemia]].<ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid24799638">{{cite journal| author=Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L | display-authors=etal| title=Strategies to prevent surgical site infections in acute care hospitals: 2014 update. | journal=Infect Control Hosp Epidemiol | year= 2014 | volume= 35 | issue= 6 | pages= 605-27 | pmid=24799638 | doi=10.1086/676022 | pmc=4267723 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24799638 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref>
*Usage of continuous [[intravenous]] [[insulin]] after [[CABG]] lessens the likelihood of [[surgery|postoperative]] [[complications]], such as [[mediastinitis]], deep [[sternum|sternal]] [[wound]] [[infections]], [[cardiac arrhythmias]], [[renal failure]], and length of [[hospital|hospitalization]].<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
*The following table represents some of the strategies proposed as best practices to reduce the risk of [[sternum|sternal]] [[wound]] [[infection]].<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref><ref name="pmid21106051">{{cite journal| author=Vestergaard RF, Jensen H, Vind-Kezunovic S, Jakobsen T, Søballe K, Hasenkam JM| title=Bone healing after median sternotomy: a comparison of two hemostatic devices. | journal=J Cardiothorac Surg | year= 2010 | volume= 5 | issue= | pages= 117 | pmid=21106051 | doi=10.1186/1749-8090-5-117 | pmc=3001423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106051 }} </ref><ref name="pmid28161384">{{cite journal| author=Cardona S, Pasquel FJ, Fayfman M, Peng L, Jacobs S, Vellanki P | display-authors=etal| title=Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy. | journal=J Diabetes Complications | year= 2017 | volume= 31 | issue= 4 | pages= 742-747 | pmid=28161384 | doi=10.1016/j.jdiacomp.2017.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28161384 }} </ref><ref name="pmid22064600">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG | display-authors=etal| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 23 | pages= 2610-42 | pmid=22064600 | doi=10.1161/CIR.0b013e31823b5fee | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064600 }} </ref>
{| class="wikitable" style="background-color:#dae8fc;"
|-
| [[Prophylactic]] [[antibiotics]] is recommended, nevertheless it should not be continued beyond 48 hours. The [[dose]] of [[prophylactic]] [[antibiotics]] must be tailored for lengthy [[surgery|procedures]] (more than two [[half-lives]]) or for those who lost excessive amount of [[blood]] during [[CABG]].
|- style="background-color:#ecf4ff;"
| [[nose|Nasal]] [[Cotton swab|swab]] [[test]] for [[Staphylococcus aureus]] is recommended.
|- style="background-color:#dae8fc;"
| For known carriers of [[Staphylococcus aureus]], [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#ecf4ff;"
| For those with unknown [[nose|nasal]] [[culture]] or [[PCR]], [[surgery|preoperative]] [[nose|intranasal]] [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#dae8fc;"
| It is recommended to measure [[HbA1c]] before [[CABG]]
|- style="background-color:#ecf4ff;"
| If it is a nonemergent [[surgery|surgical]] [[coronary revascularization]], all [[Chest|extrathoracic]] [[infections]] must be [[treatment|treated]] before the [[surgery]].
|- style="background-color:#dae8fc;"
| Guide [[patients]] to [[smoking cessation]] before [[elective]] [[CABG]]
|- style="background-color:#ecf4ff;"
| For [[surgery|procedures]] involving a [[median sternotomy]], it is recommended to apply [[topical]] [[antibiotics]] ([[vancomycin]]) to the cut edges of the [[sternum]] on opening and before closing.
|- style="background-color:#dae8fc;"
| In BIMA [[grafting]], it is recommended to use a skeletonized harvest of [[IMA]].
|}
*The target [[blood glucose]] level in order to improve the outcome of [[CABG]] is controversial. One study compared the outcome among those with a target [[glucose]] level of 100 to 140 mg/dL with [[glucose]] level of 141 mg/dL to 180 mg/dL in the [[intensive care unit]]. The result did not report reduced [[surgery|perioperative]] [[complications]] among the two different groups.<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
|-
| bgcolor="LightGreen"| 1. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]] an [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] should be initiated with the goal to keep [[blood sugar]] lower than 180 mg/dL.
2. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]], an [[surgery|postoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] is recommended with the goal to keep an early [[surgery|postoperative]] [[blood sugar]] lower than 180 mg/dL.
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid19932261">{{cite journal| author=Steingrímsson S, Gustafsson R, Gudbjartsson T, Mokhtari A, Ingemansson R, Sjögren J| title=Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up. | journal=Ann Thorac Surg | year= 2009 | volume= 88 | issue= 6 | pages= 1910-5 | pmid=19932261 | doi=10.1016/j.athoracsur.2009.07.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19932261 }} </ref><ref name="pmid24613159">{{cite journal| author=Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I| title=Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 5 | pages= 1887-95 | pmid=24613159 | doi=10.1016/j.jtcvs.2014.02.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24613159 }} </ref>
|-
| bgcolor="Yellow"| A comprehensive approach to decrease the risk of [[Sternum|sternal]] [[wound]] [[infection]] is recommended in [[patients]] undergoing [[CABG]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
|-
| bgcolor="Lightblue"| The effectiveness of [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] with the goal to keep [[blood sugar]] lower than 140 mg/dL in [[patients]] undergoing [[CABG]] is not certain.
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery maintaining glucose level

2022-10-21T05:38:02Z

Anahita: /* 2022 ACA Revascularization Guideline */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==

==Maintaining Glucose Level in CABG==
*Even though the rate of [[Sternum|sternal]] [[wound]] [[infection]] has decreased among [[patients]] undergoing [[CABG]], its strong relation to death is not neglectable.<ref name="pmid25855820">{{cite journal| author=| title=Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. doi: 10.1002/ cncr.28811. | journal=Cancer | year= 2015 | volume= 121 | issue= 5 | pages= 800 | pmid=25855820 | doi=10.1002/cncr.29118 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855820 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid25060372">{{cite journal| author=Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD | display-authors=etal| title=Management practices and major infections after cardiac surgery. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 4 | pages= 372-81 | pmid=25060372 | doi=10.1016/j.jacc.2014.04.052 | pmc=4222509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25060372 }} </ref>
*[[Surgery|Perioperative]] [[insulin]] [[infusion]] to control [[hyperglycemia]] and maintaining the blood sugar lower than 180 mg/dl can prevent the likelihood of [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] with known [[diabetes]] and in those with [[stress hyperglycemia]].<ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid24799638">{{cite journal| author=Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L | display-authors=etal| title=Strategies to prevent surgical site infections in acute care hospitals: 2014 update. | journal=Infect Control Hosp Epidemiol | year= 2014 | volume= 35 | issue= 6 | pages= 605-27 | pmid=24799638 | doi=10.1086/676022 | pmc=4267723 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24799638 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref>
*Usage of continuous [[intravenous]] [[insulin]] after [[CABG]] lessens the likelihood of [[surgery|postoperative]] [[complications]], such as [[mediastinitis]], deep [[sternum|sternal]] [[wound]] [[infections]], [[cardiac arrhythmias]], [[renal failure]], and length of [[hospital|hospitalization]].<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
*The following table represents some of the strategies proposed as best practices to reduce the risk of [[sternum|sternal]] [[wound]] [[infection]].<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref><ref name="pmid21106051">{{cite journal| author=Vestergaard RF, Jensen H, Vind-Kezunovic S, Jakobsen T, Søballe K, Hasenkam JM| title=Bone healing after median sternotomy: a comparison of two hemostatic devices. | journal=J Cardiothorac Surg | year= 2010 | volume= 5 | issue= | pages= 117 | pmid=21106051 | doi=10.1186/1749-8090-5-117 | pmc=3001423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106051 }} </ref><ref name="pmid28161384">{{cite journal| author=Cardona S, Pasquel FJ, Fayfman M, Peng L, Jacobs S, Vellanki P | display-authors=etal| title=Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy. | journal=J Diabetes Complications | year= 2017 | volume= 31 | issue= 4 | pages= 742-747 | pmid=28161384 | doi=10.1016/j.jdiacomp.2017.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28161384 }} </ref><ref name="pmid22064600">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG | display-authors=etal| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 23 | pages= 2610-42 | pmid=22064600 | doi=10.1161/CIR.0b013e31823b5fee | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064600 }} </ref>
{| class="wikitable" style="background-color:#dae8fc;"
|-
| [[Prophylactic]] [[antibiotics]] is recommended, nevertheless it should not be continued beyond 48 hours. The [[dose]] of [[prophylactic]] [[antibiotics]] must be tailored for lengthy [[surgery|procedures]] (more than two [[half-lives]]) or for those who lost excessive amount of [[blood]] during [[CABG]].
|- style="background-color:#ecf4ff;"
| [[nose|Nasal]] [[Cotton swab|swab]] [[test]] for [[Staphylococcus aureus]] is recommended.
|- style="background-color:#dae8fc;"
| For known carriers of [[Staphylococcus aureus]], [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#ecf4ff;"
| For those with unknown [[nose|nasal]] [[culture]] or [[PCR]], [[surgery|preoperative]] [[nose|intranasal]] [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#dae8fc;"
| It is recommended to measure [[HbA1c]] before [[CABG]]
|- style="background-color:#ecf4ff;"
| If it is a nonemergent [[surgery|surgical]] [[coronary revascularization]], all [[Chest|extrathoracic]] [[infections]] must be [[treatment|treated]] before the [[surgery]].
|- style="background-color:#dae8fc;"
| Guide [[patients]] to [[smoking cessation]] before [[elective]] [[CABG]]
|- style="background-color:#ecf4ff;"
| For [[surgery|procedures]] involving a [[median sternotomy]], it is recommended to apply [[topical]] [[antibiotics]] ([[vancomycin]]) to the cut edges of the [[sternum]] on opening and before closing.
|- style="background-color:#dae8fc;"
| In BIMA [[grafting]], it is recommended to use a skeletonized harvest of [[IMA]].
|}
===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
|-
| bgcolor="LightGreen"| 1. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]] an [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] should be initiated with the goal to keep [[blood sugar]] lower than 180 mg/dL.
2. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]], an [[surgery|postoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] is recommended with the goal to keep an early [[surgery|postoperative]] [[blood sugar]] lower than 180 mg/dL.
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid19932261">{{cite journal| author=Steingrímsson S, Gustafsson R, Gudbjartsson T, Mokhtari A, Ingemansson R, Sjögren J| title=Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up. | journal=Ann Thorac Surg | year= 2009 | volume= 88 | issue= 6 | pages= 1910-5 | pmid=19932261 | doi=10.1016/j.athoracsur.2009.07.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19932261 }} </ref><ref name="pmid24613159">{{cite journal| author=Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I| title=Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 5 | pages= 1887-95 | pmid=24613159 | doi=10.1016/j.jtcvs.2014.02.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24613159 }} </ref>
|-
| bgcolor="Yellow"| A comprehensive approach to decrease the risk of [[Sternum|sternal]] [[wound]] [[infection]] is recommended in [[patients]] undergoing [[CABG]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
|-
| bgcolor="Lightblue"| The effectiveness of [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] with the goal to keep [[blood sugar]] lower than 140 mg/dL in [[patients]] undergoing [[CABG]] is not certain.
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery maintaining glucose level

2022-10-21T05:36:35Z

Anahita: /* Maintaining Glucose Level in CABG */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==

==Maintaining Glucose Level in CABG==
*Even though the rate of [[Sternum|sternal]] [[wound]] [[infection]] has decreased among [[patients]] undergoing [[CABG]], its strong relation to death is not neglectable.<ref name="pmid25855820">{{cite journal| author=| title=Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. doi: 10.1002/ cncr.28811. | journal=Cancer | year= 2015 | volume= 121 | issue= 5 | pages= 800 | pmid=25855820 | doi=10.1002/cncr.29118 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855820 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid25060372">{{cite journal| author=Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD | display-authors=etal| title=Management practices and major infections after cardiac surgery. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 4 | pages= 372-81 | pmid=25060372 | doi=10.1016/j.jacc.2014.04.052 | pmc=4222509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25060372 }} </ref>
*[[Surgery|Perioperative]] [[insulin]] [[infusion]] to control [[hyperglycemia]] and maintaining the blood sugar lower than 180 mg/dl can prevent the likelihood of [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] with known [[diabetes]] and in those with [[stress hyperglycemia]].<ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid24799638">{{cite journal| author=Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L | display-authors=etal| title=Strategies to prevent surgical site infections in acute care hospitals: 2014 update. | journal=Infect Control Hosp Epidemiol | year= 2014 | volume= 35 | issue= 6 | pages= 605-27 | pmid=24799638 | doi=10.1086/676022 | pmc=4267723 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24799638 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref>
*Usage of continuous [[intravenous]] [[insulin]] after [[CABG]] lessens the likelihood of [[surgery|postoperative]] [[complications]], such as [[mediastinitis]], deep [[sternum|sternal]] [[wound]] [[infections]], [[cardiac arrhythmias]], [[renal failure]], and length of [[hospital|hospitalization]].<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
*The following table represents some of the strategies proposed as best practices to reduce the risk of [[sternum|sternal]] [[wound]] [[infection]].<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref><ref name="pmid21106051">{{cite journal| author=Vestergaard RF, Jensen H, Vind-Kezunovic S, Jakobsen T, Søballe K, Hasenkam JM| title=Bone healing after median sternotomy: a comparison of two hemostatic devices. | journal=J Cardiothorac Surg | year= 2010 | volume= 5 | issue= | pages= 117 | pmid=21106051 | doi=10.1186/1749-8090-5-117 | pmc=3001423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106051 }} </ref><ref name="pmid28161384">{{cite journal| author=Cardona S, Pasquel FJ, Fayfman M, Peng L, Jacobs S, Vellanki P | display-authors=etal| title=Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy. | journal=J Diabetes Complications | year= 2017 | volume= 31 | issue= 4 | pages= 742-747 | pmid=28161384 | doi=10.1016/j.jdiacomp.2017.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28161384 }} </ref><ref name="pmid22064600">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG | display-authors=etal| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 23 | pages= 2610-42 | pmid=22064600 | doi=10.1161/CIR.0b013e31823b5fee | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064600 }} </ref>
{| class="wikitable" style="background-color:#dae8fc;"
|-
| [[Prophylactic]] [[antibiotics]] is recommended, nevertheless it should not be continued beyond 48 hours. The [[dose]] of [[prophylactic]] [[antibiotics]] must be tailored for lengthy [[surgery|procedures]] (more than two [[half-lives]]) or for those who lost excessive amount of [[blood]] during [[CABG]].
|- style="background-color:#ecf4ff;"
| [[nose|Nasal]] [[Cotton swab|swab]] [[test]] for [[Staphylococcus aureus]] is recommended.
|- style="background-color:#dae8fc;"
| For known carriers of [[Staphylococcus aureus]], [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#ecf4ff;"
| For those with unknown [[nose|nasal]] [[culture]] or [[PCR]], [[surgery|preoperative]] [[nose|intranasal]] [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#dae8fc;"
| It is recommended to measure [[HbA1c]] before [[CABG]]
|- style="background-color:#ecf4ff;"
| If it is a nonemergent [[surgery|surgical]] [[coronary revascularization]], all [[Chest|extrathoracic]] [[infections]] must be [[treatment|treated]] before the [[surgery]].
|- style="background-color:#dae8fc;"
| Guide [[patients]] to [[smoking cessation]] before [[elective]] [[CABG]]
|- style="background-color:#ecf4ff;"
| For [[surgery|procedures]] involving a [[median sternotomy]], it is recommended to apply [[topical]] [[antibiotics]] ([[vancomycin]]) to the cut edges of the [[sternum]] on opening and before closing.
|- style="background-color:#dae8fc;"
| In BIMA [[grafting]], it is recommended to use a skeletonized harvest of [[IMA]].
|}
===2022 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
|-
| bgcolor="LightGreen"| 1. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]] an [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] should be initiated with the goal to keep [[blood sugar]] lower than 180 mg/dL.
2. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]], an [[surgery|postoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] is recommended with the goal to keep an early [[surgery|postoperative]] [[blood sugar]] lower than 180 mg/dL.
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid19932261">{{cite journal| author=Steingrímsson S, Gustafsson R, Gudbjartsson T, Mokhtari A, Ingemansson R, Sjögren J| title=Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up. | journal=Ann Thorac Surg | year= 2009 | volume= 88 | issue= 6 | pages= 1910-5 | pmid=19932261 | doi=10.1016/j.athoracsur.2009.07.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19932261 }} </ref><ref name="pmid24613159">{{cite journal| author=Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I| title=Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 5 | pages= 1887-95 | pmid=24613159 | doi=10.1016/j.jtcvs.2014.02.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24613159 }} </ref>
|-
| bgcolor="Yellow"| A comprehensive approach to decrease the risk of [[Sternum|sternal]] [[wound]] [[infection]] is recommended in [[patients]] undergoing [[CABG]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
|-
| bgcolor="Lightblue"| The effectiveness of [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] with the goal to keep [[blood sugar]] lower than 140 mg/dL in [[patients]] undergoing [[CABG]] is not certain.
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery maintaining glucose level

2022-10-21T05:35:20Z

Anahita: /* Maintaining Glucose Level in CABG */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==

==Maintaining Glucose Level in CABG==
*Even though the rate of [[Sternum|sternal]] [[wound]] [[infection]] has decreased among [[patients]] undergoing [[CABG]], its strong relation to death is not neglectable.<ref name="pmid25855820">{{cite journal| author=| title=Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. doi: 10.1002/ cncr.28811. | journal=Cancer | year= 2015 | volume= 121 | issue= 5 | pages= 800 | pmid=25855820 | doi=10.1002/cncr.29118 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855820 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid25060372">{{cite journal| author=Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD | display-authors=etal| title=Management practices and major infections after cardiac surgery. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 4 | pages= 372-81 | pmid=25060372 | doi=10.1016/j.jacc.2014.04.052 | pmc=4222509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25060372 }} </ref>
*[[Surgery|Perioperative]] [[insulin]] [[infusion]] to control [[hyperglycemia]] and maintaining the blood sugar lower than 180 mg/dl can prevent the likelihood of [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] with known [[diabetes]] and in those with [[stress hyperglycemia]].<ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid24799638">{{cite journal| author=Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L | display-authors=etal| title=Strategies to prevent surgical site infections in acute care hospitals: 2014 update. | journal=Infect Control Hosp Epidemiol | year= 2014 | volume= 35 | issue= 6 | pages= 605-27 | pmid=24799638 | doi=10.1086/676022 | pmc=4267723 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24799638 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref>
*Usage of continuous [[intravenous]] [[insulin]] after [[CABG]] lessens the likelihood of [[surgery|postoperative]] [[complications]], such as [[mediastinitis]], deep [[sternum|sternal]] [[wound]] [[infections]], [[cardiac arrhythmias]], [[renal failure]], and length of [[hospital|hospitalization]].<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
*The following table represents some of the strategies proposed as best practices to reduce the risk of [[sternum|sternal]] [[wound]] [[infection]].<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref><ref name="pmid21106051">{{cite journal| author=Vestergaard RF, Jensen H, Vind-Kezunovic S, Jakobsen T, Søballe K, Hasenkam JM| title=Bone healing after median sternotomy: a comparison of two hemostatic devices. | journal=J Cardiothorac Surg | year= 2010 | volume= 5 | issue= | pages= 117 | pmid=21106051 | doi=10.1186/1749-8090-5-117 | pmc=3001423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106051 }} </ref><ref name="pmid28161384">{{cite journal| author=Cardona S, Pasquel FJ, Fayfman M, Peng L, Jacobs S, Vellanki P | display-authors=etal| title=Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy. | journal=J Diabetes Complications | year= 2017 | volume= 31 | issue= 4 | pages= 742-747 | pmid=28161384 | doi=10.1016/j.jdiacomp.2017.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28161384 }} </ref><ref name="pmid22064600">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG | display-authors=etal| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 23 | pages= 2610-42 | pmid=22064600 | doi=10.1161/CIR.0b013e31823b5fee | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064600 }} </ref>
{| class="wikitable" style="background-color:#dae8fc;"
|-
| [[Prophylactic]] [[antibiotics]] is recommended, nevertheless it should not be continued beyond 48 hours. The [[dose]] of [[prophylactic]] [[antibiotics]] must be tailored for lengthy [[surgery|procedures]] (more than two [[half-lives]]) or for those who lost excessive amount of [[blood]] during [[CABG]].
|- style="background-color:#ecf4ff;"
| [[nose|Nasal]] [[Cotton swab|swab]] [[test]] for [[Staphylococcus aureus]] is recommended.
|- style="background-color:#ecf4ff;"
| For known carriers of [[Staphylococcus aureus]], [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#ecf4ff;"
| For those with unknown [[nose|nasal]] [[culture]] or [[PCR]], [[surgery|preoperative]] [[nose|intranasal]] [[mupirocin]] 2% ointment should be applied.
|- style="background-color:#ecf4ff;"
| It is recommended to measure [[HbA1c]] before [[CABG]]
|- style="background-color:#ecf4ff;"
| If it is a nonemergent [[surgery|surgical]] [[coronary revascularization]], all [[Chest|extrathoracic]] [[infections]] must be [[treatment|treated]] before the [[surgery]].
|- style="background-color:#ecf4ff;"
| Guide [[patients]] to [[smoking cessation]] before [[elective]] [[CABG]]
|- style="background-color:#ecf4ff;"
| For [[surgery|procedures]] involving a [[median sternotomy]], it is recommended to apply [[topical]] [[antibiotics]] ([[vancomycin]]) to the cut edges of the [[sternum]] on opening and before closing.
|- style="background-color:#ecf4ff;"
| In BIMA [[grafting]], it is recommended to use a skeletonized harvest of [[IMA]].
|}
===2022 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
|-
| bgcolor="LightGreen"| 1. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]] an [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] should be initiated with the goal to keep [[blood sugar]] lower than 180 mg/dL.
2. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]], an [[surgery|postoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] is recommended with the goal to keep an early [[surgery|postoperative]] [[blood sugar]] lower than 180 mg/dL.
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid19932261">{{cite journal| author=Steingrímsson S, Gustafsson R, Gudbjartsson T, Mokhtari A, Ingemansson R, Sjögren J| title=Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up. | journal=Ann Thorac Surg | year= 2009 | volume= 88 | issue= 6 | pages= 1910-5 | pmid=19932261 | doi=10.1016/j.athoracsur.2009.07.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19932261 }} </ref><ref name="pmid24613159">{{cite journal| author=Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I| title=Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 5 | pages= 1887-95 | pmid=24613159 | doi=10.1016/j.jtcvs.2014.02.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24613159 }} </ref>
|-
| bgcolor="Yellow"| A comprehensive approach to decrease the risk of [[Sternum|sternal]] [[wound]] [[infection]] is recommended in [[patients]] undergoing [[CABG]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
|-
| bgcolor="Lightblue"| The effectiveness of [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] with the goal to keep [[blood sugar]] lower than 140 mg/dL in [[patients]] undergoing [[CABG]] is not certain.
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery maintaining glucose level

2022-10-21T05:31:01Z

Anahita: /* Maintaining Glucose Level in CABG */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==

==Maintaining Glucose Level in CABG==
*Even though the rate of [[Sternum|sternal]] [[wound]] [[infection]] has decreased among [[patients]] undergoing [[CABG]], its strong relation to death is not neglectable.<ref name="pmid25855820">{{cite journal| author=| title=Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. doi: 10.1002/ cncr.28811. | journal=Cancer | year= 2015 | volume= 121 | issue= 5 | pages= 800 | pmid=25855820 | doi=10.1002/cncr.29118 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855820 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid25060372">{{cite journal| author=Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD | display-authors=etal| title=Management practices and major infections after cardiac surgery. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 4 | pages= 372-81 | pmid=25060372 | doi=10.1016/j.jacc.2014.04.052 | pmc=4222509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25060372 }} </ref>
*[[Surgery|Perioperative]] [[insulin]] [[infusion]] to control [[hyperglycemia]] and maintaining the blood sugar lower than 180 mg/dl can prevent the likelihood of [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] with known [[diabetes]] and in those with [[stress hyperglycemia]].<ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid24799638">{{cite journal| author=Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L | display-authors=etal| title=Strategies to prevent surgical site infections in acute care hospitals: 2014 update. | journal=Infect Control Hosp Epidemiol | year= 2014 | volume= 35 | issue= 6 | pages= 605-27 | pmid=24799638 | doi=10.1086/676022 | pmc=4267723 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24799638 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref>
*Usage of continuous [[intravenous]] [[insulin]] after [[CABG]] lessens the likelihood of [[surgery|postoperative]] [[complications]], such as [[mediastinitis]], deep [[sternum|sternal]] [[wound]] [[infections]], [[cardiac arrhythmias]], [[renal failure]], and length of [[hospital|hospitalization]].<ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
*The following table represents some of the strategies proposed as best practices to reduce the risk of [[sternum|sternal]] [[wound]] [[infection]].<ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid25855820">{{cite journal| author=| title=Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. doi: 10.1002/ cncr.28811. | journal=Cancer | year= 2015 | volume= 121 | issue= 5 | pages= 800 | pmid=25855820 | doi=10.1002/cncr.29118 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855820 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid30423335">{{cite journal| author=D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW | display-authors=etal| title=The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. | journal=Ann Thorac Surg | year= 2019 | volume= 107 | issue= 1 | pages= 24-32 | pmid=30423335 | doi=10.1016/j.athoracsur.2018.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423335 }} </ref><ref name="pmid19161815">{{cite journal| author=Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. | journal=Ann Thorac Surg | year= 2009 | volume= 87 | issue= 2 | pages= 663-9 | pmid=19161815 | doi=10.1016/j.athoracsur.2008.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19161815 }} </ref><ref name="pmid21106051">{{cite journal| author=Vestergaard RF, Jensen H, Vind-Kezunovic S, Jakobsen T, Søballe K, Hasenkam JM| title=Bone healing after median sternotomy: a comparison of two hemostatic devices. | journal=J Cardiothorac Surg | year= 2010 | volume= 5 | issue= | pages= 117 | pmid=21106051 | doi=10.1186/1749-8090-5-117 | pmc=3001423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106051 }} </ref><ref name="pmid28161384">{{cite journal| author=Cardona S, Pasquel FJ, Fayfman M, Peng L, Jacobs S, Vellanki P | display-authors=etal| title=Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy. | journal=J Diabetes Complications | year= 2017 | volume= 31 | issue= 4 | pages= 742-747 | pmid=28161384 | doi=10.1016/j.jdiacomp.2017.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28161384 }} </ref><ref name="pmid22064600">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG | display-authors=etal| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 124 | issue= 23 | pages= 2610-42 | pmid=22064600 | doi=10.1161/CIR.0b013e31823b5fee | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064600 }} </ref>
{| class="wikitable"
|-
! [[Prophylactic]] [[antibiotics]] is recommended, nevertheless it should not be continued beyond 48 hours. The [[dose]] of [[prophylactic]] [[antibiotics]] must be tailored for lengthy [[surgery|procedures]] (more than two [[half-lives]]) or for those who lost excessive amount of [[blood]] during [[CABG]].
|-
| [[nose|Nasal]] [[Cotton swab|swab]] [[test]] for [[Staphylococcus aureus]] is recommended.
|-
| For known carriers of [[Staphylococcus aureus]], [[mupirocin]] 2% ointment should be applied.
|-
| For those with unknown [[nose|nasal]] [[culture]] or [[PCR]], [[surgery|preoperative]] [[nose|intranasal]] [[mupirocin]] 2% ointment should be applied.
|-
| It is recommended to measure [[HbA1c]] before [[CABG]]
|-
| If it is a nonemergent [[surgery|surgical]] [[coronary revascularization]], all [[Chest|extrathoracic]] [[infections]] must be [[treatment|treated]] before the [[surgery]].
|-
| Guide [[patients]] to [[smoking cessation]] before [[elective]] [[CABG]]
|-
| For [[surgery|procedures]] involving a [[median sternotomy]], it is recommended to apply [[topical]] [[antibiotics]] ([[vancomycin]]) to the cut edges of the [[sternum]] on opening and before closing.
|-
| In BIMA [[grafting]], it is recommended to use skeletonized harvest of [[IMA]].
|}
===2022 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref><ref name="pmid12771873">{{cite journal| author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO | display-authors=etal| title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 5 | pages= 1007-21 | pmid=12771873 | doi=10.1067/mtc.2003.181 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12771873 }} </ref><ref name="pmid17395026">{{cite journal| author=Furnary AP, Wu Y| title=Eliminating the diabetic disadvantage: the Portland Diabetic Project. | journal=Semin Thorac Cardiovasc Surg | year= 2006 | volume= 18 | issue= 4 | pages= 302-8 | pmid=17395026 | doi=10.1053/j.semtcvs.2006.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17395026 }} </ref>
|-
| bgcolor="LightGreen"| 1. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]] an [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] should be initiated with the goal to keep [[blood sugar]] lower than 180 mg/dL.
2. In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]], an [[surgery|postoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] is recommended with the goal to keep an early [[surgery|postoperative]] [[blood sugar]] lower than 180 mg/dL.
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid999352">{{cite journal| author=Edwards LD| title=The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago. | journal=Ann Surg | year= 1976 | volume= 184 | issue= 6 | pages= 758-66 | pmid=999352 | doi=10.1097/00000658-197612000-00017 | pmc=1345421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=999352 }} </ref><ref name="pmid17383396">{{cite journal| author=Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F | display-authors=etal| title=The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. | journal=Ann Thorac Surg | year= 2007 | volume= 83 | issue= 4 | pages= 1569-76 | pmid=17383396 | doi=10.1016/j.athoracsur.2006.09.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17383396 }} </ref><ref name="pmid27555340">{{cite journal| author=Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S| title=Prevention and management of sternal wound infections. | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 4 | pages= 962-72 | pmid=27555340 | doi=10.1016/j.jtcvs.2016.01.060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555340 }} </ref><ref name="pmid2796369">{{cite journal| author=Vander Salm TJ, Okike ON, Pasque MK, Pezzella AT, Lew R, Traina V | display-authors=etal| title=Reduction of sternal infection by application of topical vancomycin. | journal=J Thorac Cardiovasc Surg | year= 1989 | volume= 98 | issue= 4 | pages= 618-22 | pmid=2796369 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2796369 }} </ref><ref name="pmid19932261">{{cite journal| author=Steingrímsson S, Gustafsson R, Gudbjartsson T, Mokhtari A, Ingemansson R, Sjögren J| title=Sternocutaneous fistulas after cardiac surgery: incidence and late outcome during a ten-year follow-up. | journal=Ann Thorac Surg | year= 2009 | volume= 88 | issue= 6 | pages= 1910-5 | pmid=19932261 | doi=10.1016/j.athoracsur.2009.07.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19932261 }} </ref><ref name="pmid24613159">{{cite journal| author=Kieser TM, Rose MS, Aluthman U, Montgomery M, Louie T, Belenkie I| title=Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 5 | pages= 1887-95 | pmid=24613159 | doi=10.1016/j.jtcvs.2014.02.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24613159 }} </ref>
|-
| bgcolor="Yellow"| A comprehensive approach to decrease the risk of [[Sternum|sternal]] [[wound]] [[infection]] is recommended in [[patients]] undergoing [[CABG]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid26180108">{{cite journal| author=Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M | display-authors=etal| title=Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. | journal=Diabetes Care | year= 2015 | volume= 38 | issue= 9 | pages= 1665-72 | pmid=26180108 | doi=10.2337/dc15-0303 | pmc=4542267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26180108 }} </ref>
|-
| bgcolor="Lightblue"| The effectiveness of [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] with the goal to keep [[blood sugar]] lower than 140 mg/dL in [[patients]] undergoing [[CABG]] is not certain.
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery maintaining glucose level

2022-10-15T22:07:54Z

Anahita: /* Maintaining Glucose Level in CABG */

Coronary artery bypass surgery maintaining glucose level

2022-09-30T19:34:28Z

Anahita:

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==

==Maintaining Glucose Level in CABG==
===2022 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid10197653">{{cite journal| author=Furnary AP, Zerr KJ, Grunkemeier GL, Starr A| title=Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. | journal=Ann Thorac Surg | year= 1999 | volume= 67 | issue= 2 | pages= 352-60; discussion 360-2 | pmid=10197653 | doi=10.1016/s0003-4975(99)00014-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10197653 }} </ref><ref name="pmid16153268">{{cite journal| author=Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S| title=Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. | journal=J Card Surg | year= 2005 | volume= 20 | issue= 5 | pages= 403-7 | pmid=16153268 | doi=10.1111/j.1540-8191.2005.200472.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16153268 }} </ref><ref name="pmid15006999">{{cite journal| author=Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS| title=Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. | journal=Circulation | year= 2004 | volume= 109 | issue= 12 | pages= 1497-502 | pmid=15006999 | doi=10.1161/01.CIR.0000121747.71054.79 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006999 }} </ref>
|-
| bgcolor="LightGreen"| In order to reduce [[Sternum|sternal]] [[wound]] [[infection]] in [[patients]] undergoing [[CABG]] an [[surgery|intraoperative]] [[Intravenous therapy|continuous infusion]] of [[insulin]] should be initiated with the goal to keep [[blood sugar]] lower than 180 mg/dL.
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery maintaining glucose level

2022-09-30T19:26:40Z

Anahita:

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==

==Maintaining Glucose Level in CABG==

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery maintaining glucose level

2022-09-30T19:26:18Z

Anahita:

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{Anahita}} {{VK}}
==Overview==

==Maintaining Glucose Level in CABG==

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
===Hormonal Manipulation (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding [[hypoglycemia]] is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.<ref name="pmid12771873">{{cite journal |author=Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A |title=Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=125 |issue=5 |pages=1007–21 |year=2003 |month=May |pmid=12771873 |doi=10.1067/mtc.2003.181 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303501052 |accessdate=2011-12-14}}</ref><ref name="pmid16608860">{{cite journal |author=Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, Vanhoutte T, Van Damme A, Schetz M, Wouters PJ, Van den Berghe G |title=Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life |journal=[[European Heart Journal]] |volume=27 |issue=22 |pages=2716–24 |year=2006 |month=November |pmid=16608860 |doi=10.1093/eurheartj/ehi855 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16608860 |accessdate=2011-12-14}}</ref><ref name="pmid11794168">{{cite journal |author=van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R |title=Intensive insulin therapy in the critically ill patients |journal=[[The New England Journal of Medicine]] |volume=345 |issue=19 |pages=1359–67 |year=2001 |month=November |pmid=11794168 |doi=10.1056/NEJMoa011300 |url=http://dx.doi.org/10.1056/NEJMoa011300 |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.<ref name="pmid16256784">{{cite journal |author=Butterworth J, Wagenknecht LE, Legault C, Zaccaro DJ, Kon ND, Hammon JW, Rogers AT, Troost BT, Stump DA, Furberg CD, Coker LH |title=Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=130 |issue=5 |pages=1319 |year=2005 |month=November |pmid=16256784 |doi=10.1016/j.jtcvs.2005.02.049 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(05)00368-5 |accessdate=2011-12-14}}</ref><ref name="pmid20216389">{{cite journal |author=Duncan AE, Abd-Elsayed A, Maheshwari A, Xu M, Soltesz E, Koch CG |title=Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery |journal=[[Anesthesiology]] |volume=112 |issue=4 |pages=860–71 |year=2010 |month=April |pmid=20216389 |doi=10.1097/ALN.0b013e3181d3d4b4 |url= |accessdate=2011-12-14}}</ref><ref name="pmid17310047">{{cite journal |author=Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM |title=Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial |journal=[[Annals of Internal Medicine]] |volume=146 |issue=4 |pages=233–43 |year=2007 |month=February |pmid=17310047 |doi= |url= |accessdate=2011-12-14}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery

2022-09-30T19:23:51Z

Anahita: /* Perioperative Management */

'''For the WikiPatient page for this topic, click [[{{PAGENAME}} (patient information)|here]]'''
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[User: Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{Anahita}}; {{CZ}}; {{VK}} {{PTD}}

'''''Synonyms and keywords:''''' Coronary artery bypass grafting, and colloquially heart bypass, bypass, bypass surgery, open heart surgery, or CABG (pronounced like cabbage), aortocoronary bypass (ACB). The term Coronary Artery Graft Surgery (CAGS) is often used outside the United States and should not be confused with [[Coronary angiography|Coronary Angiography (CAG)]]. OPCAB refers to [[Off-pump coronary artery bypass]], a procedure during which the patient is not placed on extracorporeal circulation ("the pump").

==[[Coronary artery bypass surgery overview|Overview]]==
[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is a [[surgery|surgical]] [[coronary revascularization|revascularization]] procedure that is used to circumvent or bypass blockages in the [[Epicardium|epicardial]] [[coronary arteries]] associated with [[acute coronary syndromes]] (including [[ST elevation MI]], [[non ST elevation MI]], [[unstable angina]]) and [[stable angina]]. The technique was pioneered by Argentine [[cardiac surgeon]] [[René Favaloro]] at the [[Cleveland Clinic]] in the late 1960s. As part of the procedure, [[artery|arteries]] or [[vein]]s from elsewhere in the [[patient]]'s body are [[medical grafting|grafted]] from the [[aorta]] to the [[coronary artery|coronary arteries]] to bypass [[atherosclerosis|atherosclerotic]] [[stenosis|narrowings]] and improve the [[blood]] supply to the [[coronary circulation]] supplying the [[myocardium]] ([[myocardium|heart muscle]]). This surgery is usually performed with the [[heart]] stopped, necessitating the usage of [[cardiopulmonary bypass]]. However, recent advances allow the procedure to be performed with the [[heart]] beating and through smaller [[incisions]]. Currently, about 500,000 [[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) are performed in the United States each year.

==Pathophysiology==
[[Coronary artery bypass surgery saphenous vein graft disease| Saphenous Vein Graft Disease]] | [[Coronary artery bypass surgery other non-atherosclerotic saphenous vein graft diseases|Other Non-Atherosclerotic Saphenous Vein Graft Diseases]]

==[[Coronary artery bypass surgery indications|Indications for CABG]]==
[[Coronary artery bypass surgery in patients with acute MI|CABG in Patients with Acute MI]] | [[Coronary artery bypass surgery in ventricular arrhythmias|CABG in Patients with Ventricular Arrhythmias]] | [[Coronary artery bypass surgery after failed PCI|Emergency CABG after Failed PCI]] | [[Coronary artery bypass surgery in association with other cardiac procedures|CABG in Association with Other Cardiac Procedures]] | [[Coronary artery bypass surgery heart team approach to revascularization decisions|Heart Team Approach to Revascularization Decisions]] | [[Coronary artery bypass surgery of left main CAD to improve survival|Revascularization of Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery of non–left main CAD to improve survival|Revascularization of Non-Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery revascularization to improve symptoms|Revascularization to Improve Symptoms]] | [[Coronary artery bypass surgery CABG in left ventricular dysfunction|CABG in Left Ventricular Dysfunction]]

==[[Coronary artery bypass surgery prognosis|Prognosis]]==

==Imaging in the patient undergoing CABG==
[[Coronary artery bypass surgery X-ray|Chest x-ray]] | [[Coronary artery bypass surgery angiography|Coronary Angiography]]
| [[Coronary artery bypass surgery CT angiography|CT Angiography]] | [[Coronary artery bypass surgery mri angiography|MRI Angiography]] | [[Coronary artery bypass surgery TEE|Trans-Esophageal Echocardiography]] | [[Coronary artery bypass surgery epiaortic ultrasound|Epiaortic Ultrasound]]

==[[Coronary artery bypass surgery goals of treatment|Goals of Treatment]]==

==[[Coronary artery bypass surgery perioperative management|Perioperative and Intraoperative Management]]==
[[Coronary artery bypass surgery aspirin and clopidogrel|Aspirin and Clopidogrel]] | [[Coronary artery bypass surgery use of beta-blockers|Beta-Blockers]] | [[Coronary artery bypass surgery use of ACE Inhibitors/ARBs|ACE Inhibitors/ARBs]] | [[Coronary artery bypass surgery management of hyperlipidemia|Management of Hyperlipidemia]] | [[Coronary artery bypass surgery management of perioperative infection|Management of Mediastinitis/Perioperative Infection]] | [[Coronary artery bypass surgery percutaneous coronary intervention (PCI) to treat saphenous vein graft failure|Percutaneous Coronary Intervention (PCI) To Treat Saphenous Vein Graft Failure]] | [[Coronary artery bypass surgery postoperative antiplatelet therapy|Postoperative Antiplatelet Therapy]] | [[Coronary artery bypass surgery maintaining glucose level|Maintaining Glucose Level]] | [[Coronary artery bypass surgery bleeding/transfusion]] | [[Coronary artery bypass surgery management of dysrhythmias|Management of Dysrhythmias]] | [[Coronary artery bypass surgery smoking cessation|Smoking Cessation]] | [[Coronary artery bypass surgery perioperative management of myocardial dysfunction|Perioperative Management of Myocardial Dysfunction]] | [[Coronary artery bypass surgery perioperative carotid artery noninvasive screening|Perioperative Carotid Artery Noninvasive Screening]]

==[[Coronary artery bypass surgery perioperative monitoring|Perioperative and Intraoperative Monitoring]]==
[[Coronary artery bypass surgery electrocardiographic monitoring|Electrocardiographic Monitoring]] | [[Coronary artery bypass surgery pulmonary artery catheterization|Pulmonary Artery Catheterization]] | [[Coronary artery bypass surgery central nervous system monitoring|Central Nervous System Monitoring]]

==[[Coronary artery bypass surgery surgical procedure|Surgical Procedure]]==
[[Coronary artery bypass surgery anesthetic considerations|Anesthetic Considerations]] | [[Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified)| The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)]] | [[Coronary artery bypass surgery minimally invasive CABG| Minimally Invasive CABG]] | [[Coronary artery bypass surgery conduits used for bypass|Conduits Used for Bypass]] | [[Coronary artery bypass surgery videos on spahenous vein graft harvesting| Videos on Saphenous Vein-Graft Harvesting]] | [[Coronary artery bypass surgery videos on Coronary artery bypass surgery|Videos on Coronary Artery Bypass Surgery]] | [[Coronary artery bypass surgery cardiopulmonary bypass|Cardiopulmonary Bypass]]

==[[Coronary artery bypass surgery post-operative care and complications|Post-Operative Care and Complications]]==

==Special Scenarios==
[[Coronary artery bypass surgery in anomalous coronary arteries|Anomalous Coronary Arteries]] | [[Coronary artery bypass surgery in patients with COPD/respiratory insufficiency|Chronic Obstructive Pulmonary Disease/Respiratory Insufficiency]] | [[Coronary artery bypass surgery in patients with existing renal disease|Existing Renal Disease]] | [[Coronary artery bypass surgery in patients with valvular disease|Concomitant Valvular Disease]] | [[Coronary artery bypass surgery in patients with previous cardiac surgery|Previous Cardiac Surgery]] | [[Coronary artery bypass surgery in patients with menopause|Menopause]] | [[Coronary artery bypass surgery carotid disease evaluation before surgery|Carotid Disease Evaluation Before Surgery]]

==Related Chapters==

* [[CABG]]
* [[Hybrid bypass]]
* [[Off-pump coronary artery bypass surgery|Off-Pump Coronary Artery Bypass Surgery (OPCAB)]]
* [[Minimally invasive direct coronary artery bypass surgery]] ([[MIDCAB]])
* [[Cardiothoracic surgery]]
* [[Dressler's syndrome]]
* [[Hybrid bypass]]

==External Links==
*[http://www.texheartsurgeons.com/ Advances in Cardiovascular Surgery and Cardiothoracic Surgical Procedures]
*[http://www.ctsnet.org/residents/ctsn/ Cardiothoracic Surgery Notes] an online interactive review developed by residents in cardiothoracic surgery
*[http://www.enferpro.com/cirugia1.htm#DIRECCIONES Contenidos de Enfermería y Cirugía Cardiaca]
*[http://www.ctsnet.org/ CTSNet: The Cardiothoracic Surgery Network]
*[http://www.enferpro.com/cirugiacurso.htm Curso de Enfermería y Cirugía Cardiaca]
*[http://www.texheartsurgeons.com/AssistDvcs.htm Heart Assist Devices]
*[http://www1.cs.columbia.edu/robotics/projects/lvad/lvad_form.html LVAD Simulator]
*[http://perfline.com/index.htm Perfusion Line]
*[http://www.ctsnet.org/section/residents/ The CardioThoracic Surgery Network: Residents Section]
*[http://www.heartpioneers.com/ The Implantable Artificial Heart Project]
*[http://perfline.com/textbook/textbook.html The Virtual Textbook Of Extracorporeal Technology]
*[http://info.med.yale.edu/intmed/cardio/imaging/ Yale: Introduction to Cardiothoracic Imaging]

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

[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:mature chapter]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Overview complete]]
[[Category:Template complete]]

[[es:Bypass]]
[[fr:pontage aorto-coronarien]]
[[ja:冠動脈大動脈バイパス移植術]]
[[pl:CABG]]
[[pt:Cirurgia cardiovascular]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Coronary artery bypass surgery cardiopulmonary bypass

2022-09-30T19:19:55Z

Anahita: /* Overview */

{{CMG}}; {{AE}} {{Anahita}}

{{SK}}

==[[Overview]]==
There are [[surgery|alternative operative strategies]] such as [[Off-pump coronary artery bypass surgery|off-pump]] or beating [[heart]], which have their own risks and benefits. These alternatives could be used when the risks of [[aorta|aortic]] manipulation outweigh the safe use of a [[Aortic cross-clamp|cross-clamp]] or [[cannulation]] of the [[ascending aorta]]. Furthermore, [[surgery|surgeon]] experience with the strategies mentioned above should be considered.

==Cardiopulmonary Bypass in CABG Patients==
*The risks and benefits of [[surgery|alternative operative strategies]] such as [[Off-pump coronary artery bypass surgery|off-pump]] or beating [[heart]], can be considered when the risks of [[aorta|aortic]] manipulation outweigh the safe use of a [[Aortic cross-clamp|cross-clamp]] or [[cannulation]] of the [[ascending aorta]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
*Furthermore, [[surgery|surgeon]] experience with the aforementioned strategies should be taken into consideration.
*One major concern that exists for the [[Off-pump coronary artery bypass surgery|off-pump approach]] is the technical difficulty of bypassing [[coronary arteries]] in the circumflex distribution, in addition to small and intramyocardial segments. This concern created a tendency toward fewer grafts per [[patient]], a higher rate of incomplete [[revascularization]], and more concern regarding the [[graft]] patency in long term.<ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid26276839">{{cite journal| author=Deppe AC, Arbash W, Kuhn EW, Slottosch I, Scherner M, Liakopoulos OJ | display-authors=etal| title=Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16,900 patients investigated in randomized controlled trials†. | journal=Eur J Cardiothorac Surg | year= 2016 | volume= 49 | issue= 4 | pages= 1031-41; discussion 1041 | pmid=26276839 | doi=10.1093/ejcts/ezv268 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26276839 }} </ref><ref name="pmid21511187">{{cite journal| author=Edelman JJ, Yan TD, Bannon PG, Wilson MK, Vallely MP| title=Coronary artery bypass grafting with and without manipulation of the ascending aorta--a meta-analysis. | journal=Heart Lung Circ | year= 2011 | volume= 20 | issue= 5 | pages= 318-24 | pmid=21511187 | doi=10.1016/j.hlc.2011.02.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21511187 }} </ref><ref name="pmid27771985">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z | display-authors=etal| title=Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 24 | pages= 2359-2368 | pmid=27771985 | doi=10.1056/NEJMoa1601564 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27771985 }} </ref><ref name="pmid28813218">{{cite journal| author=Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA | display-authors=etal| title=Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass. | journal=N Engl J Med | year= 2017 | volume= 377 | issue= 7 | pages= 623-632 | pmid=28813218 | doi=10.1056/NEJMoa1614341 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28813218 }} </ref><ref name="pmid20494043">{{cite journal| author=Takagi H, Matsui M, Umemoto T| title=Off-pump coronary artery bypass may increase late mortality: a meta-analysis of randomized trials. | journal=Ann Thorac Surg | year= 2010 | volume= 89 | issue= 6 | pages= 1881-8 | pmid=20494043 | doi=10.1016/j.athoracsur.2010.03.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20494043 }} </ref><ref name="pmid22419321">{{cite journal| author=Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C| title=Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. | journal=Cochrane Database Syst Rev | year= 2012 | volume= | issue= 3 | pages= CD007224 | pmid=22419321 | doi=10.1002/14651858.CD007224.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22419321 }} </ref>
*The following are some of the advantages of [[off-pump coronary artery bypass surgery]] compared with on-pump [[CABG]]:<ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid16740529">{{cite journal| author=Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T | display-authors=etal| title=Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. | journal=BMJ | year= 2006 | volume= 332 | issue= 7554 | pages= 1365 | pmid=16740529 | doi=10.1136/bmj.38852.479907.7C | pmc=1476725 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740529 }} </ref><ref name="pmid11955537">{{cite journal| author=Angelini GD, Taylor FC, Reeves BC, Ascione R| title=Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. | journal=Lancet | year= 2002 | volume= 359 | issue= 9313 | pages= 1194-9 | pmid=11955537 | doi=10.1016/S0140-6736(02)08216-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11955537 }} </ref><ref name="pmid22523305">{{cite journal| author=Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH | display-authors=etal| title=On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. | journal=Circulation | year= 2012 | volume= 125 | issue= 20 | pages= 2431-9 | pmid=22523305 | doi=10.1161/CIRCULATIONAHA.111.052571 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22523305 }} </ref><ref name="pmid23477676">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 13 | pages= 1179-88 | pmid=23477676 | doi=10.1056/NEJMoa1301228 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23477676 }} </ref>
**Earlier [[Mechanical ventilation|extubation]]
**Lower rate of [[blood transfusion]]
**Better outcome for [[patients]] with increased [[pulmonary disease]] risks
*[[Cardiopulmonary bypass]] is associated with a less [[Inflammation|systemic inflammatory response]], and therefore has a less negative impact on [[Lung|pulmonary]] function.<ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid16740529">{{cite journal| author=Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T | display-authors=etal| title=Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. | journal=BMJ | year= 2006 | volume= 332 | issue= 7554 | pages= 1365 | pmid=16740529 | doi=10.1136/bmj.38852.479907.7C | pmc=1476725 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740529 }} </ref><ref name="pmid11955537">{{cite journal| author=Angelini GD, Taylor FC, Reeves BC, Ascione R| title=Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. | journal=Lancet | year= 2002 | volume= 359 | issue= 9313 | pages= 1194-9 | pmid=11955537 | doi=10.1016/S0140-6736(02)08216-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11955537 }} </ref><ref name="pmid22523305">{{cite journal| author=Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH | display-authors=etal| title=On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. | journal=Circulation | year= 2012 | volume= 125 | issue= 20 | pages= 2431-9 | pmid=22523305 | doi=10.1161/CIRCULATIONAHA.111.052571 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22523305 }} </ref><ref name="pmid23477676">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 13 | pages= 1179-88 | pmid=23477676 | doi=10.1056/NEJMoa1301228 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23477676 }} </ref>
===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid22449296">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Off-pump or on-pump coronary-artery bypass grafting at 30 days. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 16 | pages= 1489-97 | pmid=22449296 | doi=10.1056/NEJMoa1200388 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22449296 }} </ref><ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref>
|-
| bgcolor="LightGreen"| When significant [[calcification]] of the [[aorta]] is present, usage of techniques such as [[Off-pump coronary artery bypass surgery|off-pump techniques]] or beating [[heart]] (to avoid [[aorta|aortic]] manipulation) is rational to reduce the [[surgery|perioperative]] [[stroke]] [[incidence]] when performed by experienced [[surgeons]].
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:yellow"|Class 2b Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid16740529">{{cite journal| author=Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T | display-authors=etal| title=Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. | journal=BMJ | year= 2006 | volume= 332 | issue= 7554 | pages= 1365 | pmid=16740529 | doi=10.1136/bmj.38852.479907.7C | pmc=1476725 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740529 }} </ref><ref name="pmid11955537">{{cite journal| author=Angelini GD, Taylor FC, Reeves BC, Ascione R| title=Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. | journal=Lancet | year= 2002 | volume= 359 | issue= 9313 | pages= 1194-9 | pmid=11955537 | doi=10.1016/S0140-6736(02)08216-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11955537 }} </ref><ref name="pmid22523305">{{cite journal| author=Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH | display-authors=etal| title=On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. | journal=Circulation | year= 2012 | volume= 125 | issue= 20 | pages= 2431-9 | pmid=22523305 | doi=10.1161/CIRCULATIONAHA.111.052571 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22523305 }} </ref><ref name="pmid23477676">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 13 | pages= 1179-88 | pmid=23477676 | doi=10.1056/NEJMoa1301228 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23477676 }} </ref>
|-
| bgcolor="yellow"| Utilizing [[Off-pump coronary artery bypass surgery|off-pump surgery]] could be rational for [[patients]] with significant [[Pulmonology|pulmonary disease]] in order to decrease [[surgery|perioperative]] risk when performed by experienced [[surgeons]].
|}

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

{{WH}}
{{WS}}
[[Category: (name of the system)]]

Coronary artery bypass surgery cardiopulmonary bypass

2022-09-30T19:15:50Z

Anahita: /* Cardiopulmonary Bypass in CABG Patients */

{{CMG}}; {{AE}} {{Anahita}}

{{SK}}

==[[Overview]]==

==Cardiopulmonary Bypass in CABG Patients==
*The risks and benefits of [[surgery|alternative operative strategies]] such as [[Off-pump coronary artery bypass surgery|off-pump]] or beating [[heart]], can be considered when the risks of [[aorta|aortic]] manipulation outweigh the safe use of a [[Aortic cross-clamp|cross-clamp]] or [[cannulation]] of the [[ascending aorta]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
*Furthermore, [[surgery|surgeon]] experience with the aforementioned strategies should be taken into consideration.
*One major concern that exists for the [[Off-pump coronary artery bypass surgery|off-pump approach]] is the technical difficulty of bypassing [[coronary arteries]] in the circumflex distribution, in addition to small and intramyocardial segments. This concern created a tendency toward fewer grafts per [[patient]], a higher rate of incomplete [[revascularization]], and more concern regarding the [[graft]] patency in long term.<ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid26276839">{{cite journal| author=Deppe AC, Arbash W, Kuhn EW, Slottosch I, Scherner M, Liakopoulos OJ | display-authors=etal| title=Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16,900 patients investigated in randomized controlled trials†. | journal=Eur J Cardiothorac Surg | year= 2016 | volume= 49 | issue= 4 | pages= 1031-41; discussion 1041 | pmid=26276839 | doi=10.1093/ejcts/ezv268 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26276839 }} </ref><ref name="pmid21511187">{{cite journal| author=Edelman JJ, Yan TD, Bannon PG, Wilson MK, Vallely MP| title=Coronary artery bypass grafting with and without manipulation of the ascending aorta--a meta-analysis. | journal=Heart Lung Circ | year= 2011 | volume= 20 | issue= 5 | pages= 318-24 | pmid=21511187 | doi=10.1016/j.hlc.2011.02.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21511187 }} </ref><ref name="pmid27771985">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z | display-authors=etal| title=Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 24 | pages= 2359-2368 | pmid=27771985 | doi=10.1056/NEJMoa1601564 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27771985 }} </ref><ref name="pmid28813218">{{cite journal| author=Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA | display-authors=etal| title=Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass. | journal=N Engl J Med | year= 2017 | volume= 377 | issue= 7 | pages= 623-632 | pmid=28813218 | doi=10.1056/NEJMoa1614341 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28813218 }} </ref><ref name="pmid20494043">{{cite journal| author=Takagi H, Matsui M, Umemoto T| title=Off-pump coronary artery bypass may increase late mortality: a meta-analysis of randomized trials. | journal=Ann Thorac Surg | year= 2010 | volume= 89 | issue= 6 | pages= 1881-8 | pmid=20494043 | doi=10.1016/j.athoracsur.2010.03.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20494043 }} </ref><ref name="pmid22419321">{{cite journal| author=Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C| title=Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. | journal=Cochrane Database Syst Rev | year= 2012 | volume= | issue= 3 | pages= CD007224 | pmid=22419321 | doi=10.1002/14651858.CD007224.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22419321 }} </ref>
*The following are some of the advantages of [[off-pump coronary artery bypass surgery]] compared with on-pump [[CABG]]:<ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid16740529">{{cite journal| author=Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T | display-authors=etal| title=Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. | journal=BMJ | year= 2006 | volume= 332 | issue= 7554 | pages= 1365 | pmid=16740529 | doi=10.1136/bmj.38852.479907.7C | pmc=1476725 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740529 }} </ref><ref name="pmid11955537">{{cite journal| author=Angelini GD, Taylor FC, Reeves BC, Ascione R| title=Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. | journal=Lancet | year= 2002 | volume= 359 | issue= 9313 | pages= 1194-9 | pmid=11955537 | doi=10.1016/S0140-6736(02)08216-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11955537 }} </ref><ref name="pmid22523305">{{cite journal| author=Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH | display-authors=etal| title=On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. | journal=Circulation | year= 2012 | volume= 125 | issue= 20 | pages= 2431-9 | pmid=22523305 | doi=10.1161/CIRCULATIONAHA.111.052571 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22523305 }} </ref><ref name="pmid23477676">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 13 | pages= 1179-88 | pmid=23477676 | doi=10.1056/NEJMoa1301228 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23477676 }} </ref>
**Earlier [[Mechanical ventilation|extubation]]
**Lower rate of [[blood transfusion]]
**Better outcome for [[patients]] with increased [[pulmonary disease]] risks
*[[Cardiopulmonary bypass]] is associated with a less [[Inflammation|systemic inflammatory response]], and therefore has a less negative impact on [[Lung|pulmonary]] function.<ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid16740529">{{cite journal| author=Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T | display-authors=etal| title=Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. | journal=BMJ | year= 2006 | volume= 332 | issue= 7554 | pages= 1365 | pmid=16740529 | doi=10.1136/bmj.38852.479907.7C | pmc=1476725 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740529 }} </ref><ref name="pmid11955537">{{cite journal| author=Angelini GD, Taylor FC, Reeves BC, Ascione R| title=Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. | journal=Lancet | year= 2002 | volume= 359 | issue= 9313 | pages= 1194-9 | pmid=11955537 | doi=10.1016/S0140-6736(02)08216-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11955537 }} </ref><ref name="pmid22523305">{{cite journal| author=Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH | display-authors=etal| title=On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. | journal=Circulation | year= 2012 | volume= 125 | issue= 20 | pages= 2431-9 | pmid=22523305 | doi=10.1161/CIRCULATIONAHA.111.052571 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22523305 }} </ref><ref name="pmid23477676">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 13 | pages= 1179-88 | pmid=23477676 | doi=10.1056/NEJMoa1301228 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23477676 }} </ref>
===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid22449296">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Off-pump or on-pump coronary-artery bypass grafting at 30 days. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 16 | pages= 1489-97 | pmid=22449296 | doi=10.1056/NEJMoa1200388 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22449296 }} </ref><ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref>
|-
| bgcolor="LightGreen"| When significant [[calcification]] of the [[aorta]] is present, usage of techniques such as [[Off-pump coronary artery bypass surgery|off-pump techniques]] or beating [[heart]] (to avoid [[aorta|aortic]] manipulation) is rational to reduce the [[surgery|perioperative]] [[stroke]] [[incidence]] when performed by experienced [[surgeons]].
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:yellow"|Class 2b Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid16740529">{{cite journal| author=Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T | display-authors=etal| title=Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. | journal=BMJ | year= 2006 | volume= 332 | issue= 7554 | pages= 1365 | pmid=16740529 | doi=10.1136/bmj.38852.479907.7C | pmc=1476725 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740529 }} </ref><ref name="pmid11955537">{{cite journal| author=Angelini GD, Taylor FC, Reeves BC, Ascione R| title=Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. | journal=Lancet | year= 2002 | volume= 359 | issue= 9313 | pages= 1194-9 | pmid=11955537 | doi=10.1016/S0140-6736(02)08216-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11955537 }} </ref><ref name="pmid22523305">{{cite journal| author=Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH | display-authors=etal| title=On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. | journal=Circulation | year= 2012 | volume= 125 | issue= 20 | pages= 2431-9 | pmid=22523305 | doi=10.1161/CIRCULATIONAHA.111.052571 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22523305 }} </ref><ref name="pmid23477676">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 13 | pages= 1179-88 | pmid=23477676 | doi=10.1056/NEJMoa1301228 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23477676 }} </ref>
|-
| bgcolor="yellow"| Utilizing [[Off-pump coronary artery bypass surgery|off-pump surgery]] could be rational for [[patients]] with significant [[Pulmonology|pulmonary disease]] in order to decrease [[surgery|perioperative]] risk when performed by experienced [[surgeons]].
|}

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

{{WH}}
{{WS}}
[[Category: (name of the system)]]

Coronary artery bypass surgery cardiopulmonary bypass

2022-09-15T05:10:36Z

Anahita:

Coronary artery bypass surgery cardiopulmonary bypass

2022-09-15T05:09:25Z

Anahita: /* Cardiopulmonary Bypass in CABG Patients */

{{CMG}}; {{AE}}

{{SK}}

==[[Overview]]==

==Cardiopulmonary Bypass in CABG Patients==
*The risks and benefits of [[surgery|alternative operative strategies]] such as [[Off-pump coronary artery bypass surgery|off-pump]] or beating [[heart]], can be considered when the risks of [[aorta|aortic]] manipulation outweigh the safe use of a [[Aortic cross-clamp|cross-clamp]] or [[cannulation]] of the [[ascending aorta]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
*Furthermore, [[surgery|surgeon]] experience with the aforementioned strategies should be taken into consideration.
*One major concern that exists for the [[Off-pump coronary artery bypass surgery|off-pump approach]] is the technical difficulty of bypassing [[coronary arteries]] in the circumflex distribution, in addition to small and intramyocardial segments. This concern created a tendency toward fewer grafts per [[patient]], a higher rate of incomplete [[revascularization]], and more concern regarding the [[graft]] patency in long term.<ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid26276839">{{cite journal| author=Deppe AC, Arbash W, Kuhn EW, Slottosch I, Scherner M, Liakopoulos OJ | display-authors=etal| title=Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16,900 patients investigated in randomized controlled trials†. | journal=Eur J Cardiothorac Surg | year= 2016 | volume= 49 | issue= 4 | pages= 1031-41; discussion 1041 | pmid=26276839 | doi=10.1093/ejcts/ezv268 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26276839 }} </ref><ref name="pmid21511187">{{cite journal| author=Edelman JJ, Yan TD, Bannon PG, Wilson MK, Vallely MP| title=Coronary artery bypass grafting with and without manipulation of the ascending aorta--a meta-analysis. | journal=Heart Lung Circ | year= 2011 | volume= 20 | issue= 5 | pages= 318-24 | pmid=21511187 | doi=10.1016/j.hlc.2011.02.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21511187 }} </ref><ref name="pmid27771985">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z | display-authors=etal| title=Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 24 | pages= 2359-2368 | pmid=27771985 | doi=10.1056/NEJMoa1601564 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27771985 }} </ref><ref name="pmid28813218">{{cite journal| author=Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA | display-authors=etal| title=Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass. | journal=N Engl J Med | year= 2017 | volume= 377 | issue= 7 | pages= 623-632 | pmid=28813218 | doi=10.1056/NEJMoa1614341 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28813218 }} </ref><ref name="pmid20494043">{{cite journal| author=Takagi H, Matsui M, Umemoto T| title=Off-pump coronary artery bypass may increase late mortality: a meta-analysis of randomized trials. | journal=Ann Thorac Surg | year= 2010 | volume= 89 | issue= 6 | pages= 1881-8 | pmid=20494043 | doi=10.1016/j.athoracsur.2010.03.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20494043 }} </ref><ref name="pmid22419321">{{cite journal| author=Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C| title=Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. | journal=Cochrane Database Syst Rev | year= 2012 | volume= | issue= 3 | pages= CD007224 | pmid=22419321 | doi=10.1002/14651858.CD007224.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22419321 }} </ref>

===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid22449296">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Off-pump or on-pump coronary-artery bypass grafting at 30 days. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 16 | pages= 1489-97 | pmid=22449296 | doi=10.1056/NEJMoa1200388 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22449296 }} </ref><ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref>
|-
| bgcolor="LightGreen"| When significant [[calcification]] of the [[aorta]] is present, usage of techniques such as [[Off-pump coronary artery bypass surgery|off-pump techniques]] or beating [[heart]] (to avoid [[aorta|aortic]] manipulation) is rational to reduce the [[surgery|perioperative]] [[stroke]] [[incidence]] when performed by experienced [[surgeons]].
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:yellow"|Class 2b Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid16740529">{{cite journal| author=Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T | display-authors=etal| title=Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. | journal=BMJ | year= 2006 | volume= 332 | issue= 7554 | pages= 1365 | pmid=16740529 | doi=10.1136/bmj.38852.479907.7C | pmc=1476725 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740529 }} </ref><ref name="pmid11955537">{{cite journal| author=Angelini GD, Taylor FC, Reeves BC, Ascione R| title=Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. | journal=Lancet | year= 2002 | volume= 359 | issue= 9313 | pages= 1194-9 | pmid=11955537 | doi=10.1016/S0140-6736(02)08216-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11955537 }} </ref><ref name="pmid22523305">{{cite journal| author=Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH | display-authors=etal| title=On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. | journal=Circulation | year= 2012 | volume= 125 | issue= 20 | pages= 2431-9 | pmid=22523305 | doi=10.1161/CIRCULATIONAHA.111.052571 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22523305 }} </ref><ref name="pmid23477676">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 13 | pages= 1179-88 | pmid=23477676 | doi=10.1056/NEJMoa1301228 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23477676 }} </ref>
|-
| bgcolor="yellow"| Utilizing [[Off-pump coronary artery bypass surgery|off-pump surgery]] could be rational for [[patients]] with significant [[Pulmonology|pulmonary disease]] in order to decrease [[surgery|perioperative]] risk when performed by experienced [[surgeons]].
|}

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

{{WH}}
{{WS}}
[[Category: (name of the system)]]

Coronary artery bypass surgery cardiopulmonary bypass

2022-09-15T04:41:00Z

Anahita:

{{CMG}}; {{AE}}

{{SK}}

==[[Overview]]==

==Cardiopulmonary Bypass in CABG Patients==

===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid22449296">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Off-pump or on-pump coronary-artery bypass grafting at 30 days. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 16 | pages= 1489-97 | pmid=22449296 | doi=10.1056/NEJMoa1200388 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22449296 }} </ref><ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref>
|-
| bgcolor="LightGreen"| When significant [[calcification]] of the [[aorta]] is present, usage of techniques such as [[Off-pump coronary artery bypass surgery|off-pump techniques]] or beating [[heart]] (to avoid [[aorta|aortic]] manipulation) is rational to reduce the [[surgery|perioperative]] [[stroke]] [[incidence]] when performed by experienced [[surgeons]].
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:yellow"|Class 2b Recommendation, Level of Evidence: B-R <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid29495998">{{cite journal| author=Smart NA, Dieberg G, King N| title=Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting. | journal=J Am Coll Cardiol | year= 2018 | volume= 71 | issue= 9 | pages= 983-991 | pmid=29495998 | doi=10.1016/j.jacc.2017.12.049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29495998 }} </ref><ref name="pmid16740529">{{cite journal| author=Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T | display-authors=etal| title=Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. | journal=BMJ | year= 2006 | volume= 332 | issue= 7554 | pages= 1365 | pmid=16740529 | doi=10.1136/bmj.38852.479907.7C | pmc=1476725 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740529 }} </ref><ref name="pmid11955537">{{cite journal| author=Angelini GD, Taylor FC, Reeves BC, Ascione R| title=Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. | journal=Lancet | year= 2002 | volume= 359 | issue= 9313 | pages= 1194-9 | pmid=11955537 | doi=10.1016/S0140-6736(02)08216-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11955537 }} </ref><ref name="pmid22523305">{{cite journal| author=Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH | display-authors=etal| title=On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. | journal=Circulation | year= 2012 | volume= 125 | issue= 20 | pages= 2431-9 | pmid=22523305 | doi=10.1161/CIRCULATIONAHA.111.052571 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22523305 }} </ref><ref name="pmid23477676">{{cite journal| author=Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E | display-authors=etal| title=Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 13 | pages= 1179-88 | pmid=23477676 | doi=10.1056/NEJMoa1301228 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23477676 }} </ref>
|-
| bgcolor="yellow"| Utilizing [[Off-pump coronary artery bypass surgery|off-pump surgery]] could be rational for [[patients]] with significant [[Pulmonology|pulmonary disease]] in order to decrease [[surgery|perioperative]] risk when performed by experienced [[surgeons]].
|}

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

{{WH}}
{{WS}}
[[Category: (name of the system)]]

Coronary artery bypass surgery cardiopulmonary bypass

2022-09-15T03:37:14Z

Anahita: /* verview */

{{CMG}}; {{AE}}

{{SK}}

==[[Overview]]==

==Cardiopulmonary Bypass in CABG Patients==

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

{{WH}}
{{WS}}
[[Category: (name of the system)]]

Coronary artery bypass surgery cardiopulmonary bypass

2022-09-15T03:37:02Z

Anahita: Created page with "{{CMG}}; {{AE}} {{SK}} ==verview== ==Cardiopulmonary Bypass in CABG Patients== ==References== {{Reflist|2}} {{WH}} {{WS}} Category: (name of the system)"

{{CMG}}; {{AE}}

{{SK}}

==[[verview]]==

==Cardiopulmonary Bypass in CABG Patients==

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

{{WH}}
{{WS}}
[[Category: (name of the system)]]

Coronary artery bypass surgery

2022-09-15T03:35:18Z

Anahita: /* Surgical Procedure */

'''For the WikiPatient page for this topic, click [[{{PAGENAME}} (patient information)|here]]'''
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[User: Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{Anahita}}; {{CZ}}; {{VK}} {{PTD}}

'''''Synonyms and keywords:''''' Coronary artery bypass grafting, and colloquially heart bypass, bypass, bypass surgery, open heart surgery, or CABG (pronounced like cabbage), aortocoronary bypass (ACB). The term Coronary Artery Graft Surgery (CAGS) is often used outside the United States and should not be confused with [[Coronary angiography|Coronary Angiography (CAG)]]. OPCAB refers to [[Off-pump coronary artery bypass]], a procedure during which the patient is not placed on extracorporeal circulation ("the pump").

==[[Coronary artery bypass surgery overview|Overview]]==
[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is a [[surgery|surgical]] [[coronary revascularization|revascularization]] procedure that is used to circumvent or bypass blockages in the [[Epicardium|epicardial]] [[coronary arteries]] associated with [[acute coronary syndromes]] (including [[ST elevation MI]], [[non ST elevation MI]], [[unstable angina]]) and [[stable angina]]. The technique was pioneered by Argentine [[cardiac surgeon]] [[René Favaloro]] at the [[Cleveland Clinic]] in the late 1960s. As part of the procedure, [[artery|arteries]] or [[vein]]s from elsewhere in the [[patient]]'s body are [[medical grafting|grafted]] from the [[aorta]] to the [[coronary artery|coronary arteries]] to bypass [[atherosclerosis|atherosclerotic]] [[stenosis|narrowings]] and improve the [[blood]] supply to the [[coronary circulation]] supplying the [[myocardium]] ([[myocardium|heart muscle]]). This surgery is usually performed with the [[heart]] stopped, necessitating the usage of [[cardiopulmonary bypass]]. However, recent advances allow the procedure to be performed with the [[heart]] beating and through smaller [[incisions]]. Currently, about 500,000 [[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) are performed in the United States each year.

==Pathophysiology==
[[Coronary artery bypass surgery saphenous vein graft disease| Saphenous Vein Graft Disease]] | [[Coronary artery bypass surgery other non-atherosclerotic saphenous vein graft diseases|Other Non-Atherosclerotic Saphenous Vein Graft Diseases]]

==[[Coronary artery bypass surgery indications|Indications for CABG]]==
[[Coronary artery bypass surgery in patients with acute MI|CABG in Patients with Acute MI]] | [[Coronary artery bypass surgery in ventricular arrhythmias|CABG in Patients with Ventricular Arrhythmias]] | [[Coronary artery bypass surgery after failed PCI|Emergency CABG after Failed PCI]] | [[Coronary artery bypass surgery in association with other cardiac procedures|CABG in Association with Other Cardiac Procedures]] | [[Coronary artery bypass surgery heart team approach to revascularization decisions|Heart Team Approach to Revascularization Decisions]] | [[Coronary artery bypass surgery of left main CAD to improve survival|Revascularization of Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery of non–left main CAD to improve survival|Revascularization of Non-Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery revascularization to improve symptoms|Revascularization to Improve Symptoms]] | [[Coronary artery bypass surgery CABG in left ventricular dysfunction|CABG in Left Ventricular Dysfunction]]

==[[Coronary artery bypass surgery prognosis|Prognosis]]==

==Imaging in the patient undergoing CABG==
[[Coronary artery bypass surgery X-ray|Chest x-ray]] | [[Coronary artery bypass surgery angiography|Coronary Angiography]]
| [[Coronary artery bypass surgery CT angiography|CT Angiography]] | [[Coronary artery bypass surgery mri angiography|MRI Angiography]] | [[Coronary artery bypass surgery TEE|Trans-Esophageal Echocardiography]] | [[Coronary artery bypass surgery epiaortic ultrasound|Epiaortic Ultrasound]]

==[[Coronary artery bypass surgery goals of treatment|Goals of Treatment]]==

==[[Coronary artery bypass surgery perioperative management|Perioperative Management]]==
[[Coronary artery bypass surgery aspirin and clopidogrel|Aspirin and Clopidogrel]] | [[Coronary artery bypass surgery use of beta-blockers|Beta-Blockers]] | [[Coronary artery bypass surgery use of ACE Inhibitors/ARBs|ACE Inhibitors/ARBs]] | [[Coronary artery bypass surgery management of hyperlipidemia|Management of Hyperlipidemia]] | [[Coronary artery bypass surgery management of perioperative infection|Management of Mediastinitis/Perioperative Infection]] | [[Coronary artery bypass surgery percutaneous coronary intervention (PCI) to treat saphenous vein graft failure|Percutaneous Coronary Intervention (PCI) To Treat Saphenous Vein Graft Failure]] | [[Coronary artery bypass surgery postoperative antiplatelet therapy|Postoperative Antiplatelet Therapy]] | [[Coronary artery bypass surgery maintaining glucose level|Maintaining Glucose Level]] | [[Coronary artery bypass surgery bleeding/transfusion]] | [[Coronary artery bypass surgery management of dysrhythmias|Management of Dysrhythmias]] | [[Coronary artery bypass surgery smoking cessation|Smoking Cessation]] | [[Coronary artery bypass surgery perioperative management of myocardial dysfunction|Perioperative Management of Myocardial Dysfunction]] | [[Coronary artery bypass surgery perioperative carotid artery noninvasive screening|Perioperative Carotid Artery Noninvasive Screening]]

==[[Coronary artery bypass surgery perioperative monitoring|Perioperative and Intraoperative Monitoring]]==
[[Coronary artery bypass surgery electrocardiographic monitoring|Electrocardiographic Monitoring]] | [[Coronary artery bypass surgery pulmonary artery catheterization|Pulmonary Artery Catheterization]] | [[Coronary artery bypass surgery central nervous system monitoring|Central Nervous System Monitoring]]

==[[Coronary artery bypass surgery surgical procedure|Surgical Procedure]]==
[[Coronary artery bypass surgery anesthetic considerations|Anesthetic Considerations]] | [[Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified)| The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)]] | [[Coronary artery bypass surgery minimally invasive CABG| Minimally Invasive CABG]] | [[Coronary artery bypass surgery conduits used for bypass|Conduits Used for Bypass]] | [[Coronary artery bypass surgery videos on spahenous vein graft harvesting| Videos on Saphenous Vein-Graft Harvesting]] | [[Coronary artery bypass surgery videos on Coronary artery bypass surgery|Videos on Coronary Artery Bypass Surgery]] | [[Coronary artery bypass surgery cardiopulmonary bypass|Cardiopulmonary Bypass]]

==[[Coronary artery bypass surgery post-operative care and complications|Post-Operative Care and Complications]]==

==Special Scenarios==
[[Coronary artery bypass surgery in anomalous coronary arteries|Anomalous Coronary Arteries]] | [[Coronary artery bypass surgery in patients with COPD/respiratory insufficiency|Chronic Obstructive Pulmonary Disease/Respiratory Insufficiency]] | [[Coronary artery bypass surgery in patients with existing renal disease|Existing Renal Disease]] | [[Coronary artery bypass surgery in patients with valvular disease|Concomitant Valvular Disease]] | [[Coronary artery bypass surgery in patients with previous cardiac surgery|Previous Cardiac Surgery]] | [[Coronary artery bypass surgery in patients with menopause|Menopause]] | [[Coronary artery bypass surgery carotid disease evaluation before surgery|Carotid Disease Evaluation Before Surgery]]

==Related Chapters==

* [[CABG]]
* [[Hybrid bypass]]
* [[Off-pump coronary artery bypass surgery|Off-Pump Coronary Artery Bypass Surgery (OPCAB)]]
* [[Minimally invasive direct coronary artery bypass surgery]] ([[MIDCAB]])
* [[Cardiothoracic surgery]]
* [[Dressler's syndrome]]
* [[Hybrid bypass]]

==External Links==
*[http://www.texheartsurgeons.com/ Advances in Cardiovascular Surgery and Cardiothoracic Surgical Procedures]
*[http://www.ctsnet.org/residents/ctsn/ Cardiothoracic Surgery Notes] an online interactive review developed by residents in cardiothoracic surgery
*[http://www.enferpro.com/cirugia1.htm#DIRECCIONES Contenidos de Enfermería y Cirugía Cardiaca]
*[http://www.ctsnet.org/ CTSNet: The Cardiothoracic Surgery Network]
*[http://www.enferpro.com/cirugiacurso.htm Curso de Enfermería y Cirugía Cardiaca]
*[http://www.texheartsurgeons.com/AssistDvcs.htm Heart Assist Devices]
*[http://www1.cs.columbia.edu/robotics/projects/lvad/lvad_form.html LVAD Simulator]
*[http://perfline.com/index.htm Perfusion Line]
*[http://www.ctsnet.org/section/residents/ The CardioThoracic Surgery Network: Residents Section]
*[http://www.heartpioneers.com/ The Implantable Artificial Heart Project]
*[http://perfline.com/textbook/textbook.html The Virtual Textbook Of Extracorporeal Technology]
*[http://info.med.yale.edu/intmed/cardio/imaging/ Yale: Introduction to Cardiothoracic Imaging]

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

[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:mature chapter]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Overview complete]]
[[Category:Template complete]]

[[es:Bypass]]
[[fr:pontage aorto-coronarien]]
[[ja:冠動脈大動脈バイパス移植術]]
[[pl:CABG]]
[[pt:Cirurgia cardiovascular]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Coronary artery bypass surgery

2022-09-15T03:34:21Z

Anahita: Undo revision 1729858 by Anahita (talk)

'''For the WikiPatient page for this topic, click [[{{PAGENAME}} (patient information)|here]]'''
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[User: Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{Anahita}}; {{CZ}}; {{VK}} {{PTD}}

'''''Synonyms and keywords:''''' Coronary artery bypass grafting, and colloquially heart bypass, bypass, bypass surgery, open heart surgery, or CABG (pronounced like cabbage), aortocoronary bypass (ACB). The term Coronary Artery Graft Surgery (CAGS) is often used outside the United States and should not be confused with [[Coronary angiography|Coronary Angiography (CAG)]]. OPCAB refers to [[Off-pump coronary artery bypass]], a procedure during which the patient is not placed on extracorporeal circulation ("the pump").

==[[Coronary artery bypass surgery overview|Overview]]==
[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is a [[surgery|surgical]] [[coronary revascularization|revascularization]] procedure that is used to circumvent or bypass blockages in the [[Epicardium|epicardial]] [[coronary arteries]] associated with [[acute coronary syndromes]] (including [[ST elevation MI]], [[non ST elevation MI]], [[unstable angina]]) and [[stable angina]]. The technique was pioneered by Argentine [[cardiac surgeon]] [[René Favaloro]] at the [[Cleveland Clinic]] in the late 1960s. As part of the procedure, [[artery|arteries]] or [[vein]]s from elsewhere in the [[patient]]'s body are [[medical grafting|grafted]] from the [[aorta]] to the [[coronary artery|coronary arteries]] to bypass [[atherosclerosis|atherosclerotic]] [[stenosis|narrowings]] and improve the [[blood]] supply to the [[coronary circulation]] supplying the [[myocardium]] ([[myocardium|heart muscle]]). This surgery is usually performed with the [[heart]] stopped, necessitating the usage of [[cardiopulmonary bypass]]. However, recent advances allow the procedure to be performed with the [[heart]] beating and through smaller [[incisions]]. Currently, about 500,000 [[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) are performed in the United States each year.

==Pathophysiology==
[[Coronary artery bypass surgery saphenous vein graft disease| Saphenous Vein Graft Disease]] | [[Coronary artery bypass surgery other non-atherosclerotic saphenous vein graft diseases|Other Non-Atherosclerotic Saphenous Vein Graft Diseases]]

==[[Coronary artery bypass surgery indications|Indications for CABG]]==
[[Coronary artery bypass surgery in patients with acute MI|CABG in Patients with Acute MI]] | [[Coronary artery bypass surgery in ventricular arrhythmias|CABG in Patients with Ventricular Arrhythmias]] | [[Coronary artery bypass surgery after failed PCI|Emergency CABG after Failed PCI]] | [[Coronary artery bypass surgery in association with other cardiac procedures|CABG in Association with Other Cardiac Procedures]] | [[Coronary artery bypass surgery heart team approach to revascularization decisions|Heart Team Approach to Revascularization Decisions]] | [[Coronary artery bypass surgery of left main CAD to improve survival|Revascularization of Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery of non–left main CAD to improve survival|Revascularization of Non-Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery revascularization to improve symptoms|Revascularization to Improve Symptoms]] | [[Coronary artery bypass surgery CABG in left ventricular dysfunction|CABG in Left Ventricular Dysfunction]]

==[[Coronary artery bypass surgery prognosis|Prognosis]]==

==Imaging in the patient undergoing CABG==
[[Coronary artery bypass surgery X-ray|Chest x-ray]] | [[Coronary artery bypass surgery angiography|Coronary Angiography]]
| [[Coronary artery bypass surgery CT angiography|CT Angiography]] | [[Coronary artery bypass surgery mri angiography|MRI Angiography]] | [[Coronary artery bypass surgery TEE|Trans-Esophageal Echocardiography]] | [[Coronary artery bypass surgery epiaortic ultrasound|Epiaortic Ultrasound]]

==[[Coronary artery bypass surgery goals of treatment|Goals of Treatment]]==

==[[Coronary artery bypass surgery perioperative management|Perioperative Management]]==
[[Coronary artery bypass surgery aspirin and clopidogrel|Aspirin and Clopidogrel]] | [[Coronary artery bypass surgery use of beta-blockers|Beta-Blockers]] | [[Coronary artery bypass surgery use of ACE Inhibitors/ARBs|ACE Inhibitors/ARBs]] | [[Coronary artery bypass surgery management of hyperlipidemia|Management of Hyperlipidemia]] | [[Coronary artery bypass surgery management of perioperative infection|Management of Mediastinitis/Perioperative Infection]] | [[Coronary artery bypass surgery percutaneous coronary intervention (PCI) to treat saphenous vein graft failure|Percutaneous Coronary Intervention (PCI) To Treat Saphenous Vein Graft Failure]] | [[Coronary artery bypass surgery postoperative antiplatelet therapy|Postoperative Antiplatelet Therapy]] | [[Coronary artery bypass surgery maintaining glucose level|Maintaining Glucose Level]] | [[Coronary artery bypass surgery bleeding/transfusion]] | [[Coronary artery bypass surgery management of dysrhythmias|Management of Dysrhythmias]] | [[Coronary artery bypass surgery smoking cessation|Smoking Cessation]] | [[Coronary artery bypass surgery perioperative management of myocardial dysfunction|Perioperative Management of Myocardial Dysfunction]] | [[Coronary artery bypass surgery perioperative carotid artery noninvasive screening|Perioperative Carotid Artery Noninvasive Screening]]

==[[Coronary artery bypass surgery perioperative monitoring|Perioperative and Intraoperative Monitoring]]==
[[Coronary artery bypass surgery electrocardiographic monitoring|Electrocardiographic Monitoring]] | [[Coronary artery bypass surgery pulmonary artery catheterization|Pulmonary Artery Catheterization]] | [[Coronary artery bypass surgery central nervous system monitoring|Central Nervous System Monitoring]]

==[[Coronary artery bypass surgery surgical procedure|Surgical Procedure]]==
[[Coronary artery bypass surgery anesthetic considerations|Anesthetic Considerations]] | [[Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified)| The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)]] | [[Coronary artery bypass surgery minimally invasive CABG| Minimally Invasive CABG]] | [[Coronary artery bypass surgery conduits used for bypass|Conduits Used for Bypass]] | [[Coronary artery bypass surgery videos on spahenous vein graft harvesting| Videos on Saphenous Vein-Graft Harvesting]] | [[Coronary artery bypass surgery videos on Coronary artery bypass surgery|Videos on Coronary Artery Bypass Surgery]]

==[[Coronary artery bypass surgery post-operative care and complications|Post-Operative Care and Complications]]==

==Special Scenarios==
[[Coronary artery bypass surgery in anomalous coronary arteries|Anomalous Coronary Arteries]] | [[Coronary artery bypass surgery in patients with COPD/respiratory insufficiency|Chronic Obstructive Pulmonary Disease/Respiratory Insufficiency]] | [[Coronary artery bypass surgery in patients with existing renal disease|Existing Renal Disease]] | [[Coronary artery bypass surgery in patients with valvular disease|Concomitant Valvular Disease]] | [[Coronary artery bypass surgery in patients with previous cardiac surgery|Previous Cardiac Surgery]] | [[Coronary artery bypass surgery in patients with menopause|Menopause]] | [[Coronary artery bypass surgery carotid disease evaluation before surgery|Carotid Disease Evaluation Before Surgery]]

==Related Chapters==

* [[CABG]]
* [[Hybrid bypass]]
* [[Off-pump coronary artery bypass surgery|Off-Pump Coronary Artery Bypass Surgery (OPCAB)]]
* [[Minimally invasive direct coronary artery bypass surgery]] ([[MIDCAB]])
* [[Cardiothoracic surgery]]
* [[Dressler's syndrome]]
* [[Hybrid bypass]]

==External Links==
*[http://www.texheartsurgeons.com/ Advances in Cardiovascular Surgery and Cardiothoracic Surgical Procedures]
*[http://www.ctsnet.org/residents/ctsn/ Cardiothoracic Surgery Notes] an online interactive review developed by residents in cardiothoracic surgery
*[http://www.enferpro.com/cirugia1.htm#DIRECCIONES Contenidos de Enfermería y Cirugía Cardiaca]
*[http://www.ctsnet.org/ CTSNet: The Cardiothoracic Surgery Network]
*[http://www.enferpro.com/cirugiacurso.htm Curso de Enfermería y Cirugía Cardiaca]
*[http://www.texheartsurgeons.com/AssistDvcs.htm Heart Assist Devices]
*[http://www1.cs.columbia.edu/robotics/projects/lvad/lvad_form.html LVAD Simulator]
*[http://perfline.com/index.htm Perfusion Line]
*[http://www.ctsnet.org/section/residents/ The CardioThoracic Surgery Network: Residents Section]
*[http://www.heartpioneers.com/ The Implantable Artificial Heart Project]
*[http://perfline.com/textbook/textbook.html The Virtual Textbook Of Extracorporeal Technology]
*[http://info.med.yale.edu/intmed/cardio/imaging/ Yale: Introduction to Cardiothoracic Imaging]

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

[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:mature chapter]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Overview complete]]
[[Category:Template complete]]

[[es:Bypass]]
[[fr:pontage aorto-coronarien]]
[[ja:冠動脈大動脈バイパス移植術]]
[[pl:CABG]]
[[pt:Cirurgia cardiovascular]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Coronary artery bypass surgery

2022-09-15T03:33:30Z

Anahita: /* Surgical Procedure */

'''For the WikiPatient page for this topic, click [[{{PAGENAME}} (patient information)|here]]'''
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[User: Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{Anahita}}; {{CZ}}; {{VK}} {{PTD}}

'''''Synonyms and keywords:''''' Coronary artery bypass grafting, and colloquially heart bypass, bypass, bypass surgery, open heart surgery, or CABG (pronounced like cabbage), aortocoronary bypass (ACB). The term Coronary Artery Graft Surgery (CAGS) is often used outside the United States and should not be confused with [[Coronary angiography|Coronary Angiography (CAG)]]. OPCAB refers to [[Off-pump coronary artery bypass]], a procedure during which the patient is not placed on extracorporeal circulation ("the pump").

==[[Coronary artery bypass surgery overview|Overview]]==
[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is a [[surgery|surgical]] [[coronary revascularization|revascularization]] procedure that is used to circumvent or bypass blockages in the [[Epicardium|epicardial]] [[coronary arteries]] associated with [[acute coronary syndromes]] (including [[ST elevation MI]], [[non ST elevation MI]], [[unstable angina]]) and [[stable angina]]. The technique was pioneered by Argentine [[cardiac surgeon]] [[René Favaloro]] at the [[Cleveland Clinic]] in the late 1960s. As part of the procedure, [[artery|arteries]] or [[vein]]s from elsewhere in the [[patient]]'s body are [[medical grafting|grafted]] from the [[aorta]] to the [[coronary artery|coronary arteries]] to bypass [[atherosclerosis|atherosclerotic]] [[stenosis|narrowings]] and improve the [[blood]] supply to the [[coronary circulation]] supplying the [[myocardium]] ([[myocardium|heart muscle]]). This surgery is usually performed with the [[heart]] stopped, necessitating the usage of [[cardiopulmonary bypass]]. However, recent advances allow the procedure to be performed with the [[heart]] beating and through smaller [[incisions]]. Currently, about 500,000 [[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) are performed in the United States each year.

==Pathophysiology==
[[Coronary artery bypass surgery saphenous vein graft disease| Saphenous Vein Graft Disease]] | [[Coronary artery bypass surgery other non-atherosclerotic saphenous vein graft diseases|Other Non-Atherosclerotic Saphenous Vein Graft Diseases]]

==[[Coronary artery bypass surgery indications|Indications for CABG]]==
[[Coronary artery bypass surgery in patients with acute MI|CABG in Patients with Acute MI]] | [[Coronary artery bypass surgery in ventricular arrhythmias|CABG in Patients with Ventricular Arrhythmias]] | [[Coronary artery bypass surgery after failed PCI|Emergency CABG after Failed PCI]] | [[Coronary artery bypass surgery in association with other cardiac procedures|CABG in Association with Other Cardiac Procedures]] | [[Coronary artery bypass surgery heart team approach to revascularization decisions|Heart Team Approach to Revascularization Decisions]] | [[Coronary artery bypass surgery of left main CAD to improve survival|Revascularization of Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery of non–left main CAD to improve survival|Revascularization of Non-Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery revascularization to improve symptoms|Revascularization to Improve Symptoms]] | [[Coronary artery bypass surgery CABG in left ventricular dysfunction|CABG in Left Ventricular Dysfunction]]

==[[Coronary artery bypass surgery prognosis|Prognosis]]==

==Imaging in the patient undergoing CABG==
[[Coronary artery bypass surgery X-ray|Chest x-ray]] | [[Coronary artery bypass surgery angiography|Coronary Angiography]]
| [[Coronary artery bypass surgery CT angiography|CT Angiography]] | [[Coronary artery bypass surgery mri angiography|MRI Angiography]] | [[Coronary artery bypass surgery TEE|Trans-Esophageal Echocardiography]] | [[Coronary artery bypass surgery epiaortic ultrasound|Epiaortic Ultrasound]]

==[[Coronary artery bypass surgery goals of treatment|Goals of Treatment]]==

==[[Coronary artery bypass surgery perioperative management|Perioperative Management]]==
[[Coronary artery bypass surgery aspirin and clopidogrel|Aspirin and Clopidogrel]] | [[Coronary artery bypass surgery use of beta-blockers|Beta-Blockers]] | [[Coronary artery bypass surgery use of ACE Inhibitors/ARBs|ACE Inhibitors/ARBs]] | [[Coronary artery bypass surgery management of hyperlipidemia|Management of Hyperlipidemia]] | [[Coronary artery bypass surgery management of perioperative infection|Management of Mediastinitis/Perioperative Infection]] | [[Coronary artery bypass surgery percutaneous coronary intervention (PCI) to treat saphenous vein graft failure|Percutaneous Coronary Intervention (PCI) To Treat Saphenous Vein Graft Failure]] | [[Coronary artery bypass surgery postoperative antiplatelet therapy|Postoperative Antiplatelet Therapy]] | [[Coronary artery bypass surgery maintaining glucose level|Maintaining Glucose Level]] | [[Coronary artery bypass surgery bleeding/transfusion]] | [[Coronary artery bypass surgery management of dysrhythmias|Management of Dysrhythmias]] | [[Coronary artery bypass surgery smoking cessation|Smoking Cessation]] | [[Coronary artery bypass surgery perioperative management of myocardial dysfunction|Perioperative Management of Myocardial Dysfunction]] | [[Coronary artery bypass surgery perioperative carotid artery noninvasive screening|Perioperative Carotid Artery Noninvasive Screening]]

==[[Coronary artery bypass surgery perioperative monitoring|Perioperative and Intraoperative Monitoring]]==
[[Coronary artery bypass surgery electrocardiographic monitoring|Electrocardiographic Monitoring]] | [[Coronary artery bypass surgery pulmonary artery catheterization|Pulmonary Artery Catheterization]] | [[Coronary artery bypass surgery central nervous system monitoring|Central Nervous System Monitoring]]

==[[Coronary artery bypass surgery surgical procedure|Surgical Procedure]]==
[[Coronary artery bypass surgery anesthetic considerations|Anesthetic Considerations]] | [[Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified)| The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)]] | [[Coronary artery bypass surgery minimally invasive CABG| Minimally Invasive CABG]] | [[Coronary artery bypass surgery conduits used for bypass|Conduits Used for Bypass]] | [[Coronary artery bypass surgery videos on saphenous vein graft harvesting| Videos on Saphenous Vein-Graft Harvesting]] | [[Coronary artery bypass surgery videos on Coronary artery bypass surgery|Videos on Coronary Artery Bypass Surgery]] | [[Coronary artery bypass surgery cardiopulmonary bypass|Cardiopulmonary Bypass]]

==[[Coronary artery bypass surgery post-operative care and complications|Post-Operative Care and Complications]]==

==Special Scenarios==
[[Coronary artery bypass surgery in anomalous coronary arteries|Anomalous Coronary Arteries]] | [[Coronary artery bypass surgery in patients with COPD/respiratory insufficiency|Chronic Obstructive Pulmonary Disease/Respiratory Insufficiency]] | [[Coronary artery bypass surgery in patients with existing renal disease|Existing Renal Disease]] | [[Coronary artery bypass surgery in patients with valvular disease|Concomitant Valvular Disease]] | [[Coronary artery bypass surgery in patients with previous cardiac surgery|Previous Cardiac Surgery]] | [[Coronary artery bypass surgery in patients with menopause|Menopause]] | [[Coronary artery bypass surgery carotid disease evaluation before surgery|Carotid Disease Evaluation Before Surgery]]

==Related Chapters==

* [[CABG]]
* [[Hybrid bypass]]
* [[Off-pump coronary artery bypass surgery|Off-Pump Coronary Artery Bypass Surgery (OPCAB)]]
* [[Minimally invasive direct coronary artery bypass surgery]] ([[MIDCAB]])
* [[Cardiothoracic surgery]]
* [[Dressler's syndrome]]
* [[Hybrid bypass]]

==External Links==
*[http://www.texheartsurgeons.com/ Advances in Cardiovascular Surgery and Cardiothoracic Surgical Procedures]
*[http://www.ctsnet.org/residents/ctsn/ Cardiothoracic Surgery Notes] an online interactive review developed by residents in cardiothoracic surgery
*[http://www.enferpro.com/cirugia1.htm#DIRECCIONES Contenidos de Enfermería y Cirugía Cardiaca]
*[http://www.ctsnet.org/ CTSNet: The Cardiothoracic Surgery Network]
*[http://www.enferpro.com/cirugiacurso.htm Curso de Enfermería y Cirugía Cardiaca]
*[http://www.texheartsurgeons.com/AssistDvcs.htm Heart Assist Devices]
*[http://www1.cs.columbia.edu/robotics/projects/lvad/lvad_form.html LVAD Simulator]
*[http://perfline.com/index.htm Perfusion Line]
*[http://www.ctsnet.org/section/residents/ The CardioThoracic Surgery Network: Residents Section]
*[http://www.heartpioneers.com/ The Implantable Artificial Heart Project]
*[http://perfline.com/textbook/textbook.html The Virtual Textbook Of Extracorporeal Technology]
*[http://info.med.yale.edu/intmed/cardio/imaging/ Yale: Introduction to Cardiothoracic Imaging]

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

[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:mature chapter]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Overview complete]]
[[Category:Template complete]]

[[es:Bypass]]
[[fr:pontage aorto-coronarien]]
[[ja:冠動脈大動脈バイパス移植術]]
[[pl:CABG]]
[[pt:Cirurgia cardiovascular]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Coronary artery bypass surgery

2022-09-15T03:32:00Z

Anahita: /* Perioperative Monitoring */

'''For the WikiPatient page for this topic, click [[{{PAGENAME}} (patient information)|here]]'''
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[User: Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{Anahita}}; {{CZ}}; {{VK}} {{PTD}}

'''''Synonyms and keywords:''''' Coronary artery bypass grafting, and colloquially heart bypass, bypass, bypass surgery, open heart surgery, or CABG (pronounced like cabbage), aortocoronary bypass (ACB). The term Coronary Artery Graft Surgery (CAGS) is often used outside the United States and should not be confused with [[Coronary angiography|Coronary Angiography (CAG)]]. OPCAB refers to [[Off-pump coronary artery bypass]], a procedure during which the patient is not placed on extracorporeal circulation ("the pump").

==[[Coronary artery bypass surgery overview|Overview]]==
[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is a [[surgery|surgical]] [[coronary revascularization|revascularization]] procedure that is used to circumvent or bypass blockages in the [[Epicardium|epicardial]] [[coronary arteries]] associated with [[acute coronary syndromes]] (including [[ST elevation MI]], [[non ST elevation MI]], [[unstable angina]]) and [[stable angina]]. The technique was pioneered by Argentine [[cardiac surgeon]] [[René Favaloro]] at the [[Cleveland Clinic]] in the late 1960s. As part of the procedure, [[artery|arteries]] or [[vein]]s from elsewhere in the [[patient]]'s body are [[medical grafting|grafted]] from the [[aorta]] to the [[coronary artery|coronary arteries]] to bypass [[atherosclerosis|atherosclerotic]] [[stenosis|narrowings]] and improve the [[blood]] supply to the [[coronary circulation]] supplying the [[myocardium]] ([[myocardium|heart muscle]]). This surgery is usually performed with the [[heart]] stopped, necessitating the usage of [[cardiopulmonary bypass]]. However, recent advances allow the procedure to be performed with the [[heart]] beating and through smaller [[incisions]]. Currently, about 500,000 [[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) are performed in the United States each year.

==Pathophysiology==
[[Coronary artery bypass surgery saphenous vein graft disease| Saphenous Vein Graft Disease]] | [[Coronary artery bypass surgery other non-atherosclerotic saphenous vein graft diseases|Other Non-Atherosclerotic Saphenous Vein Graft Diseases]]

==[[Coronary artery bypass surgery indications|Indications for CABG]]==
[[Coronary artery bypass surgery in patients with acute MI|CABG in Patients with Acute MI]] | [[Coronary artery bypass surgery in ventricular arrhythmias|CABG in Patients with Ventricular Arrhythmias]] | [[Coronary artery bypass surgery after failed PCI|Emergency CABG after Failed PCI]] | [[Coronary artery bypass surgery in association with other cardiac procedures|CABG in Association with Other Cardiac Procedures]] | [[Coronary artery bypass surgery heart team approach to revascularization decisions|Heart Team Approach to Revascularization Decisions]] | [[Coronary artery bypass surgery of left main CAD to improve survival|Revascularization of Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery of non–left main CAD to improve survival|Revascularization of Non-Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery revascularization to improve symptoms|Revascularization to Improve Symptoms]] | [[Coronary artery bypass surgery CABG in left ventricular dysfunction|CABG in Left Ventricular Dysfunction]]

==[[Coronary artery bypass surgery prognosis|Prognosis]]==

==Imaging in the patient undergoing CABG==
[[Coronary artery bypass surgery X-ray|Chest x-ray]] | [[Coronary artery bypass surgery angiography|Coronary Angiography]]
| [[Coronary artery bypass surgery CT angiography|CT Angiography]] | [[Coronary artery bypass surgery mri angiography|MRI Angiography]] | [[Coronary artery bypass surgery TEE|Trans-Esophageal Echocardiography]] | [[Coronary artery bypass surgery epiaortic ultrasound|Epiaortic Ultrasound]]

==[[Coronary artery bypass surgery goals of treatment|Goals of Treatment]]==

==[[Coronary artery bypass surgery perioperative management|Perioperative Management]]==
[[Coronary artery bypass surgery aspirin and clopidogrel|Aspirin and Clopidogrel]] | [[Coronary artery bypass surgery use of beta-blockers|Beta-Blockers]] | [[Coronary artery bypass surgery use of ACE Inhibitors/ARBs|ACE Inhibitors/ARBs]] | [[Coronary artery bypass surgery management of hyperlipidemia|Management of Hyperlipidemia]] | [[Coronary artery bypass surgery management of perioperative infection|Management of Mediastinitis/Perioperative Infection]] | [[Coronary artery bypass surgery percutaneous coronary intervention (PCI) to treat saphenous vein graft failure|Percutaneous Coronary Intervention (PCI) To Treat Saphenous Vein Graft Failure]] | [[Coronary artery bypass surgery postoperative antiplatelet therapy|Postoperative Antiplatelet Therapy]] | [[Coronary artery bypass surgery maintaining glucose level|Maintaining Glucose Level]] | [[Coronary artery bypass surgery bleeding/transfusion]] | [[Coronary artery bypass surgery management of dysrhythmias|Management of Dysrhythmias]] | [[Coronary artery bypass surgery smoking cessation|Smoking Cessation]] | [[Coronary artery bypass surgery perioperative management of myocardial dysfunction|Perioperative Management of Myocardial Dysfunction]] | [[Coronary artery bypass surgery perioperative carotid artery noninvasive screening|Perioperative Carotid Artery Noninvasive Screening]]

==[[Coronary artery bypass surgery perioperative monitoring|Perioperative and Intraoperative Monitoring]]==
[[Coronary artery bypass surgery electrocardiographic monitoring|Electrocardiographic Monitoring]] | [[Coronary artery bypass surgery pulmonary artery catheterization|Pulmonary Artery Catheterization]] | [[Coronary artery bypass surgery central nervous system monitoring|Central Nervous System Monitoring]]

==[[Coronary artery bypass surgery surgical procedure|Surgical Procedure]]==
[[Coronary artery bypass surgery anesthetic considerations|Anesthetic Considerations]] | [[Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified)| The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)]] | [[Coronary artery bypass surgery minimally invasive CABG| Minimally Invasive CABG]] | [[Coronary artery bypass surgery conduits used for bypass|Conduits Used for Bypass]] | [[Coronary artery bypass surgery videos on spahenous vein graft harvesting| Videos on Saphenous Vein-Graft Harvesting]] | [[Coronary artery bypass surgery videos on Coronary artery bypass surgery|Videos on Coronary Artery Bypass Surgery]]

==[[Coronary artery bypass surgery post-operative care and complications|Post-Operative Care and Complications]]==

==Special Scenarios==
[[Coronary artery bypass surgery in anomalous coronary arteries|Anomalous Coronary Arteries]] | [[Coronary artery bypass surgery in patients with COPD/respiratory insufficiency|Chronic Obstructive Pulmonary Disease/Respiratory Insufficiency]] | [[Coronary artery bypass surgery in patients with existing renal disease|Existing Renal Disease]] | [[Coronary artery bypass surgery in patients with valvular disease|Concomitant Valvular Disease]] | [[Coronary artery bypass surgery in patients with previous cardiac surgery|Previous Cardiac Surgery]] | [[Coronary artery bypass surgery in patients with menopause|Menopause]] | [[Coronary artery bypass surgery carotid disease evaluation before surgery|Carotid Disease Evaluation Before Surgery]]

==Related Chapters==

* [[CABG]]
* [[Hybrid bypass]]
* [[Off-pump coronary artery bypass surgery|Off-Pump Coronary Artery Bypass Surgery (OPCAB)]]
* [[Minimally invasive direct coronary artery bypass surgery]] ([[MIDCAB]])
* [[Cardiothoracic surgery]]
* [[Dressler's syndrome]]
* [[Hybrid bypass]]

==External Links==
*[http://www.texheartsurgeons.com/ Advances in Cardiovascular Surgery and Cardiothoracic Surgical Procedures]
*[http://www.ctsnet.org/residents/ctsn/ Cardiothoracic Surgery Notes] an online interactive review developed by residents in cardiothoracic surgery
*[http://www.enferpro.com/cirugia1.htm#DIRECCIONES Contenidos de Enfermería y Cirugía Cardiaca]
*[http://www.ctsnet.org/ CTSNet: The Cardiothoracic Surgery Network]
*[http://www.enferpro.com/cirugiacurso.htm Curso de Enfermería y Cirugía Cardiaca]
*[http://www.texheartsurgeons.com/AssistDvcs.htm Heart Assist Devices]
*[http://www1.cs.columbia.edu/robotics/projects/lvad/lvad_form.html LVAD Simulator]
*[http://perfline.com/index.htm Perfusion Line]
*[http://www.ctsnet.org/section/residents/ The CardioThoracic Surgery Network: Residents Section]
*[http://www.heartpioneers.com/ The Implantable Artificial Heart Project]
*[http://perfline.com/textbook/textbook.html The Virtual Textbook Of Extracorporeal Technology]
*[http://info.med.yale.edu/intmed/cardio/imaging/ Yale: Introduction to Cardiothoracic Imaging]

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

[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:mature chapter]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Overview complete]]
[[Category:Template complete]]

[[es:Bypass]]
[[fr:pontage aorto-coronarien]]
[[ja:冠動脈大動脈バイパス移植術]]
[[pl:CABG]]
[[pt:Cirurgia cardiovascular]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Coronary artery bypass surgery epiaortic ultrasound

2022-09-15T03:26:51Z

Anahita:

__NOTOC__
{{xyz}}
{{CMG}}; {{AE}} {{Anahita}}
==Overview==
Since [[atherosclerotic disease]] of the [[aorta]] is a common finding in [[patients]] who undergo [[CABG]] [[surgery]], usage of [[ultrasonography|epiaortic ultrasonography]] is recommended for identifying [[aorta|aortic]] [[atherosclerosis]]. This imaging has been recognized as the [[Gold standard (test)|gold standard]] for identifying [[aorta|aortic]] [[atherosclerosis]] due to its superiority to either [[surgery|surgical]] digital [[palpation]] or [[transesophageal echocardiography]].
==Use of Epiaortic Ultrasound in Patients Undergoing CABG==
*The [[prevalence]] of [[atherosclerotic disease]] of the [[aorta]] ranges from 19% to 90% among [[patients]] who undergo [[CABG]] [[surgery]], based on the [[patient]] population and the [[examination]] modality.<ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446 }} </ref><ref name="pmid15653963">{{cite journal| author=Bolotin G, Domany Y, de Perini L, Frolkis I, Lev-Ran O, Nesher N | display-authors=etal| title=Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma. | journal=Chest | year= 2005 | volume= 127 | issue= 1 | pages= 60-5 | pmid=15653963 | doi=10.1378/chest.127.1.60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15653963 }} </ref><ref name="pmid18068056">{{cite journal| author=Suvarna S, Smith A, Stygall J, Kolvecar S, Walesby R, Harrison M | display-authors=etal| title=An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography. | journal=J Cardiothorac Vasc Anesth | year= 2007 | volume= 21 | issue= 6 | pages= 805-9 | pmid=18068056 | doi=10.1053/j.jvca.2007.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18068056 }} </ref><ref name="pmid9327309">{{cite journal| author=Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF | display-authors=etal| title=The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. | journal=J Cardiothorac Vasc Anesth | year= 1997 | volume= 11 | issue= 6 | pages= 704-7 | pmid=9327309 | doi=10.1016/s1053-0770(97)90161-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9327309 }} </ref><ref name="pmid12928635">{{cite journal| author=Hangler HB, Nagele G, Danzmayr M, Mueller L, Ruttmann E, Laufer G | display-authors=etal| title=Modification of surgical technique for ascending aortic atherosclerosis: impact on stroke reduction in coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 126 | issue= 2 | pages= 391-400 | pmid=12928635 | doi=10.1016/s0022-5223(03)00395-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12928635 }} </ref>
*A clear association has been reported between [[aorta|aortic]] [[atherosclerosis]] and [[stroke]], particularly among [[patients]] who are undergoing [[CABG]].<ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446 }} </ref><ref name="pmid10441102">{{cite journal| author=Hogue CW, Murphy SF, Schechtman KB, Dávila-Román VG| title=Risk factors for early or delayed stroke after cardiac surgery. | journal=Circulation | year= 1999 | volume= 100 | issue= 6 | pages= 642-7 | pmid=10441102 | doi=10.1161/01.cir.100.6.642 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10441102 }} </ref><ref name="pmid8948560">{{cite journal| author=Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R | display-authors=etal| title=Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 25 | pages= 1857-63 | pmid=8948560 | doi=10.1056/NEJM199612193352501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8948560 }} </ref><ref name="pmid15284448">{{cite journal| author=Djaiani G, Fedorko L, Borger M, Mikulis D, Carroll J, Cheng D | display-authors=etal| title=Mild to moderate atheromatous disease of the thoracic aorta and new ischemic brain lesions after conventional coronary artery bypass graft surgery. | journal=Stroke | year= 2004 | volume= 35 | issue= 9 | pages= e356-8 | pmid=15284448 | doi=10.1161/01.STR.0000138783.63858.62 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15284448 }} </ref><ref name="pmid16126401">{{cite journal| author=Schachner T, Zimmer A, Nagele G, Hangler H, Laufer G, Bonatti J| title=The influence of ascending aortic atherosclerosis on the long-term survival after CABG. | journal=Eur J Cardiothorac Surg | year= 2005 | volume= 28 | issue= 4 | pages= 558-62 | pmid=16126401 | doi=10.1016/j.ejcts.2005.07.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16126401 }} </ref>
*[[ultrasonography|Epiaortic ultrasonography]] is recognized as the [[Gold standard (test)|gold standard]] for identifying [[aorta|aortic]] [[atherosclerosis]] due to its superiority to either [[surgery|surgical]] digital [[palpation]] or [[transesophageal echocardiography]].<ref name="pmid15653963">{{cite journal| author=Bolotin G, Domany Y, de Perini L, Frolkis I, Lev-Ran O, Nesher N | display-authors=etal| title=Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma. | journal=Chest | year= 2005 | volume= 127 | issue= 1 | pages= 60-5 | pmid=15653963 | doi=10.1378/chest.127.1.60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15653963 }} </ref><ref name="pmid18068056">{{cite journal| author=Suvarna S, Smith A, Stygall J, Kolvecar S, Walesby R, Harrison M | display-authors=etal| title=An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography. | journal=J Cardiothorac Vasc Anesth | year= 2007 | volume= 21 | issue= 6 | pages= 805-9 | pmid=18068056 | doi=10.1053/j.jvca.2007.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18068056 }} </ref><ref name="pmid9327309">{{cite journal| author=Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF | display-authors=etal| title=The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. | journal=J Cardiothorac Vasc Anesth | year= 1997 | volume= 11 | issue= 6 | pages= 704-7 | pmid=9327309 | doi=10.1016/s1053-0770(97)90161-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9327309 }} </ref><ref name="pmid8837572">{{cite journal| author=Dávila-Román VG, Phillips KJ, Daily BB, Dávila RM, Kouchoukos NT, Barzilai B| title=Intraoperative transesophageal echocardiography and epiaortic ultrasound for assessment of atherosclerosis of the thoracic aorta. | journal=J Am Coll Cardiol | year= 1996 | volume= 28 | issue= 4 | pages= 942-7 | pmid=8837572 | doi=10.1016/s0735-1097(96)00263-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8837572 }} </ref><ref name="pmid9914464">{{cite journal| author=Royse C, Royse A, Blake D, Grigg L| title=Screening the thoracic aorta for atheroma: a comparison of manual palpation, transesophageal and epiaortic ultrasonography. | journal=Ann Thorac Cardiovasc Surg | year= 1998 | volume= 4 | issue= 6 | pages= 347-50 | pmid=9914464 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9914464 }} </ref><ref name="pmid18823455">{{cite journal| author=Van Zaane B, Zuithoff NP, Reitsma JB, Bax L, Nierich AP, Moons KG| title=Meta-analysis of the diagnostic accuracy of transesophageal echocardiography for assessment of atherosclerosis in the ascending aorta in patients undergoing cardiac surgery. | journal=Acta Anaesthesiol Scand | year= 2008 | volume= 52 | issue= 9 | pages= 1179-87 | pmid=18823455 | doi=10.1111/j.1399-6576.2008.01694.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18823455 }} </ref>
===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-NR<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid31421104">{{cite journal| author=Biancari F, Santini F, Tauriainen T, Bancone C, Ruggieri VG, Perrotti A | display-authors=etal| title=Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting. | journal=Ann Thorac Surg | year= 2020 | volume= 109 | issue= 1 | pages= 294-301 | pmid=31421104 | doi=10.1016/j.athoracsur.2019.06.078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31421104 }} </ref><ref name="pmid19471223">{{cite journal| author=Yamaguchi A, Adachi H, Tanaka M, Ino T| title=Efficacy of intraoperative epiaortic ultrasound scanning for preventing stroke after coronary artery bypass surgery. | journal=Ann Thorac Cardiovasc Surg | year= 2009 | volume= 15 | issue= 2 | pages= 98-104 | pmid=19471223 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19471223 }} </ref><ref name="pmid17670180">{{cite journal| author=Das S, Dunning J| title=Can epiaortic ultrasound reduce the incidence of intraoperative stroke during cardiac surgery? | journal=Interact Cardiovasc Thorac Surg | year= 2004 | volume= 3 | issue= 1 | pages= 71-5 | pmid=17670180 | doi=10.1016/S1569-9293(03)00220-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17670180 }} </ref><ref name="pmid18499587">{{cite journal| author=Djaiani G, Ali M, Borger MA, Woo A, Carroll J, Feindel C | display-authors=etal| title=Epiaortic scanning modifies planned intraoperative surgical management but not cerebral embolic load during coronary artery bypass surgery. | journal=Anesth Analg | year= 2008 | volume= 106 | issue= 6 | pages= 1611-8 | pmid=18499587 | doi=10.1213/ane.0b013e318172b044 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18499587 }} </ref><ref name="pmid15511435">{{cite journal| author=Gold JP, Torres KE, Maldarelli W, Zhuravlev I, Condit D, Wasnick J| title=Improving outcomes in coronary surgery: the impact of echo-directed aortic cannulation and perioperative hemodynamic management in 500 patients. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 5 | pages= 1579-85 | pmid=15511435 | doi=10.1016/j.athoracsur.2004.05.051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15511435 }} </ref><ref name="pmid23611913">{{cite journal| author=Joo HC, Youn YN, Kwak YL, Yi GJ, Yoo KJ| title=Intraoperative epiaortic scanning for preventing early stroke after off-pump coronary artery bypass. | journal=Br J Anaesth | year= 2013 | volume= 111 | issue= 3 | pages= 374-81 | pmid=23611913 | doi=10.1093/bja/aet113 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23611913 }} </ref><ref name="pmid22436990">{{cite journal| author=Lyons JM, Thourani VH, Puskas JD, Kilgo PD, Baio KT, Guyton RA | display-authors=etal| title=Intraoperative epiaortic ultrasound scanning guides operative strategies and identifies patients at high risk during coronary artery bypass grafting. | journal=Innovations (Phila) | year= 2009 | volume= 4 | issue= 2 | pages= 99-105 | pmid=22436990 | doi=10.1097/IMI.0b013e3181a3476f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22436990 }} </ref><ref name="pmid18222254">{{cite journal| author=Nakamura M, Okamoto F, Nakanishi K, Maruyama R, Yamada A, Ushikoshi S | display-authors=etal| title=Does intensive management of cerebral hemodynamics and atheromatous aorta reduce stroke after coronary artery surgery? | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 2 | pages= 513-9 | pmid=18222254 | doi=10.1016/j.athoracsur.2007.08.056 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222254 }} </ref><ref name="pmid18222262">{{cite journal| author=Rosenberger P, Shernan SK, Löffler M, Shekar PS, Fox JA, Tuli JK | display-authors=etal| title=The influence of epiaortic ultrasonography on intraoperative surgical management in 6051 cardiac surgical patients. | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 2 | pages= 548-53 | pmid=18222262 | doi=10.1016/j.athoracsur.2007.08.061 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222262 }} </ref><ref name="pmid16522368">{{cite journal| author=Zingone B, Rauber E, Gatti G, Pappalardo A, Benussi B, Dreas L | display-authors=etal| title=The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke. | journal=Eur J Cardiothorac Surg | year= 2006 | volume= 29 | issue= 5 | pages= 720-8 | pmid=16522368 | doi=10.1016/j.ejcts.2006.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16522368 }} </ref>
|-
| bgcolor="LightGreen"| The routine use of [[ultrasound|epiaortic ultrasound scanning]] is found to be helpful in identifying the presence, location, and severity of [[plaque]] in the [[ascending aorta]] to minimize the [[incidence]] of [[Atheroembolic disease|atheroembolic]] [[complications]] among [[patients]] who are undergoing [[CABG]].
|}

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

Coronary artery bypass surgery epiaortic ultrasound

2022-09-09T07:40:43Z

Anahita: /* Use of Epiaortic Ultrasound in Patients Undergoing CABG */

__NOTOC__
{{xyz}}
{{CMG}}; {{AE}} {{Anahita}}
==Overview==

==Use of Epiaortic Ultrasound in Patients Undergoing CABG==
*The [[prevalence]] of [[atherosclerotic disease]] of the [[aorta]] ranges from 19% to 90% among [[patients]] who undergo [[CABG]] [[surgery]], based on the [[patient]] population and the [[examination]] modality.<ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446 }} </ref><ref name="pmid15653963">{{cite journal| author=Bolotin G, Domany Y, de Perini L, Frolkis I, Lev-Ran O, Nesher N | display-authors=etal| title=Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma. | journal=Chest | year= 2005 | volume= 127 | issue= 1 | pages= 60-5 | pmid=15653963 | doi=10.1378/chest.127.1.60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15653963 }} </ref><ref name="pmid18068056">{{cite journal| author=Suvarna S, Smith A, Stygall J, Kolvecar S, Walesby R, Harrison M | display-authors=etal| title=An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography. | journal=J Cardiothorac Vasc Anesth | year= 2007 | volume= 21 | issue= 6 | pages= 805-9 | pmid=18068056 | doi=10.1053/j.jvca.2007.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18068056 }} </ref><ref name="pmid9327309">{{cite journal| author=Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF | display-authors=etal| title=The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. | journal=J Cardiothorac Vasc Anesth | year= 1997 | volume= 11 | issue= 6 | pages= 704-7 | pmid=9327309 | doi=10.1016/s1053-0770(97)90161-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9327309 }} </ref><ref name="pmid12928635">{{cite journal| author=Hangler HB, Nagele G, Danzmayr M, Mueller L, Ruttmann E, Laufer G | display-authors=etal| title=Modification of surgical technique for ascending aortic atherosclerosis: impact on stroke reduction in coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 126 | issue= 2 | pages= 391-400 | pmid=12928635 | doi=10.1016/s0022-5223(03)00395-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12928635 }} </ref>
*A clear association has been reported between [[aorta|aortic]] [[atherosclerosis]] and [[stroke]], particularly among [[patients]] who are undergoing [[CABG]].<ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446 }} </ref><ref name="pmid10441102">{{cite journal| author=Hogue CW, Murphy SF, Schechtman KB, Dávila-Román VG| title=Risk factors for early or delayed stroke after cardiac surgery. | journal=Circulation | year= 1999 | volume= 100 | issue= 6 | pages= 642-7 | pmid=10441102 | doi=10.1161/01.cir.100.6.642 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10441102 }} </ref><ref name="pmid8948560">{{cite journal| author=Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R | display-authors=etal| title=Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 25 | pages= 1857-63 | pmid=8948560 | doi=10.1056/NEJM199612193352501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8948560 }} </ref><ref name="pmid15284448">{{cite journal| author=Djaiani G, Fedorko L, Borger M, Mikulis D, Carroll J, Cheng D | display-authors=etal| title=Mild to moderate atheromatous disease of the thoracic aorta and new ischemic brain lesions after conventional coronary artery bypass graft surgery. | journal=Stroke | year= 2004 | volume= 35 | issue= 9 | pages= e356-8 | pmid=15284448 | doi=10.1161/01.STR.0000138783.63858.62 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15284448 }} </ref><ref name="pmid16126401">{{cite journal| author=Schachner T, Zimmer A, Nagele G, Hangler H, Laufer G, Bonatti J| title=The influence of ascending aortic atherosclerosis on the long-term survival after CABG. | journal=Eur J Cardiothorac Surg | year= 2005 | volume= 28 | issue= 4 | pages= 558-62 | pmid=16126401 | doi=10.1016/j.ejcts.2005.07.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16126401 }} </ref>
*[[ultrasonography|Epiaortic ultrasonography]] is recognized as the [[Gold standard (test)|gold standard]] for identifying [[aorta|aortic]] [[atherosclerosis]] due to its superiority to either [[surgery|surgical]] digital [[palpation]] or [[transesophageal echocardiography]].<ref name="pmid15653963">{{cite journal| author=Bolotin G, Domany Y, de Perini L, Frolkis I, Lev-Ran O, Nesher N | display-authors=etal| title=Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma. | journal=Chest | year= 2005 | volume= 127 | issue= 1 | pages= 60-5 | pmid=15653963 | doi=10.1378/chest.127.1.60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15653963 }} </ref><ref name="pmid18068056">{{cite journal| author=Suvarna S, Smith A, Stygall J, Kolvecar S, Walesby R, Harrison M | display-authors=etal| title=An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography. | journal=J Cardiothorac Vasc Anesth | year= 2007 | volume= 21 | issue= 6 | pages= 805-9 | pmid=18068056 | doi=10.1053/j.jvca.2007.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18068056 }} </ref><ref name="pmid9327309">{{cite journal| author=Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF | display-authors=etal| title=The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. | journal=J Cardiothorac Vasc Anesth | year= 1997 | volume= 11 | issue= 6 | pages= 704-7 | pmid=9327309 | doi=10.1016/s1053-0770(97)90161-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9327309 }} </ref><ref name="pmid8837572">{{cite journal| author=Dávila-Román VG, Phillips KJ, Daily BB, Dávila RM, Kouchoukos NT, Barzilai B| title=Intraoperative transesophageal echocardiography and epiaortic ultrasound for assessment of atherosclerosis of the thoracic aorta. | journal=J Am Coll Cardiol | year= 1996 | volume= 28 | issue= 4 | pages= 942-7 | pmid=8837572 | doi=10.1016/s0735-1097(96)00263-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8837572 }} </ref><ref name="pmid9914464">{{cite journal| author=Royse C, Royse A, Blake D, Grigg L| title=Screening the thoracic aorta for atheroma: a comparison of manual palpation, transesophageal and epiaortic ultrasonography. | journal=Ann Thorac Cardiovasc Surg | year= 1998 | volume= 4 | issue= 6 | pages= 347-50 | pmid=9914464 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9914464 }} </ref><ref name="pmid18823455">{{cite journal| author=Van Zaane B, Zuithoff NP, Reitsma JB, Bax L, Nierich AP, Moons KG| title=Meta-analysis of the diagnostic accuracy of transesophageal echocardiography for assessment of atherosclerosis in the ascending aorta in patients undergoing cardiac surgery. | journal=Acta Anaesthesiol Scand | year= 2008 | volume= 52 | issue= 9 | pages= 1179-87 | pmid=18823455 | doi=10.1111/j.1399-6576.2008.01694.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18823455 }} </ref>
===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-NR<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid31421104">{{cite journal| author=Biancari F, Santini F, Tauriainen T, Bancone C, Ruggieri VG, Perrotti A | display-authors=etal| title=Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting. | journal=Ann Thorac Surg | year= 2020 | volume= 109 | issue= 1 | pages= 294-301 | pmid=31421104 | doi=10.1016/j.athoracsur.2019.06.078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31421104 }} </ref><ref name="pmid19471223">{{cite journal| author=Yamaguchi A, Adachi H, Tanaka M, Ino T| title=Efficacy of intraoperative epiaortic ultrasound scanning for preventing stroke after coronary artery bypass surgery. | journal=Ann Thorac Cardiovasc Surg | year= 2009 | volume= 15 | issue= 2 | pages= 98-104 | pmid=19471223 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19471223 }} </ref><ref name="pmid17670180">{{cite journal| author=Das S, Dunning J| title=Can epiaortic ultrasound reduce the incidence of intraoperative stroke during cardiac surgery? | journal=Interact Cardiovasc Thorac Surg | year= 2004 | volume= 3 | issue= 1 | pages= 71-5 | pmid=17670180 | doi=10.1016/S1569-9293(03)00220-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17670180 }} </ref><ref name="pmid18499587">{{cite journal| author=Djaiani G, Ali M, Borger MA, Woo A, Carroll J, Feindel C | display-authors=etal| title=Epiaortic scanning modifies planned intraoperative surgical management but not cerebral embolic load during coronary artery bypass surgery. | journal=Anesth Analg | year= 2008 | volume= 106 | issue= 6 | pages= 1611-8 | pmid=18499587 | doi=10.1213/ane.0b013e318172b044 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18499587 }} </ref><ref name="pmid15511435">{{cite journal| author=Gold JP, Torres KE, Maldarelli W, Zhuravlev I, Condit D, Wasnick J| title=Improving outcomes in coronary surgery: the impact of echo-directed aortic cannulation and perioperative hemodynamic management in 500 patients. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 5 | pages= 1579-85 | pmid=15511435 | doi=10.1016/j.athoracsur.2004.05.051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15511435 }} </ref><ref name="pmid23611913">{{cite journal| author=Joo HC, Youn YN, Kwak YL, Yi GJ, Yoo KJ| title=Intraoperative epiaortic scanning for preventing early stroke after off-pump coronary artery bypass. | journal=Br J Anaesth | year= 2013 | volume= 111 | issue= 3 | pages= 374-81 | pmid=23611913 | doi=10.1093/bja/aet113 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23611913 }} </ref><ref name="pmid22436990">{{cite journal| author=Lyons JM, Thourani VH, Puskas JD, Kilgo PD, Baio KT, Guyton RA | display-authors=etal| title=Intraoperative epiaortic ultrasound scanning guides operative strategies and identifies patients at high risk during coronary artery bypass grafting. | journal=Innovations (Phila) | year= 2009 | volume= 4 | issue= 2 | pages= 99-105 | pmid=22436990 | doi=10.1097/IMI.0b013e3181a3476f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22436990 }} </ref><ref name="pmid18222254">{{cite journal| author=Nakamura M, Okamoto F, Nakanishi K, Maruyama R, Yamada A, Ushikoshi S | display-authors=etal| title=Does intensive management of cerebral hemodynamics and atheromatous aorta reduce stroke after coronary artery surgery? | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 2 | pages= 513-9 | pmid=18222254 | doi=10.1016/j.athoracsur.2007.08.056 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222254 }} </ref><ref name="pmid18222262">{{cite journal| author=Rosenberger P, Shernan SK, Löffler M, Shekar PS, Fox JA, Tuli JK | display-authors=etal| title=The influence of epiaortic ultrasonography on intraoperative surgical management in 6051 cardiac surgical patients. | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 2 | pages= 548-53 | pmid=18222262 | doi=10.1016/j.athoracsur.2007.08.061 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222262 }} </ref><ref name="pmid16522368">{{cite journal| author=Zingone B, Rauber E, Gatti G, Pappalardo A, Benussi B, Dreas L | display-authors=etal| title=The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke. | journal=Eur J Cardiothorac Surg | year= 2006 | volume= 29 | issue= 5 | pages= 720-8 | pmid=16522368 | doi=10.1016/j.ejcts.2006.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16522368 }} </ref>
|-
| bgcolor="LightGreen"| The routine use of [[ultrasound|epiaortic ultrasound scanning]] is found to be helpful in identifying the presence, location, and severity of [[plaque]] in the [[ascending aorta]] to minimize the [[incidence]] of [[Atheroembolic disease|atheroembolic]] [[complications]] among [[patients]] who are undergoing [[CABG]].
|}

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

Coronary artery bypass surgery epiaortic ultrasound

2022-09-09T07:33:33Z

Anahita: /* Use of Epiaortic Ultrasound in Patients Undergoing CABG */

__NOTOC__
{{xyz}}
{{CMG}}; {{AE}} {{Anahita}}
==Overview==

==Use of Epiaortic Ultrasound in Patients Undergoing CABG==
*The [[prevalence]] of [[atherosclerotic disease]] of the [[aorta]] ranges from 19% to 90% among [[patients]] who undergo [[CABG]] [[surgery]], based on the [[patient]] population and the [[examination]] modality.<ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446 }} </ref><ref name="pmid15653963">{{cite journal| author=Bolotin G, Domany Y, de Perini L, Frolkis I, Lev-Ran O, Nesher N | display-authors=etal| title=Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma. | journal=Chest | year= 2005 | volume= 127 | issue= 1 | pages= 60-5 | pmid=15653963 | doi=10.1378/chest.127.1.60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15653963 }} </ref><ref name="pmid18068056">{{cite journal| author=Suvarna S, Smith A, Stygall J, Kolvecar S, Walesby R, Harrison M | display-authors=etal| title=An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography. | journal=J Cardiothorac Vasc Anesth | year= 2007 | volume= 21 | issue= 6 | pages= 805-9 | pmid=18068056 | doi=10.1053/j.jvca.2007.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18068056 }} </ref><ref name="pmid9327309">{{cite journal| author=Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF | display-authors=etal| title=The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. | journal=J Cardiothorac Vasc Anesth | year= 1997 | volume= 11 | issue= 6 | pages= 704-7 | pmid=9327309 | doi=10.1016/s1053-0770(97)90161-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9327309 }} </ref><ref name="pmid12928635">{{cite journal| author=Hangler HB, Nagele G, Danzmayr M, Mueller L, Ruttmann E, Laufer G | display-authors=etal| title=Modification of surgical technique for ascending aortic atherosclerosis: impact on stroke reduction in coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 126 | issue= 2 | pages= 391-400 | pmid=12928635 | doi=10.1016/s0022-5223(03)00395-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12928635 }} </ref>
*A clear association has been reported between [[aorta|aortic]] [[atherosclerosis]] and [[stroke]], particularly among [[patients]] who are undergoing [[CABG]].<ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446 }} </ref><ref name="pmid10441102">{{cite journal| author=Hogue CW, Murphy SF, Schechtman KB, Dávila-Román VG| title=Risk factors for early or delayed stroke after cardiac surgery. | journal=Circulation | year= 1999 | volume= 100 | issue= 6 | pages= 642-7 | pmid=10441102 | doi=10.1161/01.cir.100.6.642 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10441102 }} </ref><ref name="pmid8948560">{{cite journal| author=Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R | display-authors=etal| title=Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 25 | pages= 1857-63 | pmid=8948560 | doi=10.1056/NEJM199612193352501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8948560 }} </ref><ref name="pmid15284448">{{cite journal| author=Djaiani G, Fedorko L, Borger M, Mikulis D, Carroll J, Cheng D | display-authors=etal| title=Mild to moderate atheromatous disease of the thoracic aorta and new ischemic brain lesions after conventional coronary artery bypass graft surgery. | journal=Stroke | year= 2004 | volume= 35 | issue= 9 | pages= e356-8 | pmid=15284448 | doi=10.1161/01.STR.0000138783.63858.62 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15284448 }} </ref><ref name="pmid16126401">{{cite journal| author=Schachner T, Zimmer A, Nagele G, Hangler H, Laufer G, Bonatti J| title=The influence of ascending aortic atherosclerosis on the long-term survival after CABG. | journal=Eur J Cardiothorac Surg | year= 2005 | volume= 28 | issue= 4 | pages= 558-62 | pmid=16126401 | doi=10.1016/j.ejcts.2005.07.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16126401 }} </ref>
===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-NR<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid31421104">{{cite journal| author=Biancari F, Santini F, Tauriainen T, Bancone C, Ruggieri VG, Perrotti A | display-authors=etal| title=Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting. | journal=Ann Thorac Surg | year= 2020 | volume= 109 | issue= 1 | pages= 294-301 | pmid=31421104 | doi=10.1016/j.athoracsur.2019.06.078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31421104 }} </ref><ref name="pmid19471223">{{cite journal| author=Yamaguchi A, Adachi H, Tanaka M, Ino T| title=Efficacy of intraoperative epiaortic ultrasound scanning for preventing stroke after coronary artery bypass surgery. | journal=Ann Thorac Cardiovasc Surg | year= 2009 | volume= 15 | issue= 2 | pages= 98-104 | pmid=19471223 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19471223 }} </ref><ref name="pmid17670180">{{cite journal| author=Das S, Dunning J| title=Can epiaortic ultrasound reduce the incidence of intraoperative stroke during cardiac surgery? | journal=Interact Cardiovasc Thorac Surg | year= 2004 | volume= 3 | issue= 1 | pages= 71-5 | pmid=17670180 | doi=10.1016/S1569-9293(03)00220-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17670180 }} </ref><ref name="pmid18499587">{{cite journal| author=Djaiani G, Ali M, Borger MA, Woo A, Carroll J, Feindel C | display-authors=etal| title=Epiaortic scanning modifies planned intraoperative surgical management but not cerebral embolic load during coronary artery bypass surgery. | journal=Anesth Analg | year= 2008 | volume= 106 | issue= 6 | pages= 1611-8 | pmid=18499587 | doi=10.1213/ane.0b013e318172b044 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18499587 }} </ref><ref name="pmid15511435">{{cite journal| author=Gold JP, Torres KE, Maldarelli W, Zhuravlev I, Condit D, Wasnick J| title=Improving outcomes in coronary surgery: the impact of echo-directed aortic cannulation and perioperative hemodynamic management in 500 patients. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 5 | pages= 1579-85 | pmid=15511435 | doi=10.1016/j.athoracsur.2004.05.051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15511435 }} </ref><ref name="pmid23611913">{{cite journal| author=Joo HC, Youn YN, Kwak YL, Yi GJ, Yoo KJ| title=Intraoperative epiaortic scanning for preventing early stroke after off-pump coronary artery bypass. | journal=Br J Anaesth | year= 2013 | volume= 111 | issue= 3 | pages= 374-81 | pmid=23611913 | doi=10.1093/bja/aet113 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23611913 }} </ref><ref name="pmid22436990">{{cite journal| author=Lyons JM, Thourani VH, Puskas JD, Kilgo PD, Baio KT, Guyton RA | display-authors=etal| title=Intraoperative epiaortic ultrasound scanning guides operative strategies and identifies patients at high risk during coronary artery bypass grafting. | journal=Innovations (Phila) | year= 2009 | volume= 4 | issue= 2 | pages= 99-105 | pmid=22436990 | doi=10.1097/IMI.0b013e3181a3476f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22436990 }} </ref><ref name="pmid18222254">{{cite journal| author=Nakamura M, Okamoto F, Nakanishi K, Maruyama R, Yamada A, Ushikoshi S | display-authors=etal| title=Does intensive management of cerebral hemodynamics and atheromatous aorta reduce stroke after coronary artery surgery? | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 2 | pages= 513-9 | pmid=18222254 | doi=10.1016/j.athoracsur.2007.08.056 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222254 }} </ref><ref name="pmid18222262">{{cite journal| author=Rosenberger P, Shernan SK, Löffler M, Shekar PS, Fox JA, Tuli JK | display-authors=etal| title=The influence of epiaortic ultrasonography on intraoperative surgical management in 6051 cardiac surgical patients. | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 2 | pages= 548-53 | pmid=18222262 | doi=10.1016/j.athoracsur.2007.08.061 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222262 }} </ref><ref name="pmid16522368">{{cite journal| author=Zingone B, Rauber E, Gatti G, Pappalardo A, Benussi B, Dreas L | display-authors=etal| title=The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke. | journal=Eur J Cardiothorac Surg | year= 2006 | volume= 29 | issue= 5 | pages= 720-8 | pmid=16522368 | doi=10.1016/j.ejcts.2006.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16522368 }} </ref>
|-
| bgcolor="LightGreen"| The routine use of [[ultrasound|epiaortic ultrasound scanning]] is found to be helpful in identifying the presence, location, and severity of [[plaque]] in the [[ascending aorta]] to minimize the [[incidence]] of [[Atheroembolic disease|atheroembolic]] [[complications]] among [[patients]] who are undergoing [[CABG]].
|}

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

Coronary artery bypass surgery epiaortic ultrasound

2022-09-09T07:32:52Z

Anahita: /* Use of Epiaortic Ultrasound in Patients Undergoing CABG */

__NOTOC__
{{xyz}}
{{CMG}}; {{AE}} {{Anahita}}
==Overview==

==Use of Epiaortic Ultrasound in Patients Undergoing CABG==
*The [[prevalence]] of [[atherosclerotic disease]] of the [[aorta]] ranges from 19% to 90% among [[patients]] who undergo [[CABG]] [[surgery]], based on the [[patient]] population and the [[examination]] modality.<ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446 }} </ref><ref name="pmid15653963">{{cite journal| author=Bolotin G, Domany Y, de Perini L, Frolkis I, Lev-Ran O, Nesher N | display-authors=etal| title=Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma. | journal=Chest | year= 2005 | volume= 127 | issue= 1 | pages= 60-5 | pmid=15653963 | doi=10.1378/chest.127.1.60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15653963 }} </ref><ref name="pmid18068056">{{cite journal| author=Suvarna S, Smith A, Stygall J, Kolvecar S, Walesby R, Harrison M | display-authors=etal| title=An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography. | journal=J Cardiothorac Vasc Anesth | year= 2007 | volume= 21 | issue= 6 | pages= 805-9 | pmid=18068056 | doi=10.1053/j.jvca.2007.05.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18068056 }} </ref><ref name="pmid9327309">{{cite journal| author=Sylivris S, Calafiore P, Matalanis G, Rosalion A, Yuen HP, Buxton BF | display-authors=etal| title=The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. | journal=J Cardiothorac Vasc Anesth | year= 1997 | volume= 11 | issue= 6 | pages= 704-7 | pmid=9327309 | doi=10.1016/s1053-0770(97)90161-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9327309 }} </ref><ref name="pmid12928635">{{cite journal| author=Hangler HB, Nagele G, Danzmayr M, Mueller L, Ruttmann E, Laufer G | display-authors=etal| title=Modification of surgical technique for ascending aortic atherosclerosis: impact on stroke reduction in coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 126 | issue= 2 | pages= 391-400 | pmid=12928635 | doi=10.1016/s0022-5223(03)00395-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12928635 }} </ref>
*A clear association has been reported between [[aorta|aortic]] [[atherosclerosis]] and [[stroke]], particularly among [[patients]] who are undergoing [[CABG]].<ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446 }} </ref><ref name="pmid8091446">{{cite journal| author=Dávila-Román VG, Barzilai B, Wareing TH, Murphy SF, Schechtman KB, Kouchoukos NT| title=Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. | journal=Stroke | year= 1994 | volume= 25 | issue= 10 | pages= 2010-6 | pmid=8091446 | doi=10.1161/01.str.25.10.2010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8091446 }} </ref><ref name="pmid10441102">{{cite journal| author=Hogue CW, Murphy SF, Schechtman KB, Dávila-Román VG| title=Risk factors for early or delayed stroke after cardiac surgery. | journal=Circulation | year= 1999 | volume= 100 | issue= 6 | pages= 642-7 | pmid=10441102 | doi=10.1161/01.cir.100.6.642 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10441102 }} </ref><ref name="pmid8948560">{{cite journal| author=Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R | display-authors=etal| title=Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 25 | pages= 1857-63 | pmid=8948560 | doi=10.1056/NEJM199612193352501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8948560 }} </ref><ref name="pmid15284448">{{cite journal| author=Djaiani G, Fedorko L, Borger M, Mikulis D, Carroll J, Cheng D | display-authors=etal| title=Mild to moderate atheromatous disease of the thoracic aorta and new ischemic brain lesions after conventional coronary artery bypass graft surgery. | journal=Stroke | year= 2004 | volume= 35 | issue= 9 | pages= e356-8 | pmid=15284448 | doi=10.1161/01.STR.0000138783.63858.62 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15284448 }} </ref><ref name="pmid16126401">{{cite journal| author=Schachner T, Zimmer A, Nagele G, Hangler H, Laufer G, Bonatti J| title=The influence of ascending aortic atherosclerosis on the long-term survival after CABG. | journal=Eur J Cardiothorac Surg | year= 2005 | volume= 28 | issue= 4 | pages= 558-62 | pmid=16126401 | doi=10.1016/j.ejcts.2005.07.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16126401 }} </ref>
===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-NR<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid31421104">{{cite journal| author=Biancari F, Santini F, Tauriainen T, Bancone C, Ruggieri VG, Perrotti A | display-authors=etal| title=Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting. | journal=Ann Thorac Surg | year= 2020 | volume= 109 | issue= 1 | pages= 294-301 | pmid=31421104 | doi=10.1016/j.athoracsur.2019.06.078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31421104 }} </ref><ref name="pmid19471223">{{cite journal| author=Yamaguchi A, Adachi H, Tanaka M, Ino T| title=Efficacy of intraoperative epiaortic ultrasound scanning for preventing stroke after coronary artery bypass surgery. | journal=Ann Thorac Cardiovasc Surg | year= 2009 | volume= 15 | issue= 2 | pages= 98-104 | pmid=19471223 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19471223 }} </ref><ref name="pmid17670180">{{cite journal| author=Das S, Dunning J| title=Can epiaortic ultrasound reduce the incidence of intraoperative stroke during cardiac surgery? | journal=Interact Cardiovasc Thorac Surg | year= 2004 | volume= 3 | issue= 1 | pages= 71-5 | pmid=17670180 | doi=10.1016/S1569-9293(03)00220-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17670180 }} </ref><ref name="pmid18499587">{{cite journal| author=Djaiani G, Ali M, Borger MA, Woo A, Carroll J, Feindel C | display-authors=etal| title=Epiaortic scanning modifies planned intraoperative surgical management but not cerebral embolic load during coronary artery bypass surgery. | journal=Anesth Analg | year= 2008 | volume= 106 | issue= 6 | pages= 1611-8 | pmid=18499587 | doi=10.1213/ane.0b013e318172b044 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18499587 }} </ref><ref name="pmid15511435">{{cite journal| author=Gold JP, Torres KE, Maldarelli W, Zhuravlev I, Condit D, Wasnick J| title=Improving outcomes in coronary surgery: the impact of echo-directed aortic cannulation and perioperative hemodynamic management in 500 patients. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 5 | pages= 1579-85 | pmid=15511435 | doi=10.1016/j.athoracsur.2004.05.051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15511435 }} </ref><ref name="pmid23611913">{{cite journal| author=Joo HC, Youn YN, Kwak YL, Yi GJ, Yoo KJ| title=Intraoperative epiaortic scanning for preventing early stroke after off-pump coronary artery bypass. | journal=Br J Anaesth | year= 2013 | volume= 111 | issue= 3 | pages= 374-81 | pmid=23611913 | doi=10.1093/bja/aet113 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23611913 }} </ref><ref name="pmid22436990">{{cite journal| author=Lyons JM, Thourani VH, Puskas JD, Kilgo PD, Baio KT, Guyton RA | display-authors=etal| title=Intraoperative epiaortic ultrasound scanning guides operative strategies and identifies patients at high risk during coronary artery bypass grafting. | journal=Innovations (Phila) | year= 2009 | volume= 4 | issue= 2 | pages= 99-105 | pmid=22436990 | doi=10.1097/IMI.0b013e3181a3476f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22436990 }} </ref><ref name="pmid18222254">{{cite journal| author=Nakamura M, Okamoto F, Nakanishi K, Maruyama R, Yamada A, Ushikoshi S | display-authors=etal| title=Does intensive management of cerebral hemodynamics and atheromatous aorta reduce stroke after coronary artery surgery? | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 2 | pages= 513-9 | pmid=18222254 | doi=10.1016/j.athoracsur.2007.08.056 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222254 }} </ref><ref name="pmid18222262">{{cite journal| author=Rosenberger P, Shernan SK, Löffler M, Shekar PS, Fox JA, Tuli JK | display-authors=etal| title=The influence of epiaortic ultrasonography on intraoperative surgical management in 6051 cardiac surgical patients. | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 2 | pages= 548-53 | pmid=18222262 | doi=10.1016/j.athoracsur.2007.08.061 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222262 }} </ref><ref name="pmid16522368">{{cite journal| author=Zingone B, Rauber E, Gatti G, Pappalardo A, Benussi B, Dreas L | display-authors=etal| title=The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke. | journal=Eur J Cardiothorac Surg | year= 2006 | volume= 29 | issue= 5 | pages= 720-8 | pmid=16522368 | doi=10.1016/j.ejcts.2006.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16522368 }} </ref>
|-
| bgcolor="LightGreen"| The routine use of [[ultrasound|epiaortic ultrasound scanning]] is found to be helpful in identifying the presence, location, and severity of [[plaque]] in the [[ascending aorta]] to minimize the [[incidence]] of [[Atheroembolic disease|atheroembolic]] [[complications]] among [[patients]] who are undergoing [[CABG]].
|}

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

Coronary artery bypass surgery epiaortic ultrasound

2022-09-09T07:20:18Z

Anahita:

__NOTOC__
{{xyz}}
{{CMG}}; {{AE}} {{Anahita}}
==Overview==

==Use of Epiaortic Ultrasound in Patients Undergoing CABG==

===2021 ACA Revascularization Guideline===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-NR<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid31421104">{{cite journal| author=Biancari F, Santini F, Tauriainen T, Bancone C, Ruggieri VG, Perrotti A | display-authors=etal| title=Epiaortic Ultrasound to Prevent Stroke in Coronary Artery Bypass Grafting. | journal=Ann Thorac Surg | year= 2020 | volume= 109 | issue= 1 | pages= 294-301 | pmid=31421104 | doi=10.1016/j.athoracsur.2019.06.078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31421104 }} </ref><ref name="pmid19471223">{{cite journal| author=Yamaguchi A, Adachi H, Tanaka M, Ino T| title=Efficacy of intraoperative epiaortic ultrasound scanning for preventing stroke after coronary artery bypass surgery. | journal=Ann Thorac Cardiovasc Surg | year= 2009 | volume= 15 | issue= 2 | pages= 98-104 | pmid=19471223 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19471223 }} </ref><ref name="pmid17670180">{{cite journal| author=Das S, Dunning J| title=Can epiaortic ultrasound reduce the incidence of intraoperative stroke during cardiac surgery? | journal=Interact Cardiovasc Thorac Surg | year= 2004 | volume= 3 | issue= 1 | pages= 71-5 | pmid=17670180 | doi=10.1016/S1569-9293(03)00220-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17670180 }} </ref><ref name="pmid18499587">{{cite journal| author=Djaiani G, Ali M, Borger MA, Woo A, Carroll J, Feindel C | display-authors=etal| title=Epiaortic scanning modifies planned intraoperative surgical management but not cerebral embolic load during coronary artery bypass surgery. | journal=Anesth Analg | year= 2008 | volume= 106 | issue= 6 | pages= 1611-8 | pmid=18499587 | doi=10.1213/ane.0b013e318172b044 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18499587 }} </ref><ref name="pmid15511435">{{cite journal| author=Gold JP, Torres KE, Maldarelli W, Zhuravlev I, Condit D, Wasnick J| title=Improving outcomes in coronary surgery: the impact of echo-directed aortic cannulation and perioperative hemodynamic management in 500 patients. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 5 | pages= 1579-85 | pmid=15511435 | doi=10.1016/j.athoracsur.2004.05.051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15511435 }} </ref><ref name="pmid23611913">{{cite journal| author=Joo HC, Youn YN, Kwak YL, Yi GJ, Yoo KJ| title=Intraoperative epiaortic scanning for preventing early stroke after off-pump coronary artery bypass. | journal=Br J Anaesth | year= 2013 | volume= 111 | issue= 3 | pages= 374-81 | pmid=23611913 | doi=10.1093/bja/aet113 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23611913 }} </ref><ref name="pmid22436990">{{cite journal| author=Lyons JM, Thourani VH, Puskas JD, Kilgo PD, Baio KT, Guyton RA | display-authors=etal| title=Intraoperative epiaortic ultrasound scanning guides operative strategies and identifies patients at high risk during coronary artery bypass grafting. | journal=Innovations (Phila) | year= 2009 | volume= 4 | issue= 2 | pages= 99-105 | pmid=22436990 | doi=10.1097/IMI.0b013e3181a3476f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22436990 }} </ref><ref name="pmid18222254">{{cite journal| author=Nakamura M, Okamoto F, Nakanishi K, Maruyama R, Yamada A, Ushikoshi S | display-authors=etal| title=Does intensive management of cerebral hemodynamics and atheromatous aorta reduce stroke after coronary artery surgery? | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 2 | pages= 513-9 | pmid=18222254 | doi=10.1016/j.athoracsur.2007.08.056 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222254 }} </ref><ref name="pmid18222262">{{cite journal| author=Rosenberger P, Shernan SK, Löffler M, Shekar PS, Fox JA, Tuli JK | display-authors=etal| title=The influence of epiaortic ultrasonography on intraoperative surgical management in 6051 cardiac surgical patients. | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 2 | pages= 548-53 | pmid=18222262 | doi=10.1016/j.athoracsur.2007.08.061 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222262 }} </ref><ref name="pmid16522368">{{cite journal| author=Zingone B, Rauber E, Gatti G, Pappalardo A, Benussi B, Dreas L | display-authors=etal| title=The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke. | journal=Eur J Cardiothorac Surg | year= 2006 | volume= 29 | issue= 5 | pages= 720-8 | pmid=16522368 | doi=10.1016/j.ejcts.2006.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16522368 }} </ref>
|-
| bgcolor="LightGreen"| The routine use of [[ultrasound|epiaortic ultrasound scanning]] is found to be helpful in identifying the presence, location, and severity of [[plaque]] in the [[ascending aorta]] to minimize the [[incidence]] of [[Atheroembolic disease|atheroembolic]] [[complications]] among [[patients]] who are undergoing [[CABG]].
|}

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

Coronary artery bypass surgery epiaortic ultrasound

2022-09-09T07:19:32Z

Anahita:

Coronary artery bypass surgery epiaortic ultrasound

2022-09-09T07:19:01Z

Anahita: Created page with "__NOTOC__ {{xyz}} {{CMG}}; {{AE}} {{Anahita}} ==Overview== ==Use of Epiaortic Ultrasound in Patients Undergoing CABG== ===2021 ACA Revascularization Guideline=== {|class="wikitable" |- | colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-NR<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/A..."

Coronary artery bypass surgery

2022-09-09T07:07:40Z

Anahita: /* Imaging in the patient undergoing CABG */

'''For the WikiPatient page for this topic, click [[{{PAGENAME}} (patient information)|here]]'''
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[User: Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{Anahita}}; {{CZ}}; {{VK}} {{PTD}}

'''''Synonyms and keywords:''''' Coronary artery bypass grafting, and colloquially heart bypass, bypass, bypass surgery, open heart surgery, or CABG (pronounced like cabbage), aortocoronary bypass (ACB). The term Coronary Artery Graft Surgery (CAGS) is often used outside the United States and should not be confused with [[Coronary angiography|Coronary Angiography (CAG)]]. OPCAB refers to [[Off-pump coronary artery bypass]], a procedure during which the patient is not placed on extracorporeal circulation ("the pump").

==[[Coronary artery bypass surgery overview|Overview]]==
[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is a [[surgery|surgical]] [[coronary revascularization|revascularization]] procedure that is used to circumvent or bypass blockages in the [[Epicardium|epicardial]] [[coronary arteries]] associated with [[acute coronary syndromes]] (including [[ST elevation MI]], [[non ST elevation MI]], [[unstable angina]]) and [[stable angina]]. The technique was pioneered by Argentine [[cardiac surgeon]] [[René Favaloro]] at the [[Cleveland Clinic]] in the late 1960s. As part of the procedure, [[artery|arteries]] or [[vein]]s from elsewhere in the [[patient]]'s body are [[medical grafting|grafted]] from the [[aorta]] to the [[coronary artery|coronary arteries]] to bypass [[atherosclerosis|atherosclerotic]] [[stenosis|narrowings]] and improve the [[blood]] supply to the [[coronary circulation]] supplying the [[myocardium]] ([[myocardium|heart muscle]]). This surgery is usually performed with the [[heart]] stopped, necessitating the usage of [[cardiopulmonary bypass]]. However, recent advances allow the procedure to be performed with the [[heart]] beating and through smaller [[incisions]]. Currently, about 500,000 [[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) are performed in the United States each year.

==Pathophysiology==
[[Coronary artery bypass surgery saphenous vein graft disease| Saphenous Vein Graft Disease]] | [[Coronary artery bypass surgery other non-atherosclerotic saphenous vein graft diseases|Other Non-Atherosclerotic Saphenous Vein Graft Diseases]]

==[[Coronary artery bypass surgery indications|Indications for CABG]]==
[[Coronary artery bypass surgery in patients with acute MI|CABG in Patients with Acute MI]] | [[Coronary artery bypass surgery in ventricular arrhythmias|CABG in Patients with Ventricular Arrhythmias]] | [[Coronary artery bypass surgery after failed PCI|Emergency CABG after Failed PCI]] | [[Coronary artery bypass surgery in association with other cardiac procedures|CABG in Association with Other Cardiac Procedures]] | [[Coronary artery bypass surgery heart team approach to revascularization decisions|Heart Team Approach to Revascularization Decisions]] | [[Coronary artery bypass surgery of left main CAD to improve survival|Revascularization of Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery of non–left main CAD to improve survival|Revascularization of Non-Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery revascularization to improve symptoms|Revascularization to Improve Symptoms]] | [[Coronary artery bypass surgery CABG in left ventricular dysfunction|CABG in Left Ventricular Dysfunction]]

==[[Coronary artery bypass surgery prognosis|Prognosis]]==

==Imaging in the patient undergoing CABG==
[[Coronary artery bypass surgery X-ray|Chest x-ray]] | [[Coronary artery bypass surgery angiography|Coronary Angiography]]
| [[Coronary artery bypass surgery CT angiography|CT Angiography]] | [[Coronary artery bypass surgery mri angiography|MRI Angiography]] | [[Coronary artery bypass surgery TEE|Trans-Esophageal Echocardiography]] | [[Coronary artery bypass surgery epiaortic ultrasound|Epiaortic Ultrasound]]

==[[Coronary artery bypass surgery goals of treatment|Goals of Treatment]]==

==[[Coronary artery bypass surgery perioperative management|Perioperative Management]]==
[[Coronary artery bypass surgery aspirin and clopidogrel|Aspirin and Clopidogrel]] | [[Coronary artery bypass surgery use of beta-blockers|Beta-Blockers]] | [[Coronary artery bypass surgery use of ACE Inhibitors/ARBs|ACE Inhibitors/ARBs]] | [[Coronary artery bypass surgery management of hyperlipidemia|Management of Hyperlipidemia]] | [[Coronary artery bypass surgery management of perioperative infection|Management of Mediastinitis/Perioperative Infection]] | [[Coronary artery bypass surgery percutaneous coronary intervention (PCI) to treat saphenous vein graft failure|Percutaneous Coronary Intervention (PCI) To Treat Saphenous Vein Graft Failure]] | [[Coronary artery bypass surgery postoperative antiplatelet therapy|Postoperative Antiplatelet Therapy]] | [[Coronary artery bypass surgery maintaining glucose level|Maintaining Glucose Level]] | [[Coronary artery bypass surgery bleeding/transfusion]] | [[Coronary artery bypass surgery management of dysrhythmias|Management of Dysrhythmias]] | [[Coronary artery bypass surgery smoking cessation|Smoking Cessation]] | [[Coronary artery bypass surgery perioperative management of myocardial dysfunction|Perioperative Management of Myocardial Dysfunction]] | [[Coronary artery bypass surgery perioperative carotid artery noninvasive screening|Perioperative Carotid Artery Noninvasive Screening]]

==[[Coronary artery bypass surgery perioperative monitoring|Perioperative Monitoring]]==
[[Coronary artery bypass surgery electrocardiographic monitoring|Electrocardiographic Monitoring]] | [[Coronary artery bypass surgery pulmonary artery catheterization|Pulmonary Artery Catheterization]] | [[Coronary artery bypass surgery central nervous system monitoring|Central Nervous System Monitoring]]

==[[Coronary artery bypass surgery surgical procedure|Surgical Procedure]]==
[[Coronary artery bypass surgery anesthetic considerations|Anesthetic Considerations]] | [[Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified)| The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)]] | [[Coronary artery bypass surgery minimally invasive CABG| Minimally Invasive CABG]] | [[Coronary artery bypass surgery conduits used for bypass|Conduits Used for Bypass]] | [[Coronary artery bypass surgery videos on spahenous vein graft harvesting| Videos on Saphenous Vein-Graft Harvesting]] | [[Coronary artery bypass surgery videos on Coronary artery bypass surgery|Videos on Coronary Artery Bypass Surgery]]

==[[Coronary artery bypass surgery post-operative care and complications|Post-Operative Care and Complications]]==

==Special Scenarios==
[[Coronary artery bypass surgery in anomalous coronary arteries|Anomalous Coronary Arteries]] | [[Coronary artery bypass surgery in patients with COPD/respiratory insufficiency|Chronic Obstructive Pulmonary Disease/Respiratory Insufficiency]] | [[Coronary artery bypass surgery in patients with existing renal disease|Existing Renal Disease]] | [[Coronary artery bypass surgery in patients with valvular disease|Concomitant Valvular Disease]] | [[Coronary artery bypass surgery in patients with previous cardiac surgery|Previous Cardiac Surgery]] | [[Coronary artery bypass surgery in patients with menopause|Menopause]] | [[Coronary artery bypass surgery carotid disease evaluation before surgery|Carotid Disease Evaluation Before Surgery]]

==Related Chapters==

* [[CABG]]
* [[Hybrid bypass]]
* [[Off-pump coronary artery bypass surgery|Off-Pump Coronary Artery Bypass Surgery (OPCAB)]]
* [[Minimally invasive direct coronary artery bypass surgery]] ([[MIDCAB]])
* [[Cardiothoracic surgery]]
* [[Dressler's syndrome]]
* [[Hybrid bypass]]

==External Links==
*[http://www.texheartsurgeons.com/ Advances in Cardiovascular Surgery and Cardiothoracic Surgical Procedures]
*[http://www.ctsnet.org/residents/ctsn/ Cardiothoracic Surgery Notes] an online interactive review developed by residents in cardiothoracic surgery
*[http://www.enferpro.com/cirugia1.htm#DIRECCIONES Contenidos de Enfermería y Cirugía Cardiaca]
*[http://www.ctsnet.org/ CTSNet: The Cardiothoracic Surgery Network]
*[http://www.enferpro.com/cirugiacurso.htm Curso de Enfermería y Cirugía Cardiaca]
*[http://www.texheartsurgeons.com/AssistDvcs.htm Heart Assist Devices]
*[http://www1.cs.columbia.edu/robotics/projects/lvad/lvad_form.html LVAD Simulator]
*[http://perfline.com/index.htm Perfusion Line]
*[http://www.ctsnet.org/section/residents/ The CardioThoracic Surgery Network: Residents Section]
*[http://www.heartpioneers.com/ The Implantable Artificial Heart Project]
*[http://perfline.com/textbook/textbook.html The Virtual Textbook Of Extracorporeal Technology]
*[http://info.med.yale.edu/intmed/cardio/imaging/ Yale: Introduction to Cardiothoracic Imaging]

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

[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:mature chapter]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Overview complete]]
[[Category:Template complete]]

[[es:Bypass]]
[[fr:pontage aorto-coronarien]]
[[ja:冠動脈大動脈バイパス移植術]]
[[pl:CABG]]
[[pt:Cirurgia cardiovascular]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Coronary artery bypass surgery in association with other cardiac procedures

2022-09-09T07:05:26Z

Anahita:

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{VK}} {{Anahita}}
==Overview==
Multiple factors should be considered when planning to add [[CABG]] to another planned [[cardiac surgery]] in [[patients]] with significant [[coronary heart disease]]. The presence of any [[comorbidities]], availability of a conduit, and [[left ventricular ejection fraction]] are some of the factors that must be evaluated before making a decision. According to numerous studies, similar long-term survival and [[Quality of life|health-related quality of life]] have been observed in [[patients]] who underwent [[aortic valve replacement]] with concomitant [[CABG]] compared to those without [[coronary heart disease]].
==Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures==
*Multiple factors should be considered when planning to add [[CABG]] to another planned [[cardiac surgery]] in [[patients]] with significant [[coronary heart disease]]. Considerations include but are not limited to the following factors:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Comorbidities]]
**Technical feasibility of [[CABG]]
**Extent of the affected myocardium
**Conduit availability
**[[Left ventricular ejection fraction]]
**The additional time required to construct the [[Coronary artery bypass surgery|coronary bypass]] while the patient is on [[cardiopulmonary bypass]]
*Studies that were done on [[patients]] between the [[Ageing|ages of 75 and 84 years]] show that [[Ageing|age]] is not a prohibitive [[risk factor]] for adding [[CABG]] to other [[cardiac surgeries]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref> Although risk increases in [[patients]] older than 85 years of age.<ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
*Numerous [[observational studies]] and [[meta-analyses]] demonstrated similar long-term survival and [[Quality of life|health-related quality of life]] in [[patients]] who underwent [[aortic valve replacement]] with concomitant [[CABG]] compared to those without [[coronary heart disease]].<ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref> However, concomitant [[CABG]] is associated to a higher rate of [[surgery|perioperative]] [[morbidity]] and [[mortality rate|mortality]] in comparison to isolated [[aortic valve replacement]].<ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid24290746">{{cite journal| author=Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V | display-authors=etal| title=Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. | journal=J Cardiothorac Vasc Anesth | year= 2014 | volume= 28 | issue= 5 | pages= 1251-6 | pmid=24290746 | doi=10.1053/j.jvca.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24290746 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref>
===2021 ACA Revascularization Guideline<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 1 Recommendation, Level of Evidence:C-LD]]
|-
| bgcolor="LightGreen"|In a [[patient]] with significant [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] is recommended with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid24290746">{{cite journal| author=Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V | display-authors=etal| title=Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. | journal=J Cardiothorac Vasc Anesth | year= 2014 | volume= 28 | issue= 5 | pages= 1251-6 | pmid=24290746 | doi=10.1053/j.jvca.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24290746 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref><ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid27237968">{{cite journal| author=Yamanaka K, Komiya T, Tsuneyoshi H, Shimamoto T| title=Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting. | journal=Ann Thorac Cardiovasc Surg | year= 2016 | volume= 22 | issue= 4 | pages= 251-7 | pmid=27237968 | doi=10.5761/atcs.oa.16-00056 | pmc=5045853 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27237968 }} </ref>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 2b Recommendation, Level of Evidence:C-LD]]
|-
|bgcolor="LemonChiffon"|In a [[patient]] with intermediate [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] may be reasonable with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
|}
===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] is recommended in patients undergoing noncoronary [[cardiac surgery]] with greater than or equal to 50% luminal diameter narrowing of the [[left main coronary artery]] or greater than or equal to 70% luminal diameter narrowing of other major coronary arteries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of the [[LIMA]] is reasonable to bypass a significantly narrowed LAD artery in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' CABG of moderately diseased coronary arteries (>50% luminal diameter narrowing) is reasonable in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery

2022-09-05T20:23:29Z

Anahita:

'''For the WikiPatient page for this topic, click [[{{PAGENAME}} (patient information)|here]]'''
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[User: Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{Anahita}}; {{CZ}}; {{VK}} {{PTD}}

'''''Synonyms and keywords:''''' Coronary artery bypass grafting, and colloquially heart bypass, bypass, bypass surgery, open heart surgery, or CABG (pronounced like cabbage), aortocoronary bypass (ACB). The term Coronary Artery Graft Surgery (CAGS) is often used outside the United States and should not be confused with [[Coronary angiography|Coronary Angiography (CAG)]]. OPCAB refers to [[Off-pump coronary artery bypass]], a procedure during which the patient is not placed on extracorporeal circulation ("the pump").

==[[Coronary artery bypass surgery overview|Overview]]==
[[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) is a [[surgery|surgical]] [[coronary revascularization|revascularization]] procedure that is used to circumvent or bypass blockages in the [[Epicardium|epicardial]] [[coronary arteries]] associated with [[acute coronary syndromes]] (including [[ST elevation MI]], [[non ST elevation MI]], [[unstable angina]]) and [[stable angina]]. The technique was pioneered by Argentine [[cardiac surgeon]] [[René Favaloro]] at the [[Cleveland Clinic]] in the late 1960s. As part of the procedure, [[artery|arteries]] or [[vein]]s from elsewhere in the [[patient]]'s body are [[medical grafting|grafted]] from the [[aorta]] to the [[coronary artery|coronary arteries]] to bypass [[atherosclerosis|atherosclerotic]] [[stenosis|narrowings]] and improve the [[blood]] supply to the [[coronary circulation]] supplying the [[myocardium]] ([[myocardium|heart muscle]]). This surgery is usually performed with the [[heart]] stopped, necessitating the usage of [[cardiopulmonary bypass]]. However, recent advances allow the procedure to be performed with the [[heart]] beating and through smaller [[incisions]]. Currently, about 500,000 [[Coronary artery bypass surgery]] ([[Coronary artery bypass surgery|CABG]]) are performed in the United States each year.

==Pathophysiology==
[[Coronary artery bypass surgery saphenous vein graft disease| Saphenous Vein Graft Disease]] | [[Coronary artery bypass surgery other non-atherosclerotic saphenous vein graft diseases|Other Non-Atherosclerotic Saphenous Vein Graft Diseases]]

==[[Coronary artery bypass surgery indications|Indications for CABG]]==
[[Coronary artery bypass surgery in patients with acute MI|CABG in Patients with Acute MI]] | [[Coronary artery bypass surgery in ventricular arrhythmias|CABG in Patients with Ventricular Arrhythmias]] | [[Coronary artery bypass surgery after failed PCI|Emergency CABG after Failed PCI]] | [[Coronary artery bypass surgery in association with other cardiac procedures|CABG in Association with Other Cardiac Procedures]] | [[Coronary artery bypass surgery heart team approach to revascularization decisions|Heart Team Approach to Revascularization Decisions]] | [[Coronary artery bypass surgery of left main CAD to improve survival|Revascularization of Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery of non–left main CAD to improve survival|Revascularization of Non-Left Main CAD to Improve Survival]] | [[Coronary artery bypass surgery revascularization to improve symptoms|Revascularization to Improve Symptoms]] | [[Coronary artery bypass surgery CABG in left ventricular dysfunction|CABG in Left Ventricular Dysfunction]]

==[[Coronary artery bypass surgery prognosis|Prognosis]]==

==Imaging in the patient undergoing CABG==
[[Coronary artery bypass surgery X-ray|Chest x-ray]] | [[Coronary artery bypass surgery angiography|Coronary Angiography]]
| [[Coronary artery bypass surgery CT angiography|CT Angiography]] | [[Coronary artery bypass surgery mri angiography|MRI Angiography]] | [[Coronary artery bypass surgery TEE|Trans-Esophageal Echocardiography]]

==[[Coronary artery bypass surgery goals of treatment|Goals of Treatment]]==

==[[Coronary artery bypass surgery perioperative management|Perioperative Management]]==
[[Coronary artery bypass surgery aspirin and clopidogrel|Aspirin and Clopidogrel]] | [[Coronary artery bypass surgery use of beta-blockers|Beta-Blockers]] | [[Coronary artery bypass surgery use of ACE Inhibitors/ARBs|ACE Inhibitors/ARBs]] | [[Coronary artery bypass surgery management of hyperlipidemia|Management of Hyperlipidemia]] | [[Coronary artery bypass surgery management of perioperative infection|Management of Mediastinitis/Perioperative Infection]] | [[Coronary artery bypass surgery percutaneous coronary intervention (PCI) to treat saphenous vein graft failure|Percutaneous Coronary Intervention (PCI) To Treat Saphenous Vein Graft Failure]] | [[Coronary artery bypass surgery postoperative antiplatelet therapy|Postoperative Antiplatelet Therapy]] | [[Coronary artery bypass surgery maintaining glucose level|Maintaining Glucose Level]] | [[Coronary artery bypass surgery bleeding/transfusion]] | [[Coronary artery bypass surgery management of dysrhythmias|Management of Dysrhythmias]] | [[Coronary artery bypass surgery smoking cessation|Smoking Cessation]] | [[Coronary artery bypass surgery perioperative management of myocardial dysfunction|Perioperative Management of Myocardial Dysfunction]] | [[Coronary artery bypass surgery perioperative carotid artery noninvasive screening|Perioperative Carotid Artery Noninvasive Screening]]

==[[Coronary artery bypass surgery perioperative monitoring|Perioperative Monitoring]]==
[[Coronary artery bypass surgery electrocardiographic monitoring|Electrocardiographic Monitoring]] | [[Coronary artery bypass surgery pulmonary artery catheterization|Pulmonary Artery Catheterization]] | [[Coronary artery bypass surgery central nervous system monitoring|Central Nervous System Monitoring]]

==[[Coronary artery bypass surgery surgical procedure|Surgical Procedure]]==
[[Coronary artery bypass surgery anesthetic considerations|Anesthetic Considerations]] | [[Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified)| The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)]] | [[Coronary artery bypass surgery minimally invasive CABG| Minimally Invasive CABG]] | [[Coronary artery bypass surgery conduits used for bypass|Conduits Used for Bypass]] | [[Coronary artery bypass surgery videos on spahenous vein graft harvesting| Videos on Saphenous Vein-Graft Harvesting]] | [[Coronary artery bypass surgery videos on Coronary artery bypass surgery|Videos on Coronary Artery Bypass Surgery]]

==[[Coronary artery bypass surgery post-operative care and complications|Post-Operative Care and Complications]]==

==Special Scenarios==
[[Coronary artery bypass surgery in anomalous coronary arteries|Anomalous Coronary Arteries]] | [[Coronary artery bypass surgery in patients with COPD/respiratory insufficiency|Chronic Obstructive Pulmonary Disease/Respiratory Insufficiency]] | [[Coronary artery bypass surgery in patients with existing renal disease|Existing Renal Disease]] | [[Coronary artery bypass surgery in patients with valvular disease|Concomitant Valvular Disease]] | [[Coronary artery bypass surgery in patients with previous cardiac surgery|Previous Cardiac Surgery]] | [[Coronary artery bypass surgery in patients with menopause|Menopause]] | [[Coronary artery bypass surgery carotid disease evaluation before surgery|Carotid Disease Evaluation Before Surgery]]

==Related Chapters==

* [[CABG]]
* [[Hybrid bypass]]
* [[Off-pump coronary artery bypass surgery|Off-Pump Coronary Artery Bypass Surgery (OPCAB)]]
* [[Minimally invasive direct coronary artery bypass surgery]] ([[MIDCAB]])
* [[Cardiothoracic surgery]]
* [[Dressler's syndrome]]
* [[Hybrid bypass]]

==External Links==
*[http://www.texheartsurgeons.com/ Advances in Cardiovascular Surgery and Cardiothoracic Surgical Procedures]
*[http://www.ctsnet.org/residents/ctsn/ Cardiothoracic Surgery Notes] an online interactive review developed by residents in cardiothoracic surgery
*[http://www.enferpro.com/cirugia1.htm#DIRECCIONES Contenidos de Enfermería y Cirugía Cardiaca]
*[http://www.ctsnet.org/ CTSNet: The Cardiothoracic Surgery Network]
*[http://www.enferpro.com/cirugiacurso.htm Curso de Enfermería y Cirugía Cardiaca]
*[http://www.texheartsurgeons.com/AssistDvcs.htm Heart Assist Devices]
*[http://www1.cs.columbia.edu/robotics/projects/lvad/lvad_form.html LVAD Simulator]
*[http://perfline.com/index.htm Perfusion Line]
*[http://www.ctsnet.org/section/residents/ The CardioThoracic Surgery Network: Residents Section]
*[http://www.heartpioneers.com/ The Implantable Artificial Heart Project]
*[http://perfline.com/textbook/textbook.html The Virtual Textbook Of Extracorporeal Technology]
*[http://info.med.yale.edu/intmed/cardio/imaging/ Yale: Introduction to Cardiothoracic Imaging]

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

[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:mature chapter]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Overview complete]]
[[Category:Template complete]]

[[es:Bypass]]
[[fr:pontage aorto-coronarien]]
[[ja:冠動脈大動脈バイパス移植術]]
[[pl:CABG]]
[[pt:Cirurgia cardiovascular]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Coronary artery bypass surgery in association with other cardiac procedures

2022-09-05T04:06:35Z

Anahita: /* Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{VK}} {{Anahita}}
==Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures==
*Multiple factors should be considered when planning to add [[CABG]] to another planned [[cardiac surgery]] in [[patients]] with significant [[coronary heart disease]]. Considerations include but are not limited to the following factors:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Comorbidities]]
**Technical feasibility of [[CABG]]
**Extent of the affected myocardium
**Conduit availability
**[[Left ventricular ejection fraction]]
**The additional time required to construct the [[Coronary artery bypass surgery|coronary bypass]] while the patient is on [[cardiopulmonary bypass]]
*Studies that were done on [[patients]] between the [[Ageing|ages of 75 and 84 years]] show that [[Ageing|age]] is not a prohibitive [[risk factor]] for adding [[CABG]] to other [[cardiac surgeries]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref> Although risk increases in [[patients]] older than 85 years of age.<ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
*Numerous [[observational studies]] and [[meta-analyses]] demonstrated similar long-term survival and [[Quality of life|health-related quality of life]] in [[patients]] who underwent [[aortic valve replacement]] with concomitant [[CABG]] compared to those without [[coronary heart disease]].<ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref> However, concomitant [[CABG]] is associated to a higher rate of [[surgery|perioperative]] [[morbidity]] and [[mortality rate|mortality]] in comparison to isolated [[aortic valve replacement]].<ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid24290746">{{cite journal| author=Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V | display-authors=etal| title=Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. | journal=J Cardiothorac Vasc Anesth | year= 2014 | volume= 28 | issue= 5 | pages= 1251-6 | pmid=24290746 | doi=10.1053/j.jvca.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24290746 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref>
===2021 ACA Revascularization Guideline<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 1 Recommendation, Level of Evidence:C-LD]]
|-
| bgcolor="LightGreen"|In a [[patient]] with significant [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] is recommended with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid24290746">{{cite journal| author=Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V | display-authors=etal| title=Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. | journal=J Cardiothorac Vasc Anesth | year= 2014 | volume= 28 | issue= 5 | pages= 1251-6 | pmid=24290746 | doi=10.1053/j.jvca.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24290746 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref><ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid27237968">{{cite journal| author=Yamanaka K, Komiya T, Tsuneyoshi H, Shimamoto T| title=Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting. | journal=Ann Thorac Cardiovasc Surg | year= 2016 | volume= 22 | issue= 4 | pages= 251-7 | pmid=27237968 | doi=10.5761/atcs.oa.16-00056 | pmc=5045853 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27237968 }} </ref>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 2b Recommendation, Level of Evidence:C-LD]]
|-
|bgcolor="LemonChiffon"|In a [[patient]] with intermediate [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] may be reasonable with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
|}
===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] is recommended in patients undergoing noncoronary [[cardiac surgery]] with greater than or equal to 50% luminal diameter narrowing of the [[left main coronary artery]] or greater than or equal to 70% luminal diameter narrowing of other major coronary arteries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of the [[LIMA]] is reasonable to bypass a significantly narrowed LAD artery in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' CABG of moderately diseased coronary arteries (>50% luminal diameter narrowing) is reasonable in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery in association with other cardiac procedures

2022-09-05T04:02:19Z

Anahita: /* Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{VK}} {{Anahita}}
==Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures==
*Multiple factors should be considered when planning to add [[CABG]] to another planned [[cardiac surgery]] in [[patients]] with significant [[coronary heart disease]]. Considerations include but are not limited to the following factors:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Comorbidities]]
**Technical feasibility of [[CABG]]
**Extent of the affected myocardium
**Conduit availability
**[[Left ventricular ejection fraction]]
**The additional time required to construct the [[Coronary artery bypass surgery|coronary bypass]] while the patient is on [[cardiopulmonary bypass]]
*Studies that were done on [[patients]] between the [[Ageing|ages of 75 and 84 years]] show that [[Ageing|age]] is not a prohibitive [[risk factor]] for adding [[CABG]] to other [[cardiac surgeries]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref> Although risk increases in [[patients]] older than 85 years of age.<ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
*Numerous [[observational studies]] and [[meta-analyses]] demonstrated similar long-term survival and [[Quality of life|health-related quality of life]] in [[patients]] who underwent [[aortic valve replacement]] with concomitant [[CABG]] compared to those without [[coronary heart disease]].<ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
===2021 ACA Revascularization Guideline<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 1 Recommendation, Level of Evidence:C-LD]]
|-
| bgcolor="LightGreen"|In a [[patient]] with significant [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] is recommended with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid24290746">{{cite journal| author=Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V | display-authors=etal| title=Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. | journal=J Cardiothorac Vasc Anesth | year= 2014 | volume= 28 | issue= 5 | pages= 1251-6 | pmid=24290746 | doi=10.1053/j.jvca.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24290746 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref><ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid27237968">{{cite journal| author=Yamanaka K, Komiya T, Tsuneyoshi H, Shimamoto T| title=Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting. | journal=Ann Thorac Cardiovasc Surg | year= 2016 | volume= 22 | issue= 4 | pages= 251-7 | pmid=27237968 | doi=10.5761/atcs.oa.16-00056 | pmc=5045853 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27237968 }} </ref>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 2b Recommendation, Level of Evidence:C-LD]]
|-
|bgcolor="LemonChiffon"|In a [[patient]] with intermediate [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] may be reasonable with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
|}
===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] is recommended in patients undergoing noncoronary [[cardiac surgery]] with greater than or equal to 50% luminal diameter narrowing of the [[left main coronary artery]] or greater than or equal to 70% luminal diameter narrowing of other major coronary arteries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of the [[LIMA]] is reasonable to bypass a significantly narrowed LAD artery in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' CABG of moderately diseased coronary arteries (>50% luminal diameter narrowing) is reasonable in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery in association with other cardiac procedures

2022-09-05T03:54:57Z

Anahita: /* Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{VK}} {{Anahita}}
==Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures==
*Multiple factors should be considered when planning to add [[CABG]] to another planned [[cardiac surgery]] in [[patients]] with significant [[coronary heart disease]]. Considerations include but are not limited to the following factors:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Comorbidities]]
**Technical feasibility of [[CABG]]
**Extent of the affected myocardium
**Conduit availability
**[[Left ventricular ejection fraction]]
**The additional time required to construct the [[Coronary artery bypass surgery|coronary bypass]] while the patient is on [[cardiopulmonary bypass]]
*Studies that were done on [[patients]] between the [[Ageing|ages of 75 and 84 years]] show that [[Ageing|age]] is not a prohibitive [[risk factor]] for adding [[CABG]] to other [[cardiac surgeries]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref> Although risk increases in [[patients]] older than 85 years of age.<ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
===2021 ACA Revascularization Guideline<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 1 Recommendation, Level of Evidence:C-LD]]
|-
| bgcolor="LightGreen"|In a [[patient]] with significant [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] is recommended with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid24290746">{{cite journal| author=Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V | display-authors=etal| title=Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. | journal=J Cardiothorac Vasc Anesth | year= 2014 | volume= 28 | issue= 5 | pages= 1251-6 | pmid=24290746 | doi=10.1053/j.jvca.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24290746 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref><ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid27237968">{{cite journal| author=Yamanaka K, Komiya T, Tsuneyoshi H, Shimamoto T| title=Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting. | journal=Ann Thorac Cardiovasc Surg | year= 2016 | volume= 22 | issue= 4 | pages= 251-7 | pmid=27237968 | doi=10.5761/atcs.oa.16-00056 | pmc=5045853 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27237968 }} </ref>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 2b Recommendation, Level of Evidence:C-LD]]
|-
|bgcolor="LemonChiffon"|In a [[patient]] with intermediate [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] may be reasonable with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
|}
===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] is recommended in patients undergoing noncoronary [[cardiac surgery]] with greater than or equal to 50% luminal diameter narrowing of the [[left main coronary artery]] or greater than or equal to 70% luminal diameter narrowing of other major coronary arteries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of the [[LIMA]] is reasonable to bypass a significantly narrowed LAD artery in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' CABG of moderately diseased coronary arteries (>50% luminal diameter narrowing) is reasonable in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery in association with other cardiac procedures

2022-09-05T03:52:41Z

Anahita: /* Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{VK}} {{Anahita}}
==Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures==
*Multiple factors should be considered when planning to add [[CABG]] to another planned [[cardiac surgery]] in [[patients]] with significant [[coronary heart disease]]. Considerations include but are not limited to the following factors:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Comorbidities]]
**Technical feasibility of [[CABG]]
**Extent of the affected myocardium
**Conduit availability
**[[Left ventricular ejection fraction]]
**The additional time required to construct the [[Coronary artery bypass surgery|coronary bypass]] while the patient is on [[cardiopulmonary bypass]]
*Studies that were done on [[patients]] between the [[Ageing|ages of 75 and 84 years]] show that [[Ageing|age]] is not a prohibitive [[risk factor]] for adding [[CABG]] to other [[cardiac surgeries]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref>
===2021 ACA Revascularization Guideline<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 1 Recommendation, Level of Evidence:C-LD]]
|-
| bgcolor="LightGreen"|In a [[patient]] with significant [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] is recommended with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid24290746">{{cite journal| author=Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V | display-authors=etal| title=Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. | journal=J Cardiothorac Vasc Anesth | year= 2014 | volume= 28 | issue= 5 | pages= 1251-6 | pmid=24290746 | doi=10.1053/j.jvca.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24290746 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref><ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid27237968">{{cite journal| author=Yamanaka K, Komiya T, Tsuneyoshi H, Shimamoto T| title=Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting. | journal=Ann Thorac Cardiovasc Surg | year= 2016 | volume= 22 | issue= 4 | pages= 251-7 | pmid=27237968 | doi=10.5761/atcs.oa.16-00056 | pmc=5045853 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27237968 }} </ref>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 2b Recommendation, Level of Evidence:C-LD]]
|-
|bgcolor="LemonChiffon"|In a [[patient]] with intermediate [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] may be reasonable with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
|}
===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] is recommended in patients undergoing noncoronary [[cardiac surgery]] with greater than or equal to 50% luminal diameter narrowing of the [[left main coronary artery]] or greater than or equal to 70% luminal diameter narrowing of other major coronary arteries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of the [[LIMA]] is reasonable to bypass a significantly narrowed LAD artery in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' CABG of moderately diseased coronary arteries (>50% luminal diameter narrowing) is reasonable in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery in association with other cardiac procedures

2022-09-05T03:52:18Z

Anahita: /* Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{VK}} {{Anahita}}
==Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures==
*Multiple factors should be considered when planning to add [[CABG]] to another planned [[cardiac surgery]] in [[patients]] with significant [[coronary heart disease]]. Considerations include but are not limited to the following factors:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref>
**[[Comorbidities]]
**Technical feasibility of [[CABG]]
**Extent of the affected myocardium
**Conduit availability
**[[Left ventricular ejection fraction]]
**The additional time required to construct the [[Coronary artery bypass surgery|coronary bypass]] while the patient is on [[cardiopulmonary bypass]]
*Studies that were done on [[patients]] between the [[Ageing|ages of 75 and 84 years]] show that [[Ageing|age]] is not a prohibitive [[risk factor]] for adding [[CABG]] to other [[cardiac surgeries]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref>
===2021 ACA Revascularization Guideline<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 1 Recommendation, Level of Evidence:C-LD]]
|-
| bgcolor="LightGreen"|In a [[patient]] with significant [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] is recommended with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid24290746">{{cite journal| author=Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V | display-authors=etal| title=Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. | journal=J Cardiothorac Vasc Anesth | year= 2014 | volume= 28 | issue= 5 | pages= 1251-6 | pmid=24290746 | doi=10.1053/j.jvca.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24290746 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref><ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid27237968">{{cite journal| author=Yamanaka K, Komiya T, Tsuneyoshi H, Shimamoto T| title=Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting. | journal=Ann Thorac Cardiovasc Surg | year= 2016 | volume= 22 | issue= 4 | pages= 251-7 | pmid=27237968 | doi=10.5761/atcs.oa.16-00056 | pmc=5045853 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27237968 }} </ref>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 2b Recommendation, Level of Evidence:C-LD]]
|-
|bgcolor="LemonChiffon"|In a [[patient]] with intermediate [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] may be reasonable with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
|}
===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] is recommended in patients undergoing noncoronary [[cardiac surgery]] with greater than or equal to 50% luminal diameter narrowing of the [[left main coronary artery]] or greater than or equal to 70% luminal diameter narrowing of other major coronary arteries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of the [[LIMA]] is reasonable to bypass a significantly narrowed LAD artery in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' CABG of moderately diseased coronary arteries (>50% luminal diameter narrowing) is reasonable in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery in association with other cardiac procedures

2022-09-05T03:47:47Z

Anahita:

Coronary artery bypass surgery in association with other cardiac procedures

2022-09-05T03:41:27Z

Anahita:

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{VK}} {{Anahita}}
==Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures==

===2021 ACA Revascularization Guideline<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 1 Recommendation, Level of Evidence:C-LD]]
|-
| bgcolor="LightGreen"|In a [[patient]] with significant [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] is recommended with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid24290746">{{cite journal| author=Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V | display-authors=etal| title=Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. | journal=J Cardiothorac Vasc Anesth | year= 2014 | volume= 28 | issue= 5 | pages= 1251-6 | pmid=24290746 | doi=10.1053/j.jvca.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24290746 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref><ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid27237968">{{cite journal| author=Yamanaka K, Komiya T, Tsuneyoshi H, Shimamoto T| title=Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting. | journal=Ann Thorac Cardiovasc Surg | year= 2016 | volume= 22 | issue= 4 | pages= 251-7 | pmid=27237968 | doi=10.5761/atcs.oa.16-00056 | pmc=5045853 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27237968 }} </ref>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 2b Recommendation, Level of Evidence:C-LD]]
|-
|bgcolor="LemonChiffon"|In a [[patient]] with intermediate [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] may be reasonable with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid24070699">{{cite journal| author=Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ| title=Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery. | journal=Ann Thorac Surg | year= 2013 | volume= 96 | issue= 6 | pages= 2075-82 | pmid=24070699 | doi=10.1016/j.athoracsur.2013.07.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24070699 }} </ref>
|}
===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] is recommended in patients undergoing noncoronary [[cardiac surgery]] with greater than or equal to 50% luminal diameter narrowing of the [[left main coronary artery]] or greater than or equal to 70% luminal diameter narrowing of other major coronary arteries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of the [[LIMA]] is reasonable to bypass a significantly narrowed LAD artery in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' CABG of moderately diseased coronary arteries (>50% luminal diameter narrowing) is reasonable in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Coronary artery bypass surgery in association with other cardiac procedures

2022-09-05T03:36:50Z

Anahita:

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{VK}} {{Anahita}}
==Coronary Artery Bypass Surgery in Association with Other Cardiac Procedures==

===2021 ACA Revascularization Guideline<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 1 Recommendation, Level of Evidence:C-LD]]
|-
| bgcolor="LightGreen"|In a [[patient]] with significant [[coronary heart disease]] who is undergoing another [[heart|cardiac]] [[surgery]], such as [[Heart valve|valve]] [[surgery]] and [[aorta|aortic]] [[surgery]], [[CABG]] is recommended with a goal of reducing [[ischemia|ischemic events]].<ref name="pmid23467192">{{cite journal| author=Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS| title=Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible? | journal=Cardiology | year= 2013 | volume= 124 | issue= 3 | pages= 163-73 | pmid=23467192 | doi=10.1159/000346153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23467192 }} </ref><ref name="pmid26183193">{{cite journal| author=Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL | display-authors=etal| title=In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 150 | issue= 3 | pages= 571-8.e8 | pmid=26183193 | doi=10.1016/j.jtcvs.2015.05.068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26183193 }} </ref><ref name="pmid24290746">{{cite journal| author=Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V | display-authors=etal| title=Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. | journal=J Cardiothorac Vasc Anesth | year= 2014 | volume= 28 | issue= 5 | pages= 1251-6 | pmid=24290746 | doi=10.1053/j.jvca.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24290746 }} </ref><ref name="pmid20100705">{{cite journal| author=Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J| title=Short- and mid-term results for aortic valve replacement in octogenarians. | journal=Interact Cardiovasc Thorac Surg | year= 2010 | volume= 10 | issue= 4 | pages= 549-54 | pmid=20100705 | doi=10.1510/icvts.2009.218040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20100705 }} </ref><ref name="pmid26883368">{{cite journal| author=Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F | display-authors=etal| title=Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. | journal=J Cardiovasc Transl Res | year= 2016 | volume= 9 | issue= 2 | pages= 145-52 | pmid=26883368 | doi=10.1007/s12265-016-9680-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26883368 }} </ref><ref name="pmid22386959">{{cite journal| author=Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL | display-authors=etal| title=Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis. | journal=Am J Cardiol | year= 2012 | volume= 109 | issue= 9 | pages= 1334-40 | pmid=22386959 | doi=10.1016/j.amjcard.2011.12.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22386959 }} </ref><ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid23415689">{{cite journal| author=Shan L, Saxena A, McMahon R, Wilson A, Newcomb A| title=A systematic review on the quality of life benefits after aortic valve replacement in the elderly. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 145 | issue= 5 | pages= 1173-89 | pmid=23415689 | doi=10.1016/j.jtcvs.2013.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23415689 }} </ref><ref name="pmid22980309">{{cite journal| author=Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F| title=Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. | journal=Am Heart J | year= 2012 | volume= 164 | issue= 3 | pages= 410-418.e1 | pmid=22980309 | doi=10.1016/j.ahj.2012.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22980309 }} </ref><ref name="pmid25308117">{{cite journal| author=Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM | display-authors=etal| title=The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. | journal=J Thorac Cardiovasc Surg | year= 2015 | volume= 149 | issue= 2 | pages= 451-60 | pmid=25308117 | doi=10.1016/j.jtcvs.2014.08.073 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308117 }} </ref><ref name="pmid27237968">{{cite journal| author=Yamanaka K, Komiya T, Tsuneyoshi H, Shimamoto T| title=Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting. | journal=Ann Thorac Cardiovasc Surg | year= 2016 | volume= 22 | issue= 4 | pages= 251-7 | pmid=27237968 | doi=10.5761/atcs.oa.16-00056 | pmc=5045853 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27237968 }} </ref>
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[CABG]] is recommended in patients undergoing noncoronary [[cardiac surgery]] with greater than or equal to 50% luminal diameter narrowing of the [[left main coronary artery]] or greater than or equal to 70% luminal diameter narrowing of other major coronary arteries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of the [[LIMA]] is reasonable to bypass a significantly narrowed LAD artery in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' CABG of moderately diseased coronary arteries (>50% luminal diameter narrowing) is reasonable in patients undergoing noncoronary cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]

Antithrombin therapy to support PCI

2022-09-05T03:08:06Z

Anahita:

__NOTOC__
{{PCI}}
{{CMG}} {{AE}} {{Anahita}}
==Overview==
[[Antithrombotic therapy]] is a centerpiece [[treatment]] in [[patients]] who are undergoing [[PCI]]. Selection of an optimal [[anticoagulant]] should be done by considering the [[patient]]’s clinical presentation such as [[Chronic stable angina definition|stable ischemic disease]], [[Unstable angina / non ST-elevation myocardial infarction|NSTE-ACS]], or [[STEMI]], and [[bleeding]] probability. [[Intravenous]] [[unfractionated heparin]] is the most common [[anticoagulant]] and has been the standard of care by default, nevertheless, other [[treatments]] such as [[direct thrombin inhibitor]] and [[low molecular weight heparins]] are also common options. Among [[low molecular weight heparins]], [[enoxaparin]] is one of the most used [[treatments]] and is considered a safe alternative for [[UFH]]. Each [[treatment]] has its advantages and disadvantages which should be discussed in a [[patient]]-centered evaluation.
==Antithrombin Therapy to Support PCI==
*[[Antithrombotic therapy]] is a centerpiece [[treatment]] in [[patients]] who are undergoing [[PCI]]. Currently, the following three [[antithrombotic]] agents have been studied among [[patient]] who have undergone [[PCI]]:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Heparin|Unfractioned Heparin]] ([[UFH]])
**[[Bivalirudin]]
**[[Enoxaparin]]
*Using [[fondaparinux]] is not recommended as the only [[anticoagulant]] in [[PCI]] [[patients]] due to a higher [[incidence]] of guiding-[[catheter]] [[thrombosis]].<ref name="pmid16537663">{{cite journal| author=Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators. Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J | display-authors=etal| title=Comparison of fondaparinux and enoxaparin in acute coronary syndromes. | journal=N Engl J Med | year= 2006 | volume= 354 | issue= 14 | pages= 1464-76 | pmid=16537663 | doi=10.1056/NEJMoa055443 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16537663 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16944851 Review in: ACP J Club. 2006 Sep-Oct;145(2):30-1] </ref><ref name="pmid16537725">{{cite journal| author=Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB | display-authors=etal| title=Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. | journal=JAMA | year= 2006 | volume= 295 | issue= 13 | pages= 1519-30 | pmid=16537725 | doi=10.1001/jama.295.13.joc60038 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16537725 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16944849 Review in: ACP J Club. 2006 Sep-Oct;145(2):29] </ref>
*Selection of an optimal [[anticoagulant]] should be done by considering the [[patient]]’s clinical presentation such as [[Chronic stable angina definition|stable ischemic disease]], [[Unstable angina / non ST-elevation myocardial infarction|NSTE-ACS]], or [[STEMI]], and [[bleeding]] probability.<ref name="pmid23500304">{{cite journal| author=Rao SC, Chhatriwalla AK, Kennedy KF, Decker CJ, Gialde E, Spertus JA | display-authors=etal| title=Pre-procedural estimate of individualized bleeding risk impacts physicians' utilization of bivalirudin during percutaneous coronary intervention. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 18 | pages= 1847-52 | pmid=23500304 | doi=10.1016/j.jacc.2013.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23500304 }} </ref>
*The following table represents the [[dose|dosing]] of [[parenteral]] [[anticoagulant]] during [[PCI]]:<ref name="pmid17560287">{{cite journal| author=Gibson CM, Murphy SA, Montalescot G, Morrow DA, Ardissino D, Cohen M | display-authors=etal| title=Percutaneous coronary intervention in patients receiving enoxaparin or unfractionated heparin after fibrinolytic therapy for ST-segment elevation myocardial infarction in the ExTRACT-TIMI 25 trial. | journal=J Am Coll Cardiol | year= 2007 | volume= 49 | issue= 23 | pages= 2238-46 | pmid=17560287 | doi=10.1016/j.jacc.2007.01.093 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560287 }} </ref><ref name="pmid15353913">{{cite journal| author=Levine GN, Ferrando T| title=Degree of anticoagulation after one subcutaneous and one subsequent intravenous booster dose of enoxaparin: implications for patients with acute coronary syndromes undergoing early percutaneous coronary intervention. | journal=J Thromb Thrombolysis | year= 2004 | volume= 17 | issue= 3 | pages= 167-71 | pmid=15353913 | doi=10.1023/B:THRO.0000040484.99422.77 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15353913 }} </ref><ref name="pmid14755805">{{cite journal| author=Martin JL, Fry ET, Sanderink GJ, Atherley TH, Guimart CM, Chevalier PJ | display-authors=etal| title=Reliable anticoagulation with enoxaparin in patients undergoing percutaneous coronary intervention: The pharmacokinetics of enoxaparin in PCI (PEPCI) study. | journal=Catheter Cardiovasc Interv | year= 2004 | volume= 61 | issue= 2 | pages= 163-70 | pmid=14755805 | doi=10.1002/ccd.10726 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14755805 }} </ref>
{| class="wikitable"
|-
! style="background-color:#ffffc7;" | Drug
! style="background-color:#ffffc7;" | For Patients Who Received Previous Anticoagulant Therapy
! style="background-color:#ffffc7;" | For Patients Who Did Not Received Any Anticoagulant Therapy
|-
| style="background-color:#ffffff;" | [[UFH]]
| style="background-color:#ffffff;" | Additional [[UFH]] as needed (e.g., 2000 – 5000 U) to achieve the [[activated clotting time]] ([[activated clotting time|ACT]]) of 250-300 seconds.
| style="background-color:#ffffff;" | 70–100 U/kg initial [[bolus]] to achieve the target [[activated clotting time|ACT]] of 250–300 seconds.
|-
| style="background-color:#ffffff;" | [[Enoxaparin]]
| style="background-color:#ffffff;" | *An [[intravenous therapy|intravenous]] [[dose]] of 0.3 mg/kg of [[enoxaparin]] for [[patients]] who received previous [[treatment]] with [[subcutaneous tissue]] [[enoxaparin]] within the last 8 –12 hours.
*If the last [[subcutaneous tissue]] [[dose]] was administered within the previous 8 hours, no additional [[enoxaparin]] should be given
| style="background-color:#ffffff;" | 0.5 – 0.75 mg/kg [[intravenous therapy|intravenous]] [[bolus]]
|-
| style="background-color:#ffffff;" | [[Bivalirudin]]
| style="background-color:#ffffff;" | For [[patients]] who have received [[UFH]], repeat [[activated clotting time|ACT]], if [[activated clotting time|ACT]] is not in the [[therapeutic range]], then give a 0.75 mg/kg [[intravenous therapy|intravenous]] [[bolus]], then continue with a 1.75 mg/kg/h [[intravenous therapy|intravenous]] [[infusion]].
| style="background-color:#ffffff;" | 0.75 mg/kg [[bolus]], then continue with a 1.75 mg/kg/h [[intravenous therapy|intravenous]] [[infusion]].
|-
| style="background-color:#ffffff;" | [[Argatroban]]
| style="background-color:#ffffff;" | 200 mg/kg [[intravenous therapy|intravenous]] [[bolus]], then continue with a 15 mg/kg/min [[intravenous therapy|intravenous]] [[infusion]].
| style="background-color:#ffffff;" | 350 mg/kg, then continue with a 15 mg/kg/min [[intravenous therapy|intravenous]] [[infusion]].
|}
HemoTec (GmbH, Switzerland) or I-Stat (Abbott) device can be used to check [[activated clotting time]] ([[activated clotting time|ACT]]) for [[UFH]] [[dose|dosing]]. However, [[activated clotting time]] ([[activated clotting time|ACT]]) goals are 50 seconds higher for Hemochron ACT (Werfen) devices. Furthermore, it is recommended to consider the higher target [[activated clotting time|ACT]] in [[patients]] with [[chronic total occlusion]]. On the other hand, target [[activated clotting time|ACT]] should be 200-250 seconds if a [[intravenous therapy|intravenous]] [[glycoprotein IIb/IIIa inhibitors]] is selected.<ref name="pmid8640994">{{cite journal| author=Narins CR, Hillegass WB, Nelson CL, Tcheng JE, Harrington RA, Phillips HR | display-authors=etal| title=Relation between activated clotting time during angioplasty and abrupt closure. | journal=Circulation | year= 1996 | volume= 93 | issue= 4 | pages= 667-71 | pmid=8640994 | doi=10.1161/01.cir.93.4.667 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8640994 }} </ref><ref name="pmid15302778">{{cite journal| author=Brener SJ, Moliterno DJ, Lincoff AM, Steinhubl SR, Wolski KE, Topol EJ| title=Relationship between activated clotting time and ischemic or hemorrhagic complications: analysis of 4 recent randomized clinical trials of percutaneous coronary intervention. | journal=Circulation | year= 2004 | volume= 110 | issue= 8 | pages= 994-8 | pmid=15302778 | doi=10.1161/01.CIR.0000139868.53594.24 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15302778 }} </ref><ref name="pmid18276619">{{cite journal| author=Montalescot G, Cohen M, Salette G, Desmet WJ, Macaya C, Aylward PE | display-authors=etal| title=Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: insights from the STEEPLE trial. | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 4 | pages= 462-71 | pmid=18276619 | doi=10.1093/eurheartj/ehn008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18276619 }} </ref><ref name="pmid11181470">{{cite journal| author=Chew DP, Bhatt DL, Lincoff AM, Moliterno DJ, Brener SJ, Wolski KE | display-authors=etal| title=Defining the optimal activated clotting time during percutaneous coronary intervention: aggregate results from 6 randomized, controlled trials. | journal=Circulation | year= 2001 | volume= 103 | issue= 7 | pages= 961-6 | pmid=11181470 | doi=10.1161/01.cir.103.7.961 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11181470 }} </ref><ref name="pmid9129894">{{cite journal| author=Boccara A, Benamer H, Juliard JM, Aubry P, Goy P, Himbert D | display-authors=etal| title=A randomized trial of a fixed high dose vs a weight-adjusted low dose of intravenous heparin during coronary angioplasty. | journal=Eur Heart J | year= 1997 | volume= 18 | issue= 4 | pages= 631-5 | pmid=9129894 | doi=10.1093/oxfordjournals.eurheartj.a015308 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9129894 }} </ref><ref name="pmid20805113">{{cite journal| author=Schulz S, Mehilli J, Neumann FJ, Schuster T, Massberg S, Valina C | display-authors=etal| title=ISAR-REACT 3A: a study of reduced dose of unfractionated heparin in biomarker negative patients undergoing percutaneous coronary intervention. | journal=Eur Heart J | year= 2010 | volume= 31 | issue= 20 | pages= 2482-91 | pmid=20805113 | doi=10.1093/eurheartj/ehq330 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20805113 }} </ref>
===Unfractionated Heparin (UFH)===
*[[Intravenous]] [[unfractionated heparin]] is the most common [[anticoagulant]] and has been the standard of care by default.<ref name="pmid7643883">{{cite journal| author=Bittl JA, Strony J, Brinker JA, Ahmed WH, Meckel CR, Chaitman BR | display-authors=etal| title=Treatment with bivalirudin (Hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina. Hirulog Angioplasty Study Investigators. | journal=N Engl J Med | year= 1995 | volume= 333 | issue= 12 | pages= 764-9 | pmid=7643883 | doi=10.1056/NEJM199509213331204 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7643883 }} </ref>
*Since studies on [[UFH]] [[dose|dosing]] were done years ago, there is no evidence that previously recommended [[doses]] can be used in the modern [[coronary stent]] era. Therefore, the effectiveness of [[UFH]] [[dose|dosing]] based on [[activated clotting time]] in modern practice is uncertain.<ref name="pmid15302778">{{cite journal| author=Brener SJ, Moliterno DJ, Lincoff AM, Steinhubl SR, Wolski KE, Topol EJ| title=Relationship between activated clotting time and ischemic or hemorrhagic complications: analysis of 4 recent randomized clinical trials of percutaneous coronary intervention. | journal=Circulation | year= 2004 | volume= 110 | issue= 8 | pages= 994-8 | pmid=15302778 | doi=10.1161/01.CIR.0000139868.53594.24 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15302778 }} </ref><ref name="pmid27545117">{{cite journal| author=Mottillo S, Filion KB, Joseph L, Eisenberg MJ| title=Defining optimal activated clotting time for percutaneous coronary intervention: A systematic review and Bayesian meta-regression. | journal=Catheter Cardiovasc Interv | year= 2017 | volume= 89 | issue= 3 | pages= 351-366 | pmid=27545117 | doi=10.1002/ccd.26652 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27545117 }} </ref><ref name="pmid24371012">{{cite journal| author=Schulz S, Angiolillo DJ, Antoniucci D, Bernlochner I, Hamm C, Jaitner J | display-authors=etal| title=Randomized comparison of ticagrelor versus prasugrel in patients with acute coronary syndrome and planned invasive strategy--design and rationale of the iNtracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial. | journal=J Cardiovasc Transl Res | year= 2014 | volume= 7 | issue= 1 | pages= 91-100 | pmid=24371012 | doi=10.1007/s12265-013-9527-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24371012 }} </ref><ref name="pmid12575964">{{cite journal| author=Tolleson TR, O'Shea JC, Bittl JA, Hillegass WB, Williams KA, Levine G | display-authors=etal| title=Relationship between heparin anticoagulation and clinical outcomes in coronary stent intervention: observations from the ESPRIT trial. | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 3 | pages= 386-93 | pmid=12575964 | doi=10.1016/s0735-1097(02)02767-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12575964 }} </ref><ref name="pmid18276619">{{cite journal| author=Montalescot G, Cohen M, Salette G, Desmet WJ, Macaya C, Aylward PE | display-authors=etal| title=Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: insights from the STEEPLE trial. | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 4 | pages= 462-71 | pmid=18276619 | doi=10.1093/eurheartj/ehn008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18276619 }} </ref>
*Furthermore, the routine use of full [[dose]] [[anticoagulation therapy]] after [[PCI]] is no longer indicated.
====Mechanism of action====
[[Heparin]] is a [[glycosaminoglycan]] of 12-15 kDa that binds [[Anti-thrombin 3]] and facilitates its ability to inhibit [[thrombin|coagulation factors 2a]] ([[thrombin]]) and [[coagulation factor Xa|10a]] by a factor of 1000. [[Thrombin]] plays a central role not only in [[plasma]] [[coagulation]] (by [[catalysing]] [[fibrinogen]] to [[fibrin]] as well as activating several [[coagulation factor]]s) but [[platelet activation]] as well.

====Advantages====
* [[Physician]] familiarity with the use
* Level of [[anticoagulation]] can be [[titrate]]d with [[activated clotting time]] ([[activated clotting time|ACT]]). Target [[activated clotting time|ACT]] typically 200-250 with [[coagulation|2b/3a]] and 250-350 without [[coagulation|2b/3a]] (these levels have been empirically derived and target ACT's have fallen in the [[stent]] era as the risk for [[acute]] [[vessel]] closure has diminished).
* Can be reversed with [[protamine]] (1mg of [[protamine]] for 100u of [[heparin]] acutely) in case of [[coronary artery perforation]] or [[vascular]] access [[complication]].
* No [[dose]] adjustment needed for [[renal dysfunction]]
* Inexpensive

====Disadvantages====
* Significant [[protein]] binding
* Monitoring required as the level of [[anticoagulation]] varies widely between [[patients]]
* Inability to inactive [[clot]]-bound [[thrombin]]
* Does not prevent the [[platelet activation]] of [[thrombin]]
* Risk of [[Heparin Induced Thrombocytopenia]] ([[Heparin Induced Thrombocytopenia|HIT]]).

===Low Molecular Weight Heparinoids (LMWH)===
*The following [[medicines]] belong to the [[low molecular weight heparins]]:<ref>{{cite journal | author=Linhardt, R.J. Gunay, N. S. | title=Production and chemical processing of low molecular weight heparins | journal=Sem. Thromb. Hem. | year=1999 | pages=5-16 | volume=25 | issue=3}}</ref>
**[[Enoxaparin]]
**[[Parnaparin]]
**[[Dalteparin]]
**[[Ardeparin]]
**[[Certoparin]]
====Enoxaparin====
*[[Enoxaparin]] is considered a safe alternative for [[UFH]]. <ref name="pmid15238590">{{cite journal| author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S | display-authors=etal| title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. | journal=JAMA | year= 2004 | volume= 292 | issue= 1 | pages= 45-54 | pmid=15238590 | doi=10.1001/jama.292.1.45 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15238590 }} </ref><ref name="pmid21856483">{{cite journal| author=Montalescot G, Zeymer U, Silvain J, Boulanger B, Cohen M, Goldstein P | display-authors=etal| title=Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. | journal=Lancet | year= 2011 | volume= 378 | issue= 9792 | pages= 693-703 | pmid=21856483 | doi=10.1016/S0140-6736(11)60876-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21856483 }} </ref><ref name="pmid22306479">{{cite journal| author=Silvain J, Beygui F, Barthélémy O, Pollack C, Cohen M, Zeymer U | display-authors=etal| title=Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis. | journal=BMJ | year= 2012 | volume= 344 | issue= | pages= e553 | pmid=22306479 | doi=10.1136/bmj.e553 | pmc=3271999 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22306479 }} </ref>
*More [[complication]] is seen in [[patients]] who were given upstream [[enoxaparin]] and then have switched to [[UFH]]. This effect is seen even when [[heparin]] is administered within a 10-hours period after the last [[dose]] of [[enoxaparin]].<ref name="pmid19619692">{{cite journal| author=Drouet L, Bal dit Sollier C, Martin J| title=Adding intravenous unfractionated heparin to standard enoxaparin causes excessive anticoagulation not detected by activated clotting time: results of the STACK-on to ENOXaparin (STACKENOX) study. | journal=Am Heart J | year= 2009 | volume= 158 | issue= 2 | pages= 177-84 | pmid=19619692 | doi=10.1016/j.ahj.2009.05.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19619692 }} </ref><ref name="pmid17010793">{{cite journal| author=Cohen M, Mahaffey KW, Pieper K, Pollack CV, Antman EM, Hoekstra J | display-authors=etal| title=A subgroup analysis of the impact of prerandomization antithrombin therapy on outcomes in the SYNERGY trial: enoxaparin versus unfractionated heparin in non-ST-segment elevation acute coronary syndromes. | journal=J Am Coll Cardiol | year= 2006 | volume= 48 | issue= 7 | pages= 1346-54 | pmid=17010793 | doi=10.1016/j.jacc.2006.05.058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17010793 }} </ref>
*In almost all [[patients]] who are undergoing [[PCI]] and have received 0.5 mg/kg [[intravenous]] [[enoxaparin]], a peak anti-Xa level more than 0.5 IU/mL will be seen.<ref name="pmid18276619">{{cite journal| author=Montalescot G, Cohen M, Salette G, Desmet WJ, Macaya C, Aylward PE | display-authors=etal| title=Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: insights from the STEEPLE trial. | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 4 | pages= 462-71 | pmid=18276619 | doi=10.1093/eurheartj/ehn008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18276619 }} </ref><ref name="pmid12475453">{{cite journal| author=Choussat R, Montalescot G, Collet JP, Vicaut E, Ankri A, Gallois V | display-authors=etal| title=A unique, low dose of intravenous enoxaparin in elective percutaneous coronary intervention. | journal=J Am Coll Cardiol | year= 2002 | volume= 40 | issue= 11 | pages= 1943-50 | pmid=12475453 | doi=10.1016/s0735-1097(02)02531-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12475453 }} </ref>
=====Clinical Trials with Enoxaparin=====
*SYNERGY: This [[clinical trial|trial]] showed no inferiority in [[enoxaparin]] compared to [[UFH]]. Furthermore, this trial showed no difference in the rate of death, [[MI]], or major [[bleeding]] among [[patients]] with [[NSTE-ACS]] who were treated with [[enoxaparin]] compared to [[UFH]].<ref name="pmid15238590">{{cite journal| author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S | display-authors=etal| title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. | journal=JAMA | year= 2004 | volume= 292 | issue= 1 | pages= 45-54 | pmid=15238590 | doi=10.1001/jama.292.1.45 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15238590 }} </ref>
*AtoZ: This [[clinical trial|trial]] showed no inferiority in [[enoxaparin]] compared to [[UFH]]. Furthermore, this trial showed no difference in the rate of death, [[MI]], or major [[bleeding]] among [[patients]] with [[NSTE-ACS]] who were treated with [[enoxaparin]] compared to [[UFH]].<ref name="pmid11479456">{{cite journal| author=Blazing MA, De Lemos JA, Dyke CK, Califf RM, Bilheimer D, Braunwald E| title=The A-to-Z Trial: Methods and rationale for a single trial investigating combined use of low-molecular-weight heparin with the glycoprotein IIb/IIIa inhibitor tirofiban and defining the efficacy of early aggressive simvastatin therapy. | journal=Am Heart J | year= 2001 | volume= 142 | issue= 2 | pages= 211-7 | pmid=11479456 | doi=10.1067/mhj.2001.116959 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11479456 }} </ref>
*ATOLL: This [[clinical trial|trial]] compared [[intravenous]] [[enoxaparin]] with [[UFH]], and reported a reduction in death, recurrent [[ACS]], urgent [[revascularization]], and [[bleeding]] among those who received [[enoxaparin]].<ref name="pmid21856483">{{cite journal| author=Montalescot G, Zeymer U, Silvain J, Boulanger B, Cohen M, Goldstein P | display-authors=etal| title=Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. | journal=Lancet | year= 2011 | volume= 378 | issue= 9792 | pages= 693-703 | pmid=21856483 | doi=10.1016/S0140-6736(11)60876-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21856483 }}</ref>
**This finding is supported by a large [[meta-analysis]] which studied [[patients]] undergoing [[PCI]] for [[STEMI]] and [[NSTE-ACS]].<ref name="pmid22306479">{{cite journal| author=Silvain J, Beygui F, Barthélémy O, Pollack C, Cohen M, Zeymer U | display-authors=etal| title=Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis. | journal=BMJ | year= 2012 | volume= 344 | issue= | pages= e553 | pmid=22306479 | doi=10.1136/bmj.e553 | pmc=3271999 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22306479 }} </ref>

===Direct thrombin inhibitor===
====Mechanism of Action====
* Unlike [[UFH]] or [[low molecular weight heparin]] ([[LMWH]]), [[direct thrombin inhibitor]]s ([[Lepirudin]], [[Argatroban]] and [[Bivalirudin]]) don't require the help of [[AT3|AT-3]] to exert their [[anticoagulation]] effect.
*These medicines are [[Intravenous therapy|IV]] only, but there is great interest in developing safe [[oral]] [[Direct thrombin inhibitor|DTI]] to replace [[coumadin]] in the [[DVT]]/[[PE]] and [[atrial fibrillation]] population.
*The following are some of the [[medications]] belong to this group:<ref name="DiNisio">{{cite journal | author = Di Nisio M, Middeldorp S, Büller H | title = Direct thrombin inhibitors. | journal = N Engl J Med | volume = 353 | issue = 10 | pages = 1028-40 | year = 2005 | id = PMID 16148288}}</ref>
** [[Bivalirudin]]
**[[Desirudin]]
**[[Argatroban]]
**[[Dabigatran]]
**[[Lepirudin]]
*[[Bivalirudin]] ([[Angiomax]]) is the only [[Direct thrombin inhibitor|DTI]] used commonly in the [[cath lab]] although the others have been studied.

====Advantages====
* Short [[half life]]. This facilitates early sheath removal after [[PCI]]
* Can inhibit [[fibrin]]-bound [[thrombin]]
* Simplified [[dosing]] regimen. Can be adjusted for [[patients]] with [[renal insufficiency]].
* Fewer [[bleeding]] [[complication]]s especially at access site. This advantage increases as [[bleeding]] risk increases due to [[aging|age]] and [[renal insufficiency]].
* Best regimen for [[patients]] with known [[HIT]]. Both [[argatroban]] and [[bivalirudin]] are acceptable alternatives for use in [[patients]] with [[heparin-induced thrombocytopenia]].<ref name="pmid12357516">{{cite journal| author=Lewis BE, Matthai WH, Cohen M, Moses JW, Hursting MJ, Leya F | display-authors=etal| title=Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. | journal=Catheter Cardiovasc Interv | year= 2002 | volume= 57 | issue= 2 | pages= 177-84 | pmid=12357516 | doi=10.1002/ccd.10276 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12357516 }} </ref><ref name="pmid14608128">{{cite journal| author=Mahaffey KW, Lewis BE, Wildermann NM, Berkowitz SD, Oliverio RM, Turco MA | display-authors=etal| title=The anticoagulant therapy with bivalirudin to assist in the performance of percutaneous coronary intervention in patients with heparin-induced thrombocytopenia (ATBAT) study: main results. | journal=J Invasive Cardiol | year= 2003 | volume= 15 | issue= 11 | pages= 611-6 | pmid=14608128 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14608128 }} </ref>

====Disadvantages====
* Cost (however this is offset if use of [[bivalirudin]] obviates need for [[coagulation|2b/3a]])

====Trials with Bivalirudin====
*There are numerous studies that compared [[bivalirudin]] and [[heparin]]. Almost all of them did not report any difference in [[ischemia|ischemic endpoints]]; however, less [[bleeding]] was reported with [[bivalirudin]].<ref name="pmid18703471">{{cite journal| author=Kastrati A, Neumann FJ, Mehilli J, Byrne RA, Iijima R, Büttner HJ | display-authors=etal| title=Bivalirudin versus unfractionated heparin during percutaneous coronary intervention. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 7 | pages= 688-96 | pmid=18703471 | doi=10.1056/NEJMoa0802944 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18703471 }} </ref><ref name="pmid12588269">{{cite journal| author=Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD | display-authors=etal| title=Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. | journal=JAMA | year= 2003 | volume= 289 | issue= 7 | pages= 853-63 | pmid=12588269 | doi=10.1001/jama.289.7.853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12588269 }} </ref><ref name="pmid17368152">{{cite journal| author=Stone GW, White HD, Ohman EM, Bertrand ME, Lincoff AM, McLaurin BT | display-authors=etal| title=Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial. | journal=Lancet | year= 2007 | volume= 369 | issue= 9565 | pages= 907-19 | pmid=17368152 | doi=10.1016/S0140-6736(07)60450-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17368152 }} </ref><ref name="pmid22077909">{{cite journal| author=Kastrati A, Neumann FJ, Schulz S, Massberg S, Byrne RA, Ferenc M | display-authors=etal| title=Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. | journal=N Engl J Med | year= 2011 | volume= 365 | issue= 21 | pages= 1980-9 | pmid=22077909 | doi=10.1056/NEJMoa1109596 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22077909 }} </ref><ref name="pmid25791214">{{cite journal| author=Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T | display-authors=etal| title=Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. | journal=Lancet | year= 2015 | volume= 385 | issue= 9986 | pages= 2465-76 | pmid=25791214 | doi=10.1016/S0140-6736(15)60292-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25791214 }} </ref><ref name="pmid18499566">{{cite journal| author=Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D | display-authors=etal| title=Bivalirudin during primary PCI in acute myocardial infarction. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 21 | pages= 2218-30 | pmid=18499566 | doi=10.1056/NEJMoa0708191 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18499566 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18783187 Review in: ACP J Club. 2008 Sep 16;149(3):11] </ref><ref name="pmid24371012">{{cite journal| author=Schulz S, Angiolillo DJ, Antoniucci D, Bernlochner I, Hamm C, Jaitner J | display-authors=etal| title=Randomized comparison of ticagrelor versus prasugrel in patients with acute coronary syndrome and planned invasive strategy--design and rationale of the iNtracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial. | journal=J Cardiovasc Transl Res | year= 2014 | volume= 7 | issue= 1 | pages= 91-100 | pmid=24371012 | doi=10.1007/s12265-013-9527-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24371012 }} </ref><ref name="pmid24371012">{{cite journal| author=Schulz S, Angiolillo DJ, Antoniucci D, Bernlochner I, Hamm C, Jaitner J | display-authors=etal| title=Randomized comparison of ticagrelor versus prasugrel in patients with acute coronary syndrome and planned invasive strategy--design and rationale of the iNtracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial. | journal=J Cardiovasc Transl Res | year= 2014 | volume= 7 | issue= 1 | pages= 91-100 | pmid=24371012 | doi=10.1007/s12265-013-9527-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24371012 }} </ref><ref name="pmid25775052">{{cite journal| author=Han Y, Guo J, Zheng Y, Zang H, Su X, Wang Y | display-authors=etal| title=Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: the BRIGHT randomized clinical trial. | journal=JAMA | year= 2015 | volume= 313 | issue= 13 | pages= 1336-46 | pmid=25775052 | doi=10.1001/jama.2015.2323 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25775052 }} </ref><ref name="pmid19717185">{{cite journal| author=Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR | display-authors=etal| title=Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial. | journal=Lancet | year= 2009 | volume= 374 | issue= 9696 | pages= 1149-59 | pmid=19717185 | doi=10.1016/S0140-6736(09)61484-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19717185 }} </ref><ref name="pmid24633823">{{cite journal| author=Schulz S, Richardt G, Laugwitz KL, Mehran R, Gershlick AH, Morath T | display-authors=etal| title=Comparison of prasugrel and bivalirudin vs clopidogrel and heparin in patients with ST-segment elevation myocardial infarction: Design and rationale of the Bavarian Reperfusion Alternatives Evaluation (BRAVE) 4 trial. | journal=Clin Cardiol | year= 2014 | volume= 37 | issue= 5 | pages= 270-6 | pmid=24633823 | doi=10.1002/clc.22268 | pmc=6649448 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24633823 }} </ref><ref name="pmid25002178">{{cite journal| author=Shahzad A, Kemp I, Mars C, Wilson K, Roome C, Cooper R | display-authors=etal| title=Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial. | journal=Lancet | year= 2014 | volume= 384 | issue= 9957 | pages= 1849-1858 | pmid=25002178 | doi=10.1016/S0140-6736(14)60924-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25002178 }} </ref><ref name="pmid24140664">{{cite journal| author=Stone GW, Clayton T, Deliargyris EN, Prats J, Mehran R, Pocock SJ| title=Reduction in cardiac mortality with bivalirudin in patients with and without major bleeding: The HORIZONS-AMI trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction). | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 1 | pages= 15-20 | pmid=24140664 | doi=10.1016/j.jacc.2013.09.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24140664 }} </ref>
*Although [[complications]] such as [[bleeding]] is lower with [[bivalirudin]] based on [[clinical trials]], in real practice, this benefit may be less pronounced with routine use of [[radial artery]] intervention and low rates of [[glycoprotein IIb/IIIa inhibitor]] use.<ref name="pmid25746943">{{cite journal| author=Capodanno D, Gargiulo G, Capranzano P, Mehran R, Tamburino C, Stone GW| title=Bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary PCI: An updated meta-analysis of 10,350 patients from five randomized clinical trials. | journal=Eur Heart J Acute Cardiovasc Care | year= 2016 | volume= 5 | issue= 3 | pages= 253-62 | pmid=25746943 | doi=10.1177/2048872615572599 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25746943 }} </ref><ref name="pmid25131979">{{cite journal| author=Cavender MA, Sabatine MS| title=Bivalirudin versus heparin in patients planned for percutaneous coronary intervention: a meta-analysis of randomised controlled trials. | journal=Lancet | year= 2014 | volume= 384 | issue= 9943 | pages= 599-606 | pmid=25131979 | doi=10.1016/S0140-6736(14)61216-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25131979 }} </ref>
**Replace 2: This [[clinical trial|trial]] compared [[bivalirudin]] plus provisional [[coagulation|2b/3a]] (which ended up being given in 7.2% of [[patients]]) vs [[heparin]] with planned [[coagulation|2b/3a]]. In this study of 6010 [[patients]], [[ischemic]] events were similar but major [[bleeding]] (mostly [[vascular]] access site) was reduced by about 40%. There was no [[mortality]] difference at one year despite a 0.8% absolute increase in peri-procedural [[MI]]'s in the [[bivalirudin]] group. Importantly ,85% of [[patients]] were pre-[[treatment|treated]] with [[plavix]] or [[ticlid]]. In Replace 2, [[bivalirudin]] strategy was found to be less expensive because of savings on [[coagulation|2b/3a]] as well as less [[bleeding]].
**ACUITY: Complex [[clinical trial|trial]] of 13,819 high risk [[UA]] or [[NSTEMI]] [[patients]] undergoing early invasive strategy comparing [[bivalirudin]] alone vs [[Bivalirudin]] with [[coagulation|2b/3a]] vs [[Heparin]] or [[Lovenox]] with [[coagulation|2b/3a]]. It was found that the [[ischemic]] composite endpoint (death, [[MI]], [[revascularization]]) at 30 days was the same in all 3 arms. However, major [[bleeding]] was significantly less with [[bivalirudin]] alone at 3.1% vs [[bivalirudin]] and [[coagulation|2b/3a]] at 5.3% vs [[Heparin]], [[Lovenox]] and [[coagulation|2b/3a]] at 5.7%. Again this was driven mostly by access site [[complication]]s, but unlike in REPLACE 2 the [[bleeding]] endpoints were significant whether one used the study definition or [[TIMI]] definition. A major caveat is also that [[patients]] who did not get [[plavix]] had increased [[ischemic]] events in the [[bivalirudin]] only arm.
**VALIDATE- SWEDEHEART: This [[clinical trial]] evaluated a prolonged [[bivalirudin]] infusion versus [[UFH]].<ref name="pmid28844201">{{cite journal| author=Erlinge D, Omerovic E, Fröbert O, Linder R, Danielewicz M, Hamid M | display-authors=etal| title=Bivalirudin versus Heparin Monotherapy in Myocardial Infarction. | journal=N Engl J Med | year= 2017 | volume= 377 | issue= 12 | pages= 1132-1142 | pmid=28844201 | doi=10.1056/NEJMoa1706443 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28844201 }} </ref> Result did not show any improvement in rates of major adverse cardiovascular events, major [[bleeding]], or [[stent thrombosis]] with [[bivalirudin]] within a 6-month follow up.
*In conclusion, [[bivalirudin]] is an excellent choice in most [[NSTEMI]]/[[UA]] [[patients]] managed with an early invasive strategy if they have been pre-[[treatment|treated]] with [[clopidogrel]]. If this has not been done then [[coagulation|2b/3a]] will need to be used and the benefits of [[bivalirudin]] are greatly attenuated.

==2021 ACA Revascularization Guideline==
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: C-EO<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
|-
| bgcolor="LightGreen"|Administration of [[intravenous]] [[heparin|unfractionated heparin]] ([[heparin|UFH]]) is useful in reducing [[ischemia|ischemia events]] in [[patients]] undergoing [[PCI]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: C-LD<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid12357516">{{cite journal| author=Lewis BE, Matthai WH, Cohen M, Moses JW, Hursting MJ, Leya F | display-authors=etal| title=Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. | journal=Catheter Cardiovasc Interv | year= 2002 | volume= 57 | issue= 2 | pages= 177-84 | pmid=12357516 | doi=10.1002/ccd.10276 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12357516 }} </ref><ref name="pmid14608128">{{cite journal| author=Mahaffey KW, Lewis BE, Wildermann NM, Berkowitz SD, Oliverio RM, Turco MA | display-authors=etal| title=The anticoagulant therapy with bivalirudin to assist in the performance of percutaneous coronary intervention in patients with heparin-induced thrombocytopenia (ATBAT) study: main results. | journal=J Invasive Cardiol | year= 2003 | volume= 15 | issue= 11 | pages= 611-6 | pmid=14608128 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14608128 }} </ref>
|-
| bgcolor="Yellow"|[[Bivalirudin]] or [[argatroban]] should be used instead of [[UFH]] in [[patients]] with [[heparin-induced thrombocytopenia]] who are undergoing [[PCI]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: A<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid18703471">{{cite journal| author=Kastrati A, Neumann FJ, Mehilli J, Byrne RA, Iijima R, Büttner HJ | display-authors=etal| title=Bivalirudin versus unfractionated heparin during percutaneous coronary intervention. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 7 | pages= 688-96 | pmid=18703471 | doi=10.1056/NEJMoa0802944 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18703471 }} </ref><ref name="pmid12588269">{{cite journal| author=Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD | display-authors=etal| title=Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. | journal=JAMA | year= 2003 | volume= 289 | issue= 7 | pages= 853-63 | pmid=12588269 | doi=10.1001/jama.289.7.853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12588269 }} </ref><ref name="pmid17368152">{{cite journal| author=Stone GW, White HD, Ohman EM, Bertrand ME, Lincoff AM, McLaurin BT | display-authors=etal| title=Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial. | journal=Lancet | year= 2007 | volume= 369 | issue= 9565 | pages= 907-19 | pmid=17368152 | doi=10.1016/S0140-6736(07)60450-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17368152 }} </ref><ref name="pmid22077909">{{cite journal| author=Kastrati A, Neumann FJ, Schulz S, Massberg S, Byrne RA, Ferenc M | display-authors=etal| title=Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. | journal=N Engl J Med | year= 2011 | volume= 365 | issue= 21 | pages= 1980-9 | pmid=22077909 | doi=10.1056/NEJMoa1109596 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22077909 }} </ref><ref name="pmid25791214">{{cite journal| author=Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T | display-authors=etal| title=Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. | journal=Lancet | year= 2015 | volume= 385 | issue= 9986 | pages= 2465-76 | pmid=25791214 | doi=10.1016/S0140-6736(15)60292-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25791214 }} </ref><ref name="pmid24171490">{{cite journal| author=Steg PG, van 't Hof A, Hamm CW, Clemmensen P, Lapostolle F, Coste P | display-authors=etal| title=Bivalirudin started during emergency transport for primary PCI. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 23 | pages= 2207-17 | pmid=24171490 | doi=10.1056/NEJMoa1311096 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24171490 }} </ref><ref name="pmid18499566">{{cite journal| author=Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D | display-authors=etal| title=Bivalirudin during primary PCI in acute myocardial infarction. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 21 | pages= 2218-30 | pmid=18499566 | doi=10.1056/NEJMoa0708191 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18499566 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18783187 Review in: ACP J Club. 2008 Sep 16;149(3):11] </ref><ref name="pmid25746943">{{cite journal| author=Capodanno D, Gargiulo G, Capranzano P, Mehran R, Tamburino C, Stone GW| title=Bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary PCI: An updated meta-analysis of 10,350 patients from five randomized clinical trials. | journal=Eur Heart J Acute Cardiovasc Care | year= 2016 | volume= 5 | issue= 3 | pages= 253-62 | pmid=25746943 | doi=10.1177/2048872615572599 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25746943 }} </ref><ref name="pmid25131979">{{cite journal| author=Cavender MA, Sabatine MS| title=Bivalirudin versus heparin in patients planned for percutaneous coronary intervention: a meta-analysis of randomised controlled trials. | journal=Lancet | year= 2014 | volume= 384 | issue= 9943 | pages= 599-606 | pmid=25131979 | doi=10.1016/S0140-6736(14)61216-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25131979 }} </ref><ref name="pmid30636368">{{cite journal| author=Shah R, Latham SB, Porta JM, Naz A, Matin K, Rao SV| title=Bivalirudin with a post-procedure infusion versus heparin monotherapy for the prevention of stent thrombosis. | journal=Catheter Cardiovasc Interv | year= 2019 | volume= 94 | issue= 2 | pages= 210-215 | pmid=30636368 | doi=10.1002/ccd.28065 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636368 }} </ref>
|-
| bgcolor="Lightblue"|[[Bivalirudin]] could be used as a reasonable alternative to [[UFH]] in order to reduce [[bleeding]] in [[patients]] undergoing [[PCI]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:lightgray"|Class 2b Recommendation, Level of Evidence: B-BR<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid11479456">{{cite journal| author=Blazing MA, De Lemos JA, Dyke CK, Califf RM, Bilheimer D, Braunwald E| title=The A-to-Z Trial: Methods and rationale for a single trial investigating combined use of low-molecular-weight heparin with the glycoprotein IIb/IIIa inhibitor tirofiban and defining the efficacy of early aggressive simvastatin therapy. | journal=Am Heart J | year= 2001 | volume= 142 | issue= 2 | pages= 211-7 | pmid=11479456 | doi=10.1067/mhj.2001.116959 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11479456 }} </ref><ref name="pmid15238590">{{cite journal| author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S | display-authors=etal| title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. | journal=JAMA | year= 2004 | volume= 292 | issue= 1 | pages= 45-54 | pmid=15238590 | doi=10.1001/jama.292.1.45 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15238590 }} </ref><ref name="pmid21856483">{{cite journal| author=Montalescot G, Zeymer U, Silvain J, Boulanger B, Cohen M, Goldstein P | display-authors=etal| title=Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. | journal=Lancet | year= 2011 | volume= 378 | issue= 9792 | pages= 693-703 | pmid=21856483 | doi=10.1016/S0140-6736(11)60876-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21856483 }} </ref><ref name="pmid0.1136/bmj.e553">{{cite journal| author=Raffle A, Gray J, MacDonald HR| title=Letter: First-aid treatment of poisoning. | journal=Br Med J | year= 1976 | volume= 1 | issue= 6001 | pages= 93 | pmid=0.1136/bmj.e553 | doi=10.1136/bmj.1.6001.93-a | pmc=1638368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1136 }} </ref><ref name="pmid16957147">{{cite journal| author=Montalescot G, White HD, Gallo R, Cohen M, Steg PG, Aylward PE | display-authors=etal| title=Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 10 | pages= 1006-17 | pmid=16957147 | doi=10.1056/NEJMoa052711 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16957147 }} </ref>
|-
| bgcolor="lightgray"|In [[patients]] who have been treated with upstream [[subcutaneous]] [[enoxaparin]] for either [[unstable angina]] or [[NSTE-ACS]], [[intravenous]] [[enoxaparin]] could be considered at the time of [[PCI]] in order to reduce [[ischemia|ischemic events]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:lightpink"|Class 3 Recommendation (HARM), Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid15238590">{{cite journal| author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S | display-authors=etal| title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. | journal=JAMA | year= 2004 | volume= 292 | issue= 1 | pages= 45-54 | pmid=15238590 | doi=10.1001/jama.292.1.45 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15238590 }} </ref><ref name="pmid19619692">{{cite journal| author=Drouet L, Bal dit Sollier C, Martin J| title=Adding intravenous unfractionated heparin to standard enoxaparin causes excessive anticoagulation not detected by activated clotting time: results of the STACK-on to ENOXaparin (STACKENOX) study. | journal=Am Heart J | year= 2009 | volume= 158 | issue= 2 | pages= 177-84 | pmid=19619692 | doi=10.1016/j.ahj.2009.05.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19619692 }} </ref><ref name="pmid17010793">{{cite journal| author=Cohen M, Mahaffey KW, Pieper K, Pollack CV, Antman EM, Hoekstra J | display-authors=etal| title=A subgroup analysis of the impact of prerandomization antithrombin therapy on outcomes in the SYNERGY trial: enoxaparin versus unfractionated heparin in non-ST-segment elevation acute coronary syndromes. | journal=J Am Coll Cardiol | year= 2006 | volume= 48 | issue= 7 | pages= 1346-54 | pmid=17010793 | doi=10.1016/j.jacc.2006.05.058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17010793 }} </ref>
|-
| bgcolor="lightpink"|[[UFH]] should be avoid in [[patients]] who are on therapeutic [[subcutaneous]] [[enoxaparin]], and have received the last [[dose]] within 12 hours of [[PCI]] due to higher rate of [[bleeding]].
|}

==ACCF/AHA/SCAI 2011 Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
===Use of Parenteral Anticoagulants during PCI (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' An [[anticoagulant]] should be administered to patients undergoing PCI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
===Unfractionated Heparin (DO NOT EDIT)<ref name="pmid22070837">{{cite journal|author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions|journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24|pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Administration of [[intravenous]] [[UFH]] is useful in patients undergoing PCI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

===Enoxaparin (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH|title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions|journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24|pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' An additional dose of 0.3 mg/kg [[enoxaparin|intravenous enoxaparin]] should be administered at the time of PCI to patients who have received fewer than 2 therapeutic subcutaneous doses (e.g., 1 mg/kg) or received the last subcutaneous[[enoxaparin]] dose 8 to 12 hours before PCI.<ref name="pmid15238590">{{cite journal |author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, Kereiakes DJ, Langer A, Mahaffey KW, Nessel CC, Armstrong PW, Avezum A, Aylward P, Becker RC, Biasucci L, Borzak S, Col J, Frey MJ, Fry E, Gulba DC, Guneri S, Gurfinkel E, Harrington R, Hochman JS, Kleiman NS, Leon MB, Lopez-Sendon JL, Pepine CJ, Ruzyllo W, Steinhubl SR, Teirstein PS, Toro-Figueroa L, White H |title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial|journal=[[JAMA : the Journal of the American Medical Association]] |volume=292 |issue=1 |pages=45–54 |year=2004 |month=July|pmid=15238590|doi=10.1001/jama.292.1.45 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15238590 |accessdate=2011-12-15}}</ref><ref name="pmid20432399">{{cite journal|author=Cohen M, Levine GN, Pieper KS, Lan L, Antman EM, Aylward PE, White HD, Kleiman NS, Califf RM, Mahaffey KW |title=Enoxaparin 0.3 mg/kg IV supplement for patients transitioning to PCI after subcutaneous enoxaparin therapy for NSTE ACS: a subgroup analysis from the SYNERGY trial|journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=75 |issue=6 |pages=928–35 |year=2010 |month=May|pmid=20432399 |doi=10.1002/ccd.22340|url=http://dx.doi.org/10.1002/ccd.22340|accessdate=2011-12-15}}</ref><ref name="pmid15077081">{{cite journal |author=Collet JP, Montalescot G, Golmard JL, Tanguy ML, Ankri A, Choussat R, Beygui F, Drobinski G, Vignolles N, Thomas D|title=Subcutaneous enoxaparin with early invasive strategy in patients with acute coronary syndromes |journal=[[American Heart Journal]] |volume=147 |issue=4 |pages=655–61|year=2004|month=April |pmid=15077081|doi=10.1016/j.ahj.2003.10.019|url=http://linkinghub.elsevier.com/retrieve/pii/S0002870303007609|accessdate=2011-12-15}}</ref><ref name="pmid15353913">{{cite journal |author=Levine GN, Ferrando T|title=Degree of anticoagulation after one subcutaneous and one subsequent intravenous booster dose of enoxaparin: implications for patients with acute coronary syndromes undergoing early percutaneous coronary intervention |journal=[[Journal of Thrombosis and Thrombolysis]] |volume=17 |issue=3|pages=167–71 |year=2004 |month=June |pmid=15353913|doi=10.1023/B:THRO.0000040484.99422.77|url=http://www.kluweronline.com/art.pdf?issn=0929-5305&volume=17&page=167|accessdate=2011-12-15}}</ref><ref name="pmid14755805">{{cite journal |author=Martin JL, Fry ET, Sanderink GJ, Atherley TH, Guimart CM, Chevalier PJ, Ozoux ML, Pensyl CE, Bigonzi F |title=Reliable anticoagulation with enoxaparin in patients undergoing percutaneous coronary intervention: The pharmacokinetics of enoxaparin in PCI (PEPCI) study |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=61|issue=2 |pages=163–70|year=2004 |month=February |pmid=14755805 |doi=10.1002/ccd.10726|url=http://dx.doi.org/10.1002/ccd.10726 |accessdate=2011-12-15}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Unstable angina / non ST elevation myocardial infarction low molecular weight heparin therapy|Unfractionated heparin (UFH)]] should not be given to patients already receiving therapeutic [[enoxaparin|subcutaneous enoxaparin]].<ref name="pmid15238590">{{cite journal |author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, Kereiakes DJ, Langer A, Mahaffey KW, Nessel CC, Armstrong PW, Avezum A, Aylward P, Becker RC, Biasucci L, Borzak S, Col J, Frey MJ, Fry E, Gulba DC, Guneri S, Gurfinkel E, Harrington R, Hochman JS, Kleiman NS, Leon MB, Lopez-Sendon JL, Pepine CJ, Ruzyllo W, Steinhubl SR, Teirstein PS, Toro-Figueroa L, White H |title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial |journal=[[JAMA :the Journal of the American Medical Association]] |volume=292 |issue=1 |pages=45–54 |year=2004|month=July |pmid=15238590 |doi=10.1001/jama.292.1.45|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15238590 |accessdate=2011-12-15}}</ref><ref name="pmid19619692">{{cite journal|author=Drouet L, Bal dit Sollier C, Martin J |title=Adding intravenous unfractionated heparin to standard enoxaparin causes excessive anticoagulation not detected by activated clotting time: results of the STACK-on to ENOXaparin (STACKENOX) study |journal=[[American Heart Journal]]|volume=158 |issue=2 |pages=177–84 |year=2009 |month=August|pmid=19619692|doi=10.1016/j.ahj.2009.05.022|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00386-X|accessdate=2011-12-15}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Performance of [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI|PCI]] with [[enoxaparin]] may be reasonable in patients either treated with ''upstream'' [[enoxaparin|subcutaneous enoxaparin]] for[[Unstable angina / non ST elevation myocardial infarction|UA/NSTEMI]] or who have not received prior [[Unstable angina / non ST elevation myocardial infarction anticoagulant therapy|antithrombin therapy]] and are administered [[enoxaparin|intravenous enoxaparin]] at the time of[[Unstable angina / non ST elevation myocardial infarction recommendations for PCI|PCI]].<ref name="pmid20578166">{{cite journal|author=Brieger D, Collet JP, Silvain J, Landivier A, Barthélémy O, Beygui F, Bellemain-Appaix A, Mercadier A, Choussat R, Vignolles N, Costagliola D, Montalescot G |title=Heparin or enoxaparin anticoagulation for primary percutaneous coronary intervention|journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]]|volume=77|issue=2 |pages=182–90 |year=2011 |month=February |pmid=20578166 |doi=10.1002/ccd.22674|url=http://dx.doi.org/10.1002/ccd.22674|accessdate=2011-12-15}}</ref><ref name="pmid12475453">{{cite journal |author=Choussat R, Montalescot G, Collet JP, Vicaut E, Ankri A, Gallois V, Drobinski G, Sotirov I, Thomas D |title=A unique, low dose of intravenous enoxaparin in elective percutaneous coronary intervention|journal=[[Journal of the American College of Cardiology]] |volume=40 |issue=11 |pages=1943–50 |year=2002 |month=December |pmid=12475453|doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702025317|accessdate=2011-12-15}}</ref><ref name="pmid15238590">{{cite journal|author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, Kereiakes DJ, Langer A, Mahaffey KW, Nessel CC, Armstrong PW, Avezum A, Aylward P, Becker RC, Biasucci L, Borzak S, Col J, Frey MJ, Fry E, Gulba DC, Guneri S, Gurfinkel E, Harrington R, Hochman JS, Kleiman NS, Leon MB, Lopez-Sendon JL, Pepine CJ, Ruzyllo W, Steinhubl SR, Teirstein PS, Toro-Figueroa L, White H |title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial |journal=[[JAMA :the Journal of the American Medical Association]] |volume=292 |issue=1 |pages=45–54|year=2004|month=July |pmid=15238590 |doi=10.1001/jama.292.1.45 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15238590|accessdate=2011-12-15}}</ref><ref name="pmid19926048">{{cite journal|author=Montalescot G, Gallo R, White HD, Cohen M, Steg PG, Aylward PE, Bode C, Chiariello M, King SB, Harrington RA, Desmet WJ, Macaya C, Steinhubl SR |title=Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention 1-year results from the STEEPLE (SafeTy and efficacy of enoxaparin in percutaneous coronary intervention patients, an international randomized evaluation) trial |journal=[[JACC. Cardiovascular Interventions]] |volume=2 |issue=11|pages=1083–91|year=2009 |month=November |pmid=19926048|doi=10.1016/j.jcin.2009.08.016|url=http://linkinghub.elsevier.com/retrieve/pii/S1936-8798(09)00581-0|accessdate=2011-12-15}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

===Bivalirudin and Argatoban (DO NOT EDIT)<ref name="pmid22070837">{{cite journal|author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]]|volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' For patients undergoing PCI, [[bivalirudin]] is useful as an anticoagulant with or without prior treatment with [[UFH|unfractionated heparin (UFH)]].<ref name="pmid19718462">{{cite journal|author=De Luca G, Cassetti E, Verdoia M, Marino P |title=Bivalirudin as compared to unfractionated heparin among patients undergoing coronary angioplasty: A meta-analyis of randomised trials|journal=[[Thrombosis and Haemostasis]] |volume=102 |issue=3 |pages=428–36 |year=2009|month=September |pmid=19718462|doi=10.1160/TH09-05-0287 |url=http://www.schattauer.de/index.php?id=1268&L=1&pii=th09-05-0287&no_cache=1 |accessdate=2011-12-15}}</ref><ref name="pmid19463378">{{cite journal |author=Lincoff AM, Steinhubl SR, Manoukian SV, Chew D, Pollack CV, Feit F, Ware JH, Bertrand ME, Ohman EM, Desmet W, Cox DA, Mehran R, Stone GW |title=Influence of timing of clopidogrel treatment on the efficacy and safety of bivalirudin in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention: an analysis of the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial|journal=[[JACC. Cardiovascular Interventions]] |volume=1 |issue=6 |pages=639–48|year=2008|month=December |pmid=19463378|doi=10.1016/j.jcin.2008.10.004|url=http://linkinghub.elsevier.com/retrieve/pii/S1936-8798(08)00438-X|accessdate=2011-12-15}}</ref><ref name="pmid18703471">{{cite journal |author=Kastrati A, Neumann FJ, Mehilli J, Byrne RA, Iijima R, Büttner HJ, Khattab AA, Schulz S, Blankenship JC, Pache J, Minners J, Seyfarth M, Graf I, Skelding KA, Dirschinger J, Richardt G, Berger PB, Schömig A|title=Bivalirudin versus unfractionated heparin during percutaneous coronary intervention|journal=[[The New England Journal of Medicine]] |volume=359 |issue=7|pages=688–96 |year=2008|month=August |pmid=18703471 |doi=10.1056/NEJMoa0802944|url=http://dx.doi.org/10.1056/NEJMoa0802944|accessdate=2011-12-15}}</ref><ref name="pmid15304466">{{cite journal |author=Lincoff AM, Kleiman NS, Kereiakes DJ, Feit F, Bittl JA, Jackman JD, Sarembock IJ, Cohen DJ, Spriggs D, Ebrahimi R, Keren G, Carr J, Cohen EA, Betriu A, Desmet W, Rutsch W, Wilcox RG, de Feyter PJ, Vahanian A, Topol EJ|title=Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial|journal=[[JAMA : the Journal of the American Medical Association]] |volume=292|issue=6 |pages=696–703 |year=2004 |month=August |pmid=15304466|doi=10.1001/jama.292.6.696|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15304466|accessdate=2011-12-15}}</ref><ref name="pmid19717185">{{cite journal |author=Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Wong SC, Nikolsky E, Gambone L, Vandertie L, Parise H, Dangas GD, Stone GW|title=Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial|journal=[[Lancet]] |volume=374|issue=9696 |pages=1149–59 |year=2009 |month=October|pmid=19717185|doi=10.1016/S0140-6736(09)61484-7|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(09)61484-7|accessdate=2011-12-15}}</ref><ref name="pmid20150324">{{cite journal |author=Schulz S, Mehilli J, Ndrepepa G, Neumann FJ, Birkmeier KA, Kufner S, Richardt G, Berger PB, Schömig A, Kastrati A|title=Bivalirudin vs. unfractionated heparin during percutaneous coronary interventions in patients with stable and unstable angina pectoris: 1-year results of the ISAR-REACT 3 trial|journal=[[European Heart Journal]] |volume=31 |issue=5 |pages=582–7 |year=2010|month=March|pmid=20150324 |doi=10.1093/eurheartj/ehq008|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20150324|accessdate=2011-12-15}}</ref><ref name="pmid17124018">{{cite journal |author=Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, White HD, Pocock SJ, Ware JH, Feit F, Colombo A, Aylward PE, Cequier AR, Darius H, Desmet W, Ebrahimi R, Hamon M, Rasmussen LH, Rupprecht HJ, Hoekstra J, Mehran R, Ohman EM |title=Bivalirudin for patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=355 |issue=21 |pages=2203–16 |year=2006 |month=November|pmid=17124018 |doi=10.1056/NEJMoa062437|url=http://dx.doi.org/10.1056/NEJMoa062437|accessdate=2011-12-15}}</ref><ref name="pmid18499566">{{cite journal |author=Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Dangas G, Wong SC, Kirtane AJ, Parise H, Mehran R |title=Bivalirudin during primary PCI in acute myocardial infarction |journal=[[The New England Journal of Medicine]]|volume=358|issue=21 |pages=2218–30 |year=2008 |month=May |pmid=18499566|doi=10.1056/NEJMoa0708191|url=http://dx.doi.org/10.1056/NEJMoa0708191 |accessdate=2011-12-15}}</ref><ref name="pmid19796737">{{cite journal|author=Dangas G, Mehran R, Guagliumi G, Caixeta A, Witzenbichler B, Aoki J, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Rabbani LE, Parise H, Stone GW |title=Role of clopidogrel loading dose in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: results from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=15 |pages=1438–46 |year=2009 |month=October|pmid=19796737|doi=10.1016/j.jacc.2009.06.021|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02367-5|accessdate=2011-12-15}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' For patients with [[heparin-induced thrombocytopenia]], it is recommended that [[bivalirudin]] or [[argatroban]] be used to replace [[UFH|unfractionated heparin (UFH)]].<ref name="pmid12357516">{{cite journal|author=Lewis BE, Matthai WH, Cohen M, Moses JW, Hursting MJ, Leya F |title=Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia |journal=[[Catheterization and Cardiovascular Interventions :Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=57 |issue=2|pages=177–84 |year=2002 |month=October |pmid=12357516|doi=10.1002/ccd.10276|url=http://dx.doi.org/10.1002/ccd.10276 |accessdate=2011-12-15}}</ref><ref name="pmid14608128">{{cite journal|author=Mahaffey KW, Lewis BE, Wildermann NM, Berkowitz SD, Oliverio RM, Turco MA, Shalev Y, Ver Lee P, Traverse JH, Rodriguez AR, Ohman EM, Harrington RA, Califf RM |title=The anticoagulant therapy with bivalirudin to assist in the performance of percutaneous coronary intervention in patients with heparin-induced thrombocytopenia (ATBAT) study: main results |journal=[[The Journal of Invasive Cardiology]] |volume=15|issue=11 |pages=611–6|year=2003 |month=November |pmid=14608128 |doi= |url= |accessdate=2011-12-15}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

===Fondaparinux (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH|title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions|journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24|pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Fondaparinux]] should not be used as the sole anticoagulant to support PCI. An additional anticoagulant with anti-IIa activity should be administered because of the risk of [[thrombosis|catheter thrombosis]].<ref name="pmid16537663">{{cite journal |author=Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA |title=Comparison of fondaparinux and enoxaparin in acute coronary syndromes|journal=[[The New England Journal of Medicine]] |volume=354 |issue=14 |pages=1464–76 |year=2006|month=April |pmid=16537663 |doi=10.1056/NEJMoa055443|url=http://dx.doi.org/10.1056/NEJMoa055443|accessdate=2011-12-15}}</ref><ref name="pmid16537725">{{cite journal |author=Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA |title=Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial |journal=[[JAMA :the Journal of the American Medical Association]] |volume=295 |issue=13 |pages=1519–30 |year=2006|month=April |pmid=16537725|doi=10.1001/jama.295.13.joc60038|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=16537725 |accessdate=2011-12-15}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
==References==
{{reflist|2}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[CME Category::Cardiology]]

[[Category:Cardiology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date Cardiology]]
[[Category:Needs overview]]

Antithrombin therapy to support PCI

2022-09-05T03:07:21Z

Anahita:

__NOTOC__
{{PCI}}
{{CMG}} {{AE}} {{Anahita}}

==Antithrombin Therapy to Support PCI==
*[[Antithrombotic therapy]] is a centerpiece [[treatment]] in [[patients]] who are undergoing [[PCI]]. Currently, the following three [[antithrombotic]] agents have been studied among [[patient]] who have undergone [[PCI]]:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Heparin|Unfractioned Heparin]] ([[UFH]])
**[[Bivalirudin]]
**[[Enoxaparin]]
*Using [[fondaparinux]] is not recommended as the only [[anticoagulant]] in [[PCI]] [[patients]] due to a higher [[incidence]] of guiding-[[catheter]] [[thrombosis]].<ref name="pmid16537663">{{cite journal| author=Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators. Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J | display-authors=etal| title=Comparison of fondaparinux and enoxaparin in acute coronary syndromes. | journal=N Engl J Med | year= 2006 | volume= 354 | issue= 14 | pages= 1464-76 | pmid=16537663 | doi=10.1056/NEJMoa055443 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16537663 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16944851 Review in: ACP J Club. 2006 Sep-Oct;145(2):30-1] </ref><ref name="pmid16537725">{{cite journal| author=Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB | display-authors=etal| title=Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. | journal=JAMA | year= 2006 | volume= 295 | issue= 13 | pages= 1519-30 | pmid=16537725 | doi=10.1001/jama.295.13.joc60038 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16537725 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=16944849 Review in: ACP J Club. 2006 Sep-Oct;145(2):29] </ref>
*Selection of an optimal [[anticoagulant]] should be done by considering the [[patient]]’s clinical presentation such as [[Chronic stable angina definition|stable ischemic disease]], [[Unstable angina / non ST-elevation myocardial infarction|NSTE-ACS]], or [[STEMI]], and [[bleeding]] probability.<ref name="pmid23500304">{{cite journal| author=Rao SC, Chhatriwalla AK, Kennedy KF, Decker CJ, Gialde E, Spertus JA | display-authors=etal| title=Pre-procedural estimate of individualized bleeding risk impacts physicians' utilization of bivalirudin during percutaneous coronary intervention. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 18 | pages= 1847-52 | pmid=23500304 | doi=10.1016/j.jacc.2013.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23500304 }} </ref>
*The following table represents the [[dose|dosing]] of [[parenteral]] [[anticoagulant]] during [[PCI]]:<ref name="pmid17560287">{{cite journal| author=Gibson CM, Murphy SA, Montalescot G, Morrow DA, Ardissino D, Cohen M | display-authors=etal| title=Percutaneous coronary intervention in patients receiving enoxaparin or unfractionated heparin after fibrinolytic therapy for ST-segment elevation myocardial infarction in the ExTRACT-TIMI 25 trial. | journal=J Am Coll Cardiol | year= 2007 | volume= 49 | issue= 23 | pages= 2238-46 | pmid=17560287 | doi=10.1016/j.jacc.2007.01.093 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560287 }} </ref><ref name="pmid15353913">{{cite journal| author=Levine GN, Ferrando T| title=Degree of anticoagulation after one subcutaneous and one subsequent intravenous booster dose of enoxaparin: implications for patients with acute coronary syndromes undergoing early percutaneous coronary intervention. | journal=J Thromb Thrombolysis | year= 2004 | volume= 17 | issue= 3 | pages= 167-71 | pmid=15353913 | doi=10.1023/B:THRO.0000040484.99422.77 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15353913 }} </ref><ref name="pmid14755805">{{cite journal| author=Martin JL, Fry ET, Sanderink GJ, Atherley TH, Guimart CM, Chevalier PJ | display-authors=etal| title=Reliable anticoagulation with enoxaparin in patients undergoing percutaneous coronary intervention: The pharmacokinetics of enoxaparin in PCI (PEPCI) study. | journal=Catheter Cardiovasc Interv | year= 2004 | volume= 61 | issue= 2 | pages= 163-70 | pmid=14755805 | doi=10.1002/ccd.10726 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14755805 }} </ref>
{| class="wikitable"
|-
! style="background-color:#ffffc7;" | Drug
! style="background-color:#ffffc7;" | For Patients Who Received Previous Anticoagulant Therapy
! style="background-color:#ffffc7;" | For Patients Who Did Not Received Any Anticoagulant Therapy
|-
| style="background-color:#ffffff;" | [[UFH]]
| style="background-color:#ffffff;" | Additional [[UFH]] as needed (e.g., 2000 – 5000 U) to achieve the [[activated clotting time]] ([[activated clotting time|ACT]]) of 250-300 seconds.
| style="background-color:#ffffff;" | 70–100 U/kg initial [[bolus]] to achieve the target [[activated clotting time|ACT]] of 250–300 seconds.
|-
| style="background-color:#ffffff;" | [[Enoxaparin]]
| style="background-color:#ffffff;" | *An [[intravenous therapy|intravenous]] [[dose]] of 0.3 mg/kg of [[enoxaparin]] for [[patients]] who received previous [[treatment]] with [[subcutaneous tissue]] [[enoxaparin]] within the last 8 –12 hours.
*If the last [[subcutaneous tissue]] [[dose]] was administered within the previous 8 hours, no additional [[enoxaparin]] should be given
| style="background-color:#ffffff;" | 0.5 – 0.75 mg/kg [[intravenous therapy|intravenous]] [[bolus]]
|-
| style="background-color:#ffffff;" | [[Bivalirudin]]
| style="background-color:#ffffff;" | For [[patients]] who have received [[UFH]], repeat [[activated clotting time|ACT]], if [[activated clotting time|ACT]] is not in the [[therapeutic range]], then give a 0.75 mg/kg [[intravenous therapy|intravenous]] [[bolus]], then continue with a 1.75 mg/kg/h [[intravenous therapy|intravenous]] [[infusion]].
| style="background-color:#ffffff;" | 0.75 mg/kg [[bolus]], then continue with a 1.75 mg/kg/h [[intravenous therapy|intravenous]] [[infusion]].
|-
| style="background-color:#ffffff;" | [[Argatroban]]
| style="background-color:#ffffff;" | 200 mg/kg [[intravenous therapy|intravenous]] [[bolus]], then continue with a 15 mg/kg/min [[intravenous therapy|intravenous]] [[infusion]].
| style="background-color:#ffffff;" | 350 mg/kg, then continue with a 15 mg/kg/min [[intravenous therapy|intravenous]] [[infusion]].
|}
HemoTec (GmbH, Switzerland) or I-Stat (Abbott) device can be used to check [[activated clotting time]] ([[activated clotting time|ACT]]) for [[UFH]] [[dose|dosing]]. However, [[activated clotting time]] ([[activated clotting time|ACT]]) goals are 50 seconds higher for Hemochron ACT (Werfen) devices. Furthermore, it is recommended to consider the higher target [[activated clotting time|ACT]] in [[patients]] with [[chronic total occlusion]]. On the other hand, target [[activated clotting time|ACT]] should be 200-250 seconds if a [[intravenous therapy|intravenous]] [[glycoprotein IIb/IIIa inhibitors]] is selected.<ref name="pmid8640994">{{cite journal| author=Narins CR, Hillegass WB, Nelson CL, Tcheng JE, Harrington RA, Phillips HR | display-authors=etal| title=Relation between activated clotting time during angioplasty and abrupt closure. | journal=Circulation | year= 1996 | volume= 93 | issue= 4 | pages= 667-71 | pmid=8640994 | doi=10.1161/01.cir.93.4.667 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8640994 }} </ref><ref name="pmid15302778">{{cite journal| author=Brener SJ, Moliterno DJ, Lincoff AM, Steinhubl SR, Wolski KE, Topol EJ| title=Relationship between activated clotting time and ischemic or hemorrhagic complications: analysis of 4 recent randomized clinical trials of percutaneous coronary intervention. | journal=Circulation | year= 2004 | volume= 110 | issue= 8 | pages= 994-8 | pmid=15302778 | doi=10.1161/01.CIR.0000139868.53594.24 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15302778 }} </ref><ref name="pmid18276619">{{cite journal| author=Montalescot G, Cohen M, Salette G, Desmet WJ, Macaya C, Aylward PE | display-authors=etal| title=Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: insights from the STEEPLE trial. | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 4 | pages= 462-71 | pmid=18276619 | doi=10.1093/eurheartj/ehn008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18276619 }} </ref><ref name="pmid11181470">{{cite journal| author=Chew DP, Bhatt DL, Lincoff AM, Moliterno DJ, Brener SJ, Wolski KE | display-authors=etal| title=Defining the optimal activated clotting time during percutaneous coronary intervention: aggregate results from 6 randomized, controlled trials. | journal=Circulation | year= 2001 | volume= 103 | issue= 7 | pages= 961-6 | pmid=11181470 | doi=10.1161/01.cir.103.7.961 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11181470 }} </ref><ref name="pmid9129894">{{cite journal| author=Boccara A, Benamer H, Juliard JM, Aubry P, Goy P, Himbert D | display-authors=etal| title=A randomized trial of a fixed high dose vs a weight-adjusted low dose of intravenous heparin during coronary angioplasty. | journal=Eur Heart J | year= 1997 | volume= 18 | issue= 4 | pages= 631-5 | pmid=9129894 | doi=10.1093/oxfordjournals.eurheartj.a015308 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9129894 }} </ref><ref name="pmid20805113">{{cite journal| author=Schulz S, Mehilli J, Neumann FJ, Schuster T, Massberg S, Valina C | display-authors=etal| title=ISAR-REACT 3A: a study of reduced dose of unfractionated heparin in biomarker negative patients undergoing percutaneous coronary intervention. | journal=Eur Heart J | year= 2010 | volume= 31 | issue= 20 | pages= 2482-91 | pmid=20805113 | doi=10.1093/eurheartj/ehq330 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20805113 }} </ref>
===Unfractionated Heparin (UFH)===
*[[Intravenous]] [[unfractionated heparin]] is the most common [[anticoagulant]] and has been the standard of care by default.<ref name="pmid7643883">{{cite journal| author=Bittl JA, Strony J, Brinker JA, Ahmed WH, Meckel CR, Chaitman BR | display-authors=etal| title=Treatment with bivalirudin (Hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina. Hirulog Angioplasty Study Investigators. | journal=N Engl J Med | year= 1995 | volume= 333 | issue= 12 | pages= 764-9 | pmid=7643883 | doi=10.1056/NEJM199509213331204 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7643883 }} </ref>
*Since studies on [[UFH]] [[dose|dosing]] have been done years ago, there is no evidence that previously recommended [[doses]] can be used in the modern [[coronary stent]] era. Therefore, the effectiveness of [[UFH]] [[dose|dosing]] based on [[activated clotting time]] in modern practice is uncertain.<ref name="pmid15302778">{{cite journal| author=Brener SJ, Moliterno DJ, Lincoff AM, Steinhubl SR, Wolski KE, Topol EJ| title=Relationship between activated clotting time and ischemic or hemorrhagic complications: analysis of 4 recent randomized clinical trials of percutaneous coronary intervention. | journal=Circulation | year= 2004 | volume= 110 | issue= 8 | pages= 994-8 | pmid=15302778 | doi=10.1161/01.CIR.0000139868.53594.24 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15302778 }} </ref><ref name="pmid27545117">{{cite journal| author=Mottillo S, Filion KB, Joseph L, Eisenberg MJ| title=Defining optimal activated clotting time for percutaneous coronary intervention: A systematic review and Bayesian meta-regression. | journal=Catheter Cardiovasc Interv | year= 2017 | volume= 89 | issue= 3 | pages= 351-366 | pmid=27545117 | doi=10.1002/ccd.26652 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27545117 }} </ref><ref name="pmid24371012">{{cite journal| author=Schulz S, Angiolillo DJ, Antoniucci D, Bernlochner I, Hamm C, Jaitner J | display-authors=etal| title=Randomized comparison of ticagrelor versus prasugrel in patients with acute coronary syndrome and planned invasive strategy--design and rationale of the iNtracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial. | journal=J Cardiovasc Transl Res | year= 2014 | volume= 7 | issue= 1 | pages= 91-100 | pmid=24371012 | doi=10.1007/s12265-013-9527-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24371012 }} </ref><ref name="pmid12575964">{{cite journal| author=Tolleson TR, O'Shea JC, Bittl JA, Hillegass WB, Williams KA, Levine G | display-authors=etal| title=Relationship between heparin anticoagulation and clinical outcomes in coronary stent intervention: observations from the ESPRIT trial. | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 3 | pages= 386-93 | pmid=12575964 | doi=10.1016/s0735-1097(02)02767-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12575964 }} </ref><ref name="pmid18276619">{{cite journal| author=Montalescot G, Cohen M, Salette G, Desmet WJ, Macaya C, Aylward PE | display-authors=etal| title=Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: insights from the STEEPLE trial. | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 4 | pages= 462-71 | pmid=18276619 | doi=10.1093/eurheartj/ehn008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18276619 }} </ref>
*Furthermore, the routine use of full [[dose]] [[anticoagulation therapy]] after [[PCI]] is no longer indicated.
====Mechanism of action====
[[Heparin]] is a [[glycosaminoglycan]] of 12-15 kDa that binds [[Anti-thrombin 3]] and facilitates its ability to inhibit [[thrombin|coagulation factors 2a]] ([[thrombin]]) and [[coagulation factor Xa|10a]] by a factor of 1000. [[Thrombin]] plays a central role not only in [[plasma]] [[coagulation]] (by [[catalysing]] [[fibrinogen]] to [[fibrin]] as well as activating several [[coagulation factor]]s) but [[platelet activation]] as well.

====Advantages====
* [[Physician]] familiarity with the use
* Level of [[anticoagulation]] can be [[titrate]]d with [[activated clotting time]] ([[activated clotting time|ACT]]). Target [[activated clotting time|ACT]] typically 200-250 with [[coagulation|2b/3a]] and 250-350 without [[coagulation|2b/3a]] (these levels have been empirically derived and target ACT's have fallen in the [[stent]] era as the risk for [[acute]] [[vessel]] closure has diminished).
* Can be reversed with [[protamine]] (1mg of [[protamine]] for 100u of [[heparin]] acutely) in case of [[coronary artery perforation]] or [[vascular]] access [[complication]].
* No [[dose]] adjustment needed for [[renal dysfunction]]
* Inexpensive

====Disadvantages====
* Significant [[protein]] binding
* Monitoring required as the level of [[anticoagulation]] varies widely between [[patients]]
* Inability to inactive [[clot]]-bound [[thrombin]]
* Does not prevent the [[platelet activation]] of [[thrombin]]
* Risk of [[Heparin Induced Thrombocytopenia]] ([[Heparin Induced Thrombocytopenia|HIT]]).

===Low Molecular Weight Heparinoids (LMWH)===
*The following [[medicines]] belong to the [[low molecular weight heparins]]:<ref>{{cite journal | author=Linhardt, R.J. Gunay, N. S. | title=Production and chemical processing of low molecular weight heparins | journal=Sem. Thromb. Hem. | year=1999 | pages=5-16 | volume=25 | issue=3}}</ref>
**[[Enoxaparin]]
**[[Parnaparin]]
**[[Dalteparin]]
**[[Ardeparin]]
**[[Certoparin]]
====Enoxaparin====
*[[Enoxaparin]] is considered a safe alternative for [[UFH]]. <ref name="pmid15238590">{{cite journal| author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S | display-authors=etal| title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. | journal=JAMA | year= 2004 | volume= 292 | issue= 1 | pages= 45-54 | pmid=15238590 | doi=10.1001/jama.292.1.45 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15238590 }} </ref><ref name="pmid21856483">{{cite journal| author=Montalescot G, Zeymer U, Silvain J, Boulanger B, Cohen M, Goldstein P | display-authors=etal| title=Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. | journal=Lancet | year= 2011 | volume= 378 | issue= 9792 | pages= 693-703 | pmid=21856483 | doi=10.1016/S0140-6736(11)60876-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21856483 }} </ref><ref name="pmid22306479">{{cite journal| author=Silvain J, Beygui F, Barthélémy O, Pollack C, Cohen M, Zeymer U | display-authors=etal| title=Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis. | journal=BMJ | year= 2012 | volume= 344 | issue= | pages= e553 | pmid=22306479 | doi=10.1136/bmj.e553 | pmc=3271999 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22306479 }} </ref>
*More [[complication]] is seen in [[patients]] who were given upstream [[enoxaparin]] and then have switched to [[UFH]]. This effect is seen even when [[heparin]] is administered within a 10-hours period after the last [[dose]] of [[enoxaparin]].<ref name="pmid19619692">{{cite journal| author=Drouet L, Bal dit Sollier C, Martin J| title=Adding intravenous unfractionated heparin to standard enoxaparin causes excessive anticoagulation not detected by activated clotting time: results of the STACK-on to ENOXaparin (STACKENOX) study. | journal=Am Heart J | year= 2009 | volume= 158 | issue= 2 | pages= 177-84 | pmid=19619692 | doi=10.1016/j.ahj.2009.05.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19619692 }} </ref><ref name="pmid17010793">{{cite journal| author=Cohen M, Mahaffey KW, Pieper K, Pollack CV, Antman EM, Hoekstra J | display-authors=etal| title=A subgroup analysis of the impact of prerandomization antithrombin therapy on outcomes in the SYNERGY trial: enoxaparin versus unfractionated heparin in non-ST-segment elevation acute coronary syndromes. | journal=J Am Coll Cardiol | year= 2006 | volume= 48 | issue= 7 | pages= 1346-54 | pmid=17010793 | doi=10.1016/j.jacc.2006.05.058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17010793 }} </ref>
*In almost all [[patients]] who are undergoing [[PCI]] and have received 0.5 mg/kg [[intravenous]] [[enoxaparin]], a peak anti-Xa level more than 0.5 IU/mL will be seen.<ref name="pmid18276619">{{cite journal| author=Montalescot G, Cohen M, Salette G, Desmet WJ, Macaya C, Aylward PE | display-authors=etal| title=Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: insights from the STEEPLE trial. | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 4 | pages= 462-71 | pmid=18276619 | doi=10.1093/eurheartj/ehn008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18276619 }} </ref><ref name="pmid12475453">{{cite journal| author=Choussat R, Montalescot G, Collet JP, Vicaut E, Ankri A, Gallois V | display-authors=etal| title=A unique, low dose of intravenous enoxaparin in elective percutaneous coronary intervention. | journal=J Am Coll Cardiol | year= 2002 | volume= 40 | issue= 11 | pages= 1943-50 | pmid=12475453 | doi=10.1016/s0735-1097(02)02531-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12475453 }} </ref>
=====Clinical Trials with Enoxaparin=====
*SYNERGY: This [[clinical trial|trial]] showed no inferiority in [[enoxaparin]] compared to [[UFH]]. Furthermore, this trial showed no difference in the rate of death, [[MI]], or major [[bleeding]] among [[patients]] with [[NSTE-ACS]] who were treated with [[enoxaparin]] compared to [[UFH]].<ref name="pmid15238590">{{cite journal| author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S | display-authors=etal| title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. | journal=JAMA | year= 2004 | volume= 292 | issue= 1 | pages= 45-54 | pmid=15238590 | doi=10.1001/jama.292.1.45 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15238590 }} </ref>
*AtoZ: This [[clinical trial|trial]] showed no inferiority in [[enoxaparin]] compared to [[UFH]]. Furthermore, this trial showed no difference in the rate of death, [[MI]], or major [[bleeding]] among [[patients]] with [[NSTE-ACS]] who were treated with [[enoxaparin]] compared to [[UFH]].<ref name="pmid11479456">{{cite journal| author=Blazing MA, De Lemos JA, Dyke CK, Califf RM, Bilheimer D, Braunwald E| title=The A-to-Z Trial: Methods and rationale for a single trial investigating combined use of low-molecular-weight heparin with the glycoprotein IIb/IIIa inhibitor tirofiban and defining the efficacy of early aggressive simvastatin therapy. | journal=Am Heart J | year= 2001 | volume= 142 | issue= 2 | pages= 211-7 | pmid=11479456 | doi=10.1067/mhj.2001.116959 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11479456 }} </ref>
*ATOLL: This [[clinical trial|trial]] compared [[intravenous]] [[enoxaparin]] with [[UFH]], and reported a reduction in death, recurrent [[ACS]], urgent [[revascularization]], and [[bleeding]] among those who received [[enoxaparin]].<ref name="pmid21856483">{{cite journal| author=Montalescot G, Zeymer U, Silvain J, Boulanger B, Cohen M, Goldstein P | display-authors=etal| title=Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. | journal=Lancet | year= 2011 | volume= 378 | issue= 9792 | pages= 693-703 | pmid=21856483 | doi=10.1016/S0140-6736(11)60876-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21856483 }}</ref>
**This finding is supported by a large [[meta-analysis]] which studied [[patients]] undergoing [[PCI]] for [[STEMI]] and [[NSTE-ACS]].<ref name="pmid22306479">{{cite journal| author=Silvain J, Beygui F, Barthélémy O, Pollack C, Cohen M, Zeymer U | display-authors=etal| title=Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis. | journal=BMJ | year= 2012 | volume= 344 | issue= | pages= e553 | pmid=22306479 | doi=10.1136/bmj.e553 | pmc=3271999 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22306479 }} </ref>

===Direct thrombin inhibitor===
====Mechanism of Action====
* Unlike [[UFH]] or [[low molecular weight heparin]] ([[LMWH]]), [[direct thrombin inhibitor]]s ([[Lepirudin]], [[Argatroban]] and [[Bivalirudin]]) don't require the help of [[AT3|AT-3]] to exert their [[anticoagulation]] effect.
*These medicines are [[Intravenous therapy|IV]] only, but there is great interest in developing safe [[oral]] [[Direct thrombin inhibitor|DTI]] to replace [[coumadin]] in the [[DVT]]/[[PE]] and [[atrial fibrillation]] population.
*The following are some of the [[medications]] belong to this group:<ref name="DiNisio">{{cite journal | author = Di Nisio M, Middeldorp S, Büller H | title = Direct thrombin inhibitors. | journal = N Engl J Med | volume = 353 | issue = 10 | pages = 1028-40 | year = 2005 | id = PMID 16148288}}</ref>
** [[Bivalirudin]]
**[[Desirudin]]
**[[Argatroban]]
**[[Dabigatran]]
**[[Lepirudin]]
*[[Bivalirudin]] ([[Angiomax]]) is the only [[Direct thrombin inhibitor|DTI]] used commonly in the [[cath lab]] although the others have been studied.

====Advantages====
* Short [[half life]]. This facilitates early sheath removal after [[PCI]]
* Can inhibit [[fibrin]]-bound [[thrombin]]
* Simplified [[dosing]] regimen. Can be adjusted for [[patients]] with [[renal insufficiency]].
* Fewer [[bleeding]] [[complication]]s especially at access site. This advantage increases as [[bleeding]] risk increases due to [[aging|age]] and [[renal insufficiency]].
* Best regimen for [[patients]] with known [[HIT]]. Both [[argatroban]] and [[bivalirudin]] are acceptable alternatives for use in [[patients]] with [[heparin-induced thrombocytopenia]].<ref name="pmid12357516">{{cite journal| author=Lewis BE, Matthai WH, Cohen M, Moses JW, Hursting MJ, Leya F | display-authors=etal| title=Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. | journal=Catheter Cardiovasc Interv | year= 2002 | volume= 57 | issue= 2 | pages= 177-84 | pmid=12357516 | doi=10.1002/ccd.10276 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12357516 }} </ref><ref name="pmid14608128">{{cite journal| author=Mahaffey KW, Lewis BE, Wildermann NM, Berkowitz SD, Oliverio RM, Turco MA | display-authors=etal| title=The anticoagulant therapy with bivalirudin to assist in the performance of percutaneous coronary intervention in patients with heparin-induced thrombocytopenia (ATBAT) study: main results. | journal=J Invasive Cardiol | year= 2003 | volume= 15 | issue= 11 | pages= 611-6 | pmid=14608128 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14608128 }} </ref>

====Disadvantages====
*Cost (however this is offset if use of [[bivalirudin]] obviates need for [[coagulation|2b/3a]])

====Trials with Bivalirudin====
*There are numerous studies that compared [[bivalirudin]] and [[heparin]]. Almost all of them did not report any difference in [[ischemia|ischemic endpoints]]; however, less [[bleeding]] was reported with [[bivalirudin]].<ref name="pmid18703471">{{cite journal| author=Kastrati A, Neumann FJ, Mehilli J, Byrne RA, Iijima R, Büttner HJ | display-authors=etal| title=Bivalirudin versus unfractionated heparin during percutaneous coronary intervention. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 7 | pages= 688-96 | pmid=18703471 | doi=10.1056/NEJMoa0802944 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18703471 }} </ref><ref name="pmid12588269">{{cite journal| author=Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD | display-authors=etal| title=Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. | journal=JAMA | year= 2003 | volume= 289 | issue= 7 | pages= 853-63 | pmid=12588269 | doi=10.1001/jama.289.7.853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12588269 }} </ref><ref name="pmid17368152">{{cite journal| author=Stone GW, White HD, Ohman EM, Bertrand ME, Lincoff AM, McLaurin BT | display-authors=etal| title=Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial. | journal=Lancet | year= 2007 | volume= 369 | issue= 9565 | pages= 907-19 | pmid=17368152 | doi=10.1016/S0140-6736(07)60450-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17368152 }} </ref><ref name="pmid22077909">{{cite journal| author=Kastrati A, Neumann FJ, Schulz S, Massberg S, Byrne RA, Ferenc M | display-authors=etal| title=Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. | journal=N Engl J Med | year= 2011 | volume= 365 | issue= 21 | pages= 1980-9 | pmid=22077909 | doi=10.1056/NEJMoa1109596 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22077909 }} </ref><ref name="pmid25791214">{{cite journal| author=Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T | display-authors=etal| title=Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. | journal=Lancet | year= 2015 | volume= 385 | issue= 9986 | pages= 2465-76 | pmid=25791214 | doi=10.1016/S0140-6736(15)60292-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25791214 }} </ref><ref name="pmid18499566">{{cite journal| author=Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D | display-authors=etal| title=Bivalirudin during primary PCI in acute myocardial infarction. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 21 | pages= 2218-30 | pmid=18499566 | doi=10.1056/NEJMoa0708191 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18499566 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18783187 Review in: ACP J Club. 2008 Sep 16;149(3):11] </ref><ref name="pmid24371012">{{cite journal| author=Schulz S, Angiolillo DJ, Antoniucci D, Bernlochner I, Hamm C, Jaitner J | display-authors=etal| title=Randomized comparison of ticagrelor versus prasugrel in patients with acute coronary syndrome and planned invasive strategy--design and rationale of the iNtracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial. | journal=J Cardiovasc Transl Res | year= 2014 | volume= 7 | issue= 1 | pages= 91-100 | pmid=24371012 | doi=10.1007/s12265-013-9527-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24371012 }} </ref><ref name="pmid24371012">{{cite journal| author=Schulz S, Angiolillo DJ, Antoniucci D, Bernlochner I, Hamm C, Jaitner J | display-authors=etal| title=Randomized comparison of ticagrelor versus prasugrel in patients with acute coronary syndrome and planned invasive strategy--design and rationale of the iNtracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial. | journal=J Cardiovasc Transl Res | year= 2014 | volume= 7 | issue= 1 | pages= 91-100 | pmid=24371012 | doi=10.1007/s12265-013-9527-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24371012 }} </ref><ref name="pmid25775052">{{cite journal| author=Han Y, Guo J, Zheng Y, Zang H, Su X, Wang Y | display-authors=etal| title=Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: the BRIGHT randomized clinical trial. | journal=JAMA | year= 2015 | volume= 313 | issue= 13 | pages= 1336-46 | pmid=25775052 | doi=10.1001/jama.2015.2323 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25775052 }} </ref><ref name="pmid19717185">{{cite journal| author=Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR | display-authors=etal| title=Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial. | journal=Lancet | year= 2009 | volume= 374 | issue= 9696 | pages= 1149-59 | pmid=19717185 | doi=10.1016/S0140-6736(09)61484-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19717185 }} </ref><ref name="pmid24633823">{{cite journal| author=Schulz S, Richardt G, Laugwitz KL, Mehran R, Gershlick AH, Morath T | display-authors=etal| title=Comparison of prasugrel and bivalirudin vs clopidogrel and heparin in patients with ST-segment elevation myocardial infarction: Design and rationale of the Bavarian Reperfusion Alternatives Evaluation (BRAVE) 4 trial. | journal=Clin Cardiol | year= 2014 | volume= 37 | issue= 5 | pages= 270-6 | pmid=24633823 | doi=10.1002/clc.22268 | pmc=6649448 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24633823 }} </ref><ref name="pmid25002178">{{cite journal| author=Shahzad A, Kemp I, Mars C, Wilson K, Roome C, Cooper R | display-authors=etal| title=Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial. | journal=Lancet | year= 2014 | volume= 384 | issue= 9957 | pages= 1849-1858 | pmid=25002178 | doi=10.1016/S0140-6736(14)60924-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25002178 }} </ref><ref name="pmid24140664">{{cite journal| author=Stone GW, Clayton T, Deliargyris EN, Prats J, Mehran R, Pocock SJ| title=Reduction in cardiac mortality with bivalirudin in patients with and without major bleeding: The HORIZONS-AMI trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction). | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 1 | pages= 15-20 | pmid=24140664 | doi=10.1016/j.jacc.2013.09.027 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24140664 }} </ref>
*Although [[complications]] such as [[bleeding]] is lower with [[bivalirudin]] based on [[clinical trials]], in real practice, this benefit may be less pronounced with routine use of [[radial artery]] intervention and low rates of [[glycoprotein IIb/IIIa inhibitor]] use.<ref name="pmid25746943">{{cite journal| author=Capodanno D, Gargiulo G, Capranzano P, Mehran R, Tamburino C, Stone GW| title=Bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary PCI: An updated meta-analysis of 10,350 patients from five randomized clinical trials. | journal=Eur Heart J Acute Cardiovasc Care | year= 2016 | volume= 5 | issue= 3 | pages= 253-62 | pmid=25746943 | doi=10.1177/2048872615572599 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25746943 }} </ref><ref name="pmid25131979">{{cite journal| author=Cavender MA, Sabatine MS| title=Bivalirudin versus heparin in patients planned for percutaneous coronary intervention: a meta-analysis of randomised controlled trials. | journal=Lancet | year= 2014 | volume= 384 | issue= 9943 | pages= 599-606 | pmid=25131979 | doi=10.1016/S0140-6736(14)61216-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25131979 }} </ref>
**Replace 2: This [[clinical trial|trial]] compared [[bivalirudin]] plus provisional [[coagulation|2b/3a]] (which ended up being given in 7.2% of [[patients]]) vs [[heparin]] with planned [[coagulation|2b/3a]]. In this study of 6010 [[patients]], [[ischemic]] events were similar but major [[bleeding]] (mostly [[vascular]] access site) was reduced by about 40%. There was no [[mortality]] difference at one year despite a 0.8% absolute increase in peri-procedural [[MI]]'s in the [[bivalirudin]] group. Importantly ,85% of [[patients]] were pre-[[treatment|treated]] with [[plavix]] or [[ticlid]]. In Replace 2, [[bivalirudin]] strategy was found to be less expensive because of savings on [[coagulation|2b/3a]] as well as less [[bleeding]].
**ACUITY: Complex [[clinical trial|trial]] of 13,819 high risk [[UA]] or [[NSTEMI]] [[patients]] undergoing early invasive strategy comparing [[bivalirudin]] alone vs [[Bivalirudin]] with [[coagulation|2b/3a]] vs [[Heparin]] or [[Lovenox]] with [[coagulation|2b/3a]]. It was found that the [[ischemic]] composite endpoint (death, [[MI]], [[revascularization]]) at 30 days was the same in all 3 arms. However, major [[bleeding]] was significantly less with [[bivalirudin]] alone at 3.1% vs [[bivalirudin]] and [[coagulation|2b/3a]] at 5.3% vs [[Heparin]], [[Lovenox]] and [[coagulation|2b/3a]] at 5.7%. Again this was driven mostly by access site [[complication]]s, but unlike in REPLACE 2 the [[bleeding]] endpoints were significant whether one used the study definition or [[TIMI]] definition. A major caveat is also that [[patients]] who did not get [[plavix]] had increased [[ischemic]] events in the [[bivalirudin]] only arm.
**VALIDATE- SWEDEHEART: This [[clinical trial]] evaluated a prolonged [[bivalirudin]] infusion versus [[UFH]].<ref name="pmid28844201">{{cite journal| author=Erlinge D, Omerovic E, Fröbert O, Linder R, Danielewicz M, Hamid M | display-authors=etal| title=Bivalirudin versus Heparin Monotherapy in Myocardial Infarction. | journal=N Engl J Med | year= 2017 | volume= 377 | issue= 12 | pages= 1132-1142 | pmid=28844201 | doi=10.1056/NEJMoa1706443 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28844201 }} </ref> Result did not show any improvement in rates of major adverse cardiovascular events, major [[bleeding]], or [[stent thrombosis]] with [[bivalirudin]] within a 6-month follow up.
*In conclusion, [[bivalirudin]] is an excellent choice in most [[NSTEMI]]/[[UA]] [[patients]] managed with an early invasive strategy if they have been pre-[[treatment|treated]] with [[clopidogrel]]. If this has not been done then [[coagulation|2b/3a]] will need to be used and the benefits of [[bivalirudin]] are greatly attenuated.

==2021 ACA Revascularization Guideline==
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: C-EO<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
|-
| bgcolor="LightGreen"|Administration of [[intravenous]] [[heparin|unfractionated heparin]] ([[heparin|UFH]]) is useful in reducing [[ischemia|ischemia events]] in [[patients]] undergoing [[PCI]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: C-LD<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid12357516">{{cite journal| author=Lewis BE, Matthai WH, Cohen M, Moses JW, Hursting MJ, Leya F | display-authors=etal| title=Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. | journal=Catheter Cardiovasc Interv | year= 2002 | volume= 57 | issue= 2 | pages= 177-84 | pmid=12357516 | doi=10.1002/ccd.10276 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12357516 }} </ref><ref name="pmid14608128">{{cite journal| author=Mahaffey KW, Lewis BE, Wildermann NM, Berkowitz SD, Oliverio RM, Turco MA | display-authors=etal| title=The anticoagulant therapy with bivalirudin to assist in the performance of percutaneous coronary intervention in patients with heparin-induced thrombocytopenia (ATBAT) study: main results. | journal=J Invasive Cardiol | year= 2003 | volume= 15 | issue= 11 | pages= 611-6 | pmid=14608128 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14608128 }} </ref>
|-
| bgcolor="Yellow"|[[Bivalirudin]] or [[argatroban]] should be used instead of [[UFH]] in [[patients]] with [[heparin-induced thrombocytopenia]] who are undergoing [[PCI]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: A<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid18703471">{{cite journal| author=Kastrati A, Neumann FJ, Mehilli J, Byrne RA, Iijima R, Büttner HJ | display-authors=etal| title=Bivalirudin versus unfractionated heparin during percutaneous coronary intervention. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 7 | pages= 688-96 | pmid=18703471 | doi=10.1056/NEJMoa0802944 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18703471 }} </ref><ref name="pmid12588269">{{cite journal| author=Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD | display-authors=etal| title=Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. | journal=JAMA | year= 2003 | volume= 289 | issue= 7 | pages= 853-63 | pmid=12588269 | doi=10.1001/jama.289.7.853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12588269 }} </ref><ref name="pmid17368152">{{cite journal| author=Stone GW, White HD, Ohman EM, Bertrand ME, Lincoff AM, McLaurin BT | display-authors=etal| title=Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial. | journal=Lancet | year= 2007 | volume= 369 | issue= 9565 | pages= 907-19 | pmid=17368152 | doi=10.1016/S0140-6736(07)60450-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17368152 }} </ref><ref name="pmid22077909">{{cite journal| author=Kastrati A, Neumann FJ, Schulz S, Massberg S, Byrne RA, Ferenc M | display-authors=etal| title=Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. | journal=N Engl J Med | year= 2011 | volume= 365 | issue= 21 | pages= 1980-9 | pmid=22077909 | doi=10.1056/NEJMoa1109596 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22077909 }} </ref><ref name="pmid25791214">{{cite journal| author=Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T | display-authors=etal| title=Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. | journal=Lancet | year= 2015 | volume= 385 | issue= 9986 | pages= 2465-76 | pmid=25791214 | doi=10.1016/S0140-6736(15)60292-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25791214 }} </ref><ref name="pmid24171490">{{cite journal| author=Steg PG, van 't Hof A, Hamm CW, Clemmensen P, Lapostolle F, Coste P | display-authors=etal| title=Bivalirudin started during emergency transport for primary PCI. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 23 | pages= 2207-17 | pmid=24171490 | doi=10.1056/NEJMoa1311096 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24171490 }} </ref><ref name="pmid18499566">{{cite journal| author=Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D | display-authors=etal| title=Bivalirudin during primary PCI in acute myocardial infarction. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 21 | pages= 2218-30 | pmid=18499566 | doi=10.1056/NEJMoa0708191 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18499566 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18783187 Review in: ACP J Club. 2008 Sep 16;149(3):11] </ref><ref name="pmid25746943">{{cite journal| author=Capodanno D, Gargiulo G, Capranzano P, Mehran R, Tamburino C, Stone GW| title=Bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary PCI: An updated meta-analysis of 10,350 patients from five randomized clinical trials. | journal=Eur Heart J Acute Cardiovasc Care | year= 2016 | volume= 5 | issue= 3 | pages= 253-62 | pmid=25746943 | doi=10.1177/2048872615572599 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25746943 }} </ref><ref name="pmid25131979">{{cite journal| author=Cavender MA, Sabatine MS| title=Bivalirudin versus heparin in patients planned for percutaneous coronary intervention: a meta-analysis of randomised controlled trials. | journal=Lancet | year= 2014 | volume= 384 | issue= 9943 | pages= 599-606 | pmid=25131979 | doi=10.1016/S0140-6736(14)61216-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25131979 }} </ref><ref name="pmid30636368">{{cite journal| author=Shah R, Latham SB, Porta JM, Naz A, Matin K, Rao SV| title=Bivalirudin with a post-procedure infusion versus heparin monotherapy for the prevention of stent thrombosis. | journal=Catheter Cardiovasc Interv | year= 2019 | volume= 94 | issue= 2 | pages= 210-215 | pmid=30636368 | doi=10.1002/ccd.28065 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636368 }} </ref>
|-
| bgcolor="Lightblue"|[[Bivalirudin]] could be used as a reasonable alternative to [[UFH]] in order to reduce [[bleeding]] in [[patients]] undergoing [[PCI]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:lightgray"|Class 2b Recommendation, Level of Evidence: B-BR<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid11479456">{{cite journal| author=Blazing MA, De Lemos JA, Dyke CK, Califf RM, Bilheimer D, Braunwald E| title=The A-to-Z Trial: Methods and rationale for a single trial investigating combined use of low-molecular-weight heparin with the glycoprotein IIb/IIIa inhibitor tirofiban and defining the efficacy of early aggressive simvastatin therapy. | journal=Am Heart J | year= 2001 | volume= 142 | issue= 2 | pages= 211-7 | pmid=11479456 | doi=10.1067/mhj.2001.116959 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11479456 }} </ref><ref name="pmid15238590">{{cite journal| author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S | display-authors=etal| title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. | journal=JAMA | year= 2004 | volume= 292 | issue= 1 | pages= 45-54 | pmid=15238590 | doi=10.1001/jama.292.1.45 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15238590 }} </ref><ref name="pmid21856483">{{cite journal| author=Montalescot G, Zeymer U, Silvain J, Boulanger B, Cohen M, Goldstein P | display-authors=etal| title=Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. | journal=Lancet | year= 2011 | volume= 378 | issue= 9792 | pages= 693-703 | pmid=21856483 | doi=10.1016/S0140-6736(11)60876-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21856483 }} </ref><ref name="pmid0.1136/bmj.e553">{{cite journal| author=Raffle A, Gray J, MacDonald HR| title=Letter: First-aid treatment of poisoning. | journal=Br Med J | year= 1976 | volume= 1 | issue= 6001 | pages= 93 | pmid=0.1136/bmj.e553 | doi=10.1136/bmj.1.6001.93-a | pmc=1638368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1136 }} </ref><ref name="pmid16957147">{{cite journal| author=Montalescot G, White HD, Gallo R, Cohen M, Steg PG, Aylward PE | display-authors=etal| title=Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. | journal=N Engl J Med | year= 2006 | volume= 355 | issue= 10 | pages= 1006-17 | pmid=16957147 | doi=10.1056/NEJMoa052711 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16957147 }} </ref>
|-
| bgcolor="lightgray"|In [[patients]] who have been treated with upstream [[subcutaneous]] [[enoxaparin]] for either [[unstable angina]] or [[NSTE-ACS]], [[intravenous]] [[enoxaparin]] could be considered at the time of [[PCI]] in order to reduce [[ischemia|ischemic events]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:lightpink"|Class 3 Recommendation (HARM), Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid15238590">{{cite journal| author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S | display-authors=etal| title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. | journal=JAMA | year= 2004 | volume= 292 | issue= 1 | pages= 45-54 | pmid=15238590 | doi=10.1001/jama.292.1.45 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15238590 }} </ref><ref name="pmid19619692">{{cite journal| author=Drouet L, Bal dit Sollier C, Martin J| title=Adding intravenous unfractionated heparin to standard enoxaparin causes excessive anticoagulation not detected by activated clotting time: results of the STACK-on to ENOXaparin (STACKENOX) study. | journal=Am Heart J | year= 2009 | volume= 158 | issue= 2 | pages= 177-84 | pmid=19619692 | doi=10.1016/j.ahj.2009.05.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19619692 }} </ref><ref name="pmid17010793">{{cite journal| author=Cohen M, Mahaffey KW, Pieper K, Pollack CV, Antman EM, Hoekstra J | display-authors=etal| title=A subgroup analysis of the impact of prerandomization antithrombin therapy on outcomes in the SYNERGY trial: enoxaparin versus unfractionated heparin in non-ST-segment elevation acute coronary syndromes. | journal=J Am Coll Cardiol | year= 2006 | volume= 48 | issue= 7 | pages= 1346-54 | pmid=17010793 | doi=10.1016/j.jacc.2006.05.058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17010793 }} </ref>
|-
| bgcolor="lightpink"|[[UFH]] should be avoid in [[patients]] who are on therapeutic [[subcutaneous]] [[enoxaparin]], and have received the last [[dose]] within 12 hours of [[PCI]] due to higher rate of [[bleeding]].
|}

==ACCF/AHA/SCAI 2011 Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
===Use of Parenteral Anticoagulants during PCI (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' An [[anticoagulant]] should be administered to patients undergoing PCI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
===Unfractionated Heparin (DO NOT EDIT)<ref name="pmid22070837">{{cite journal|author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions|journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24|pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Administration of [[intravenous]] [[UFH]] is useful in patients undergoing PCI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

===Enoxaparin (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH|title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions|journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24|pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' An additional dose of 0.3 mg/kg [[enoxaparin|intravenous enoxaparin]] should be administered at the time of PCI to patients who have received fewer than 2 therapeutic subcutaneous doses (e.g., 1 mg/kg) or received the last subcutaneous[[enoxaparin]] dose 8 to 12 hours before PCI.<ref name="pmid15238590">{{cite journal |author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, Kereiakes DJ, Langer A, Mahaffey KW, Nessel CC, Armstrong PW, Avezum A, Aylward P, Becker RC, Biasucci L, Borzak S, Col J, Frey MJ, Fry E, Gulba DC, Guneri S, Gurfinkel E, Harrington R, Hochman JS, Kleiman NS, Leon MB, Lopez-Sendon JL, Pepine CJ, Ruzyllo W, Steinhubl SR, Teirstein PS, Toro-Figueroa L, White H |title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial|journal=[[JAMA : the Journal of the American Medical Association]] |volume=292 |issue=1 |pages=45–54 |year=2004 |month=July|pmid=15238590|doi=10.1001/jama.292.1.45 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15238590 |accessdate=2011-12-15}}</ref><ref name="pmid20432399">{{cite journal|author=Cohen M, Levine GN, Pieper KS, Lan L, Antman EM, Aylward PE, White HD, Kleiman NS, Califf RM, Mahaffey KW |title=Enoxaparin 0.3 mg/kg IV supplement for patients transitioning to PCI after subcutaneous enoxaparin therapy for NSTE ACS: a subgroup analysis from the SYNERGY trial|journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=75 |issue=6 |pages=928–35 |year=2010 |month=May|pmid=20432399 |doi=10.1002/ccd.22340|url=http://dx.doi.org/10.1002/ccd.22340|accessdate=2011-12-15}}</ref><ref name="pmid15077081">{{cite journal |author=Collet JP, Montalescot G, Golmard JL, Tanguy ML, Ankri A, Choussat R, Beygui F, Drobinski G, Vignolles N, Thomas D|title=Subcutaneous enoxaparin with early invasive strategy in patients with acute coronary syndromes |journal=[[American Heart Journal]] |volume=147 |issue=4 |pages=655–61|year=2004|month=April |pmid=15077081|doi=10.1016/j.ahj.2003.10.019|url=http://linkinghub.elsevier.com/retrieve/pii/S0002870303007609|accessdate=2011-12-15}}</ref><ref name="pmid15353913">{{cite journal |author=Levine GN, Ferrando T|title=Degree of anticoagulation after one subcutaneous and one subsequent intravenous booster dose of enoxaparin: implications for patients with acute coronary syndromes undergoing early percutaneous coronary intervention |journal=[[Journal of Thrombosis and Thrombolysis]] |volume=17 |issue=3|pages=167–71 |year=2004 |month=June |pmid=15353913|doi=10.1023/B:THRO.0000040484.99422.77|url=http://www.kluweronline.com/art.pdf?issn=0929-5305&volume=17&page=167|accessdate=2011-12-15}}</ref><ref name="pmid14755805">{{cite journal |author=Martin JL, Fry ET, Sanderink GJ, Atherley TH, Guimart CM, Chevalier PJ, Ozoux ML, Pensyl CE, Bigonzi F |title=Reliable anticoagulation with enoxaparin in patients undergoing percutaneous coronary intervention: The pharmacokinetics of enoxaparin in PCI (PEPCI) study |journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=61|issue=2 |pages=163–70|year=2004 |month=February |pmid=14755805 |doi=10.1002/ccd.10726|url=http://dx.doi.org/10.1002/ccd.10726 |accessdate=2011-12-15}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Unstable angina / non ST elevation myocardial infarction low molecular weight heparin therapy|Unfractionated heparin (UFH)]] should not be given to patients already receiving therapeutic [[enoxaparin|subcutaneous enoxaparin]].<ref name="pmid15238590">{{cite journal |author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, Kereiakes DJ, Langer A, Mahaffey KW, Nessel CC, Armstrong PW, Avezum A, Aylward P, Becker RC, Biasucci L, Borzak S, Col J, Frey MJ, Fry E, Gulba DC, Guneri S, Gurfinkel E, Harrington R, Hochman JS, Kleiman NS, Leon MB, Lopez-Sendon JL, Pepine CJ, Ruzyllo W, Steinhubl SR, Teirstein PS, Toro-Figueroa L, White H |title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial |journal=[[JAMA :the Journal of the American Medical Association]] |volume=292 |issue=1 |pages=45–54 |year=2004|month=July |pmid=15238590 |doi=10.1001/jama.292.1.45|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15238590 |accessdate=2011-12-15}}</ref><ref name="pmid19619692">{{cite journal|author=Drouet L, Bal dit Sollier C, Martin J |title=Adding intravenous unfractionated heparin to standard enoxaparin causes excessive anticoagulation not detected by activated clotting time: results of the STACK-on to ENOXaparin (STACKENOX) study |journal=[[American Heart Journal]]|volume=158 |issue=2 |pages=177–84 |year=2009 |month=August|pmid=19619692|doi=10.1016/j.ahj.2009.05.022|url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00386-X|accessdate=2011-12-15}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Performance of [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI|PCI]] with [[enoxaparin]] may be reasonable in patients either treated with ''upstream'' [[enoxaparin|subcutaneous enoxaparin]] for[[Unstable angina / non ST elevation myocardial infarction|UA/NSTEMI]] or who have not received prior [[Unstable angina / non ST elevation myocardial infarction anticoagulant therapy|antithrombin therapy]] and are administered [[enoxaparin|intravenous enoxaparin]] at the time of[[Unstable angina / non ST elevation myocardial infarction recommendations for PCI|PCI]].<ref name="pmid20578166">{{cite journal|author=Brieger D, Collet JP, Silvain J, Landivier A, Barthélémy O, Beygui F, Bellemain-Appaix A, Mercadier A, Choussat R, Vignolles N, Costagliola D, Montalescot G |title=Heparin or enoxaparin anticoagulation for primary percutaneous coronary intervention|journal=[[Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions]]|volume=77|issue=2 |pages=182–90 |year=2011 |month=February |pmid=20578166 |doi=10.1002/ccd.22674|url=http://dx.doi.org/10.1002/ccd.22674|accessdate=2011-12-15}}</ref><ref name="pmid12475453">{{cite journal |author=Choussat R, Montalescot G, Collet JP, Vicaut E, Ankri A, Gallois V, Drobinski G, Sotirov I, Thomas D |title=A unique, low dose of intravenous enoxaparin in elective percutaneous coronary intervention|journal=[[Journal of the American College of Cardiology]] |volume=40 |issue=11 |pages=1943–50 |year=2002 |month=December |pmid=12475453|doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702025317|accessdate=2011-12-15}}</ref><ref name="pmid15238590">{{cite journal|author=Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, Kereiakes DJ, Langer A, Mahaffey KW, Nessel CC, Armstrong PW, Avezum A, Aylward P, Becker RC, Biasucci L, Borzak S, Col J, Frey MJ, Fry E, Gulba DC, Guneri S, Gurfinkel E, Harrington R, Hochman JS, Kleiman NS, Leon MB, Lopez-Sendon JL, Pepine CJ, Ruzyllo W, Steinhubl SR, Teirstein PS, Toro-Figueroa L, White H |title=Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial |journal=[[JAMA :the Journal of the American Medical Association]] |volume=292 |issue=1 |pages=45–54|year=2004|month=July |pmid=15238590 |doi=10.1001/jama.292.1.45 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15238590|accessdate=2011-12-15}}</ref><ref name="pmid19926048">{{cite journal|author=Montalescot G, Gallo R, White HD, Cohen M, Steg PG, Aylward PE, Bode C, Chiariello M, King SB, Harrington RA, Desmet WJ, Macaya C, Steinhubl SR |title=Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention 1-year results from the STEEPLE (SafeTy and efficacy of enoxaparin in percutaneous coronary intervention patients, an international randomized evaluation) trial |journal=[[JACC. Cardiovascular Interventions]] |volume=2 |issue=11|pages=1083–91|year=2009 |month=November |pmid=19926048|doi=10.1016/j.jcin.2009.08.016|url=http://linkinghub.elsevier.com/retrieve/pii/S1936-8798(09)00581-0|accessdate=2011-12-15}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

===Bivalirudin and Argatoban (DO NOT EDIT)<ref name="pmid22070837">{{cite journal|author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]]|volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' For patients undergoing PCI, [[bivalirudin]] is useful as an anticoagulant with or without prior treatment with [[UFH|unfractionated heparin (UFH)]].<ref name="pmid19718462">{{cite journal|author=De Luca G, Cassetti E, Verdoia M, Marino P |title=Bivalirudin as compared to unfractionated heparin among patients undergoing coronary angioplasty: A meta-analyis of randomised trials|journal=[[Thrombosis and Haemostasis]] |volume=102 |issue=3 |pages=428–36 |year=2009|month=September |pmid=19718462|doi=10.1160/TH09-05-0287 |url=http://www.schattauer.de/index.php?id=1268&L=1&pii=th09-05-0287&no_cache=1 |accessdate=2011-12-15}}</ref><ref name="pmid19463378">{{cite journal |author=Lincoff AM, Steinhubl SR, Manoukian SV, Chew D, Pollack CV, Feit F, Ware JH, Bertrand ME, Ohman EM, Desmet W, Cox DA, Mehran R, Stone GW |title=Influence of timing of clopidogrel treatment on the efficacy and safety of bivalirudin in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention: an analysis of the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial|journal=[[JACC. Cardiovascular Interventions]] |volume=1 |issue=6 |pages=639–48|year=2008|month=December |pmid=19463378|doi=10.1016/j.jcin.2008.10.004|url=http://linkinghub.elsevier.com/retrieve/pii/S1936-8798(08)00438-X|accessdate=2011-12-15}}</ref><ref name="pmid18703471">{{cite journal |author=Kastrati A, Neumann FJ, Mehilli J, Byrne RA, Iijima R, Büttner HJ, Khattab AA, Schulz S, Blankenship JC, Pache J, Minners J, Seyfarth M, Graf I, Skelding KA, Dirschinger J, Richardt G, Berger PB, Schömig A|title=Bivalirudin versus unfractionated heparin during percutaneous coronary intervention|journal=[[The New England Journal of Medicine]] |volume=359 |issue=7|pages=688–96 |year=2008|month=August |pmid=18703471 |doi=10.1056/NEJMoa0802944|url=http://dx.doi.org/10.1056/NEJMoa0802944|accessdate=2011-12-15}}</ref><ref name="pmid15304466">{{cite journal |author=Lincoff AM, Kleiman NS, Kereiakes DJ, Feit F, Bittl JA, Jackman JD, Sarembock IJ, Cohen DJ, Spriggs D, Ebrahimi R, Keren G, Carr J, Cohen EA, Betriu A, Desmet W, Rutsch W, Wilcox RG, de Feyter PJ, Vahanian A, Topol EJ|title=Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial|journal=[[JAMA : the Journal of the American Medical Association]] |volume=292|issue=6 |pages=696–703 |year=2004 |month=August |pmid=15304466|doi=10.1001/jama.292.6.696|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=15304466|accessdate=2011-12-15}}</ref><ref name="pmid19717185">{{cite journal |author=Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Wong SC, Nikolsky E, Gambone L, Vandertie L, Parise H, Dangas GD, Stone GW|title=Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial|journal=[[Lancet]] |volume=374|issue=9696 |pages=1149–59 |year=2009 |month=October|pmid=19717185|doi=10.1016/S0140-6736(09)61484-7|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(09)61484-7|accessdate=2011-12-15}}</ref><ref name="pmid20150324">{{cite journal |author=Schulz S, Mehilli J, Ndrepepa G, Neumann FJ, Birkmeier KA, Kufner S, Richardt G, Berger PB, Schömig A, Kastrati A|title=Bivalirudin vs. unfractionated heparin during percutaneous coronary interventions in patients with stable and unstable angina pectoris: 1-year results of the ISAR-REACT 3 trial|journal=[[European Heart Journal]] |volume=31 |issue=5 |pages=582–7 |year=2010|month=March|pmid=20150324 |doi=10.1093/eurheartj/ehq008|url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20150324|accessdate=2011-12-15}}</ref><ref name="pmid17124018">{{cite journal |author=Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, White HD, Pocock SJ, Ware JH, Feit F, Colombo A, Aylward PE, Cequier AR, Darius H, Desmet W, Ebrahimi R, Hamon M, Rasmussen LH, Rupprecht HJ, Hoekstra J, Mehran R, Ohman EM |title=Bivalirudin for patients with acute coronary syndromes |journal=[[The New England Journal of Medicine]] |volume=355 |issue=21 |pages=2203–16 |year=2006 |month=November|pmid=17124018 |doi=10.1056/NEJMoa062437|url=http://dx.doi.org/10.1056/NEJMoa062437|accessdate=2011-12-15}}</ref><ref name="pmid18499566">{{cite journal |author=Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Dangas G, Wong SC, Kirtane AJ, Parise H, Mehran R |title=Bivalirudin during primary PCI in acute myocardial infarction |journal=[[The New England Journal of Medicine]]|volume=358|issue=21 |pages=2218–30 |year=2008 |month=May |pmid=18499566|doi=10.1056/NEJMoa0708191|url=http://dx.doi.org/10.1056/NEJMoa0708191 |accessdate=2011-12-15}}</ref><ref name="pmid19796737">{{cite journal|author=Dangas G, Mehran R, Guagliumi G, Caixeta A, Witzenbichler B, Aoki J, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Rabbani LE, Parise H, Stone GW |title=Role of clopidogrel loading dose in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: results from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=15 |pages=1438–46 |year=2009 |month=October|pmid=19796737|doi=10.1016/j.jacc.2009.06.021|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02367-5|accessdate=2011-12-15}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' For patients with [[heparin-induced thrombocytopenia]], it is recommended that [[bivalirudin]] or [[argatroban]] be used to replace [[UFH|unfractionated heparin (UFH)]].<ref name="pmid12357516">{{cite journal|author=Lewis BE, Matthai WH, Cohen M, Moses JW, Hursting MJ, Leya F |title=Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia |journal=[[Catheterization and Cardiovascular Interventions :Official Journal of the Society for Cardiac Angiography & Interventions]] |volume=57 |issue=2|pages=177–84 |year=2002 |month=October |pmid=12357516|doi=10.1002/ccd.10276|url=http://dx.doi.org/10.1002/ccd.10276 |accessdate=2011-12-15}}</ref><ref name="pmid14608128">{{cite journal|author=Mahaffey KW, Lewis BE, Wildermann NM, Berkowitz SD, Oliverio RM, Turco MA, Shalev Y, Ver Lee P, Traverse JH, Rodriguez AR, Ohman EM, Harrington RA, Califf RM |title=The anticoagulant therapy with bivalirudin to assist in the performance of percutaneous coronary intervention in patients with heparin-induced thrombocytopenia (ATBAT) study: main results |journal=[[The Journal of Invasive Cardiology]] |volume=15|issue=11 |pages=611–6|year=2003 |month=November |pmid=14608128 |doi= |url= |accessdate=2011-12-15}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

===Fondaparinux (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH|title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions|journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24|pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Fondaparinux]] should not be used as the sole anticoagulant to support PCI. An additional anticoagulant with anti-IIa activity should be administered because of the risk of [[thrombosis|catheter thrombosis]].<ref name="pmid16537663">{{cite journal |author=Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA |title=Comparison of fondaparinux and enoxaparin in acute coronary syndromes|journal=[[The New England Journal of Medicine]] |volume=354 |issue=14 |pages=1464–76 |year=2006|month=April |pmid=16537663 |doi=10.1056/NEJMoa055443|url=http://dx.doi.org/10.1056/NEJMoa055443|accessdate=2011-12-15}}</ref><ref name="pmid16537725">{{cite journal |author=Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA |title=Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial |journal=[[JAMA :the Journal of the American Medical Association]] |volume=295 |issue=13 |pages=1519–30 |year=2006|month=April |pmid=16537725|doi=10.1001/jama.295.13.joc60038|url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=16537725 |accessdate=2011-12-15}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
==References==
{{reflist|2}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[CME Category::Cardiology]]

[[Category:Cardiology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date Cardiology]]
[[Category:Needs overview]]

Coronary artery bypass surgery anesthetic considerations

2022-08-29T06:35:27Z

Anahita: /* Overview */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; {{AOEIC}} {{VK}} {{Anahita}}
==Overview==
There are some critical [[Anesthesia|anesthetic considerations]] for [[coronary artery bypass surgery]]. Based on the 2021 ACA Revascularization guideline, usage of fast-track [[cardiac]] [[anesthesia]] which uses [[anesthesia|short-acting anesthetic agents]] is recommended due to a better outcome. Furthermore, it is recommended to avoid [[opioid]] [[medications]] and replace them with non-[[opioid]] options, such as [[acetaminophen]], [[ketamine]], and [[dexmedetomidine]], and/or [[Regional anesthesia|regional techniques]] such as truncal [[nerve]] blocks. There is evidence supporting that [[Volatile anaesthetic]] may facilitate earlier [[extubation]] compared to [[intraveous]] choices. Furthermore, it is recommended to utilize an [[surgery|intraoperative]] [[lung]]-protective [[ventilation]] strategy, which is associated with better [[lung|pulmonary mechanics]] and reduced [[surgery|postoperative]] [[lung|pulmonary]] [[complications]].

==CABG Anesthetic Considerations==
===2021 ACA Revascularization Guideline===
*Usage of fast-track [[cardiac]] [[anesthesia]] which uses [[anesthesia|short-acting anesthetic agents]] is recommended due to a better outcome after [[CABG]].<ref name="pmid22070836">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG | display-authors=etal| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 24 | pages= e123-210 | pmid=22070836 | doi=10.1016/j.jacc.2011.08.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070836 }} </ref>
*There is evidence from the early 2000s that demonstrated a lower rate of [[opioid]] use with faster [[extubation]] when fast-track [[cardiac]] [[anesthesia]] was used. Although none of the older studies showed lower [[complications]], there are newer studies that reported lower early [[surgery|postoperative]] [[complications]], shorter time in the [[intensive care unit]], and [[hospital]] length of stay after [[CABG]] among those who used fast-track [[cardiac]] [[anesthesia]].<ref name="pmid30665758">{{cite journal| author=Williams JB, McConnell G, Allender JE, Woltz P, Kane K, Smith PK | display-authors=etal| title=One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program. | journal=J Thorac Cardiovasc Surg | year= 2019 | volume= 157 | issue= 5 | pages= 1881-1888 | pmid=30665758 | doi=10.1016/j.jtcvs.2018.10.164 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30665758 }} </ref><ref name="pmid29514224">{{cite journal| author=Li M, Zhang J, Gan TJ, Qin G, Wang L, Zhu M | display-authors=etal| title=Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. | journal=Eur J Cardiothorac Surg | year= 2018 | volume= 54 | issue= 3 | pages= 491-497 | pmid=29514224 | doi=10.1093/ejcts/ezy100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29514224 }} </ref><ref name="pmid14508335">{{cite journal| author=Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC| title=A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. | journal=Anesthesiology | year= 2003 | volume= 99 | issue= 4 | pages= 982-7 | pmid=14508335 | doi=10.1097/00000542-200310000-00035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14508335 }} </ref><ref name="pmid31279510">{{cite journal| author=Grant MC, Isada T, Ruzankin P, Whitman G, Lawton JS, Dodd-O J | display-authors=etal| title=Results from an enhanced recovery program for cardiac surgery. | journal=J Thorac Cardiovasc Surg | year= 2020 | volume= 159 | issue= 4 | pages= 1393-1402.e7 | pmid=31279510 | doi=10.1016/j.jtcvs.2019.05.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31279510 }} </ref><ref name="pmid27616189">{{cite journal| author=Wong WT, Lai VK, Chee YE, Lee A| title=Fast-track cardiac care for adult cardiac surgical patients. | journal=Cochrane Database Syst Rev | year= 2016 | volume= 9 | issue= | pages= CD003587 | pmid=27616189 | doi=10.1002/14651858.CD003587.pub3 | pmc=6457798 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27616189 }} </ref>
*The following table is demonstrating [[surgery|perioperative]] [[anesthesia|anesthetics]] for [[CABG]]:<ref name="pmid30665758">{{cite journal| author=Williams JB, McConnell G, Allender JE, Woltz P, Kane K, Smith PK | display-authors=etal| title=One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program. | journal=J Thorac Cardiovasc Surg | year= 2019 | volume= 157 | issue= 5 | pages= 1881-1888 | pmid=30665758 | doi=10.1016/j.jtcvs.2018.10.164 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30665758 }} </ref><ref name="pmid31279510">{{cite journal| author=Grant MC, Isada T, Ruzankin P, Whitman G, Lawton JS, Dodd-O J | display-authors=etal| title=Results from an enhanced recovery program for cardiac surgery. | journal=J Thorac Cardiovasc Surg | year= 2020 | volume= 159 | issue= 4 | pages= 1393-1402.e7 | pmid=31279510 | doi=10.1016/j.jtcvs.2019.05.035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31279510 }} </ref><ref name="pmid29514224">{{cite journal| author=Li M, Zhang J, Gan TJ, Qin G, Wang L, Zhu M | display-authors=etal| title=Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. | journal=Eur J Cardiothorac Surg | year= 2018 | volume= 54 | issue= 3 | pages= 491-497 | pmid=29514224 | doi=10.1093/ejcts/ezy100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29514224 }} </ref><ref name="pmid22070836">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG | display-authors=etal| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 24 | pages= e123-210 | pmid=22070836 | doi=10.1016/j.jacc.2011.08.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070836 }} </ref><ref name="pmid16732083">{{cite journal| author=Silbert BS, Scott DA, Evered LA, Lewis MS, Kalpokas M, Maruff P | display-authors=etal| title=A comparison of the effect of high- and low-dose fentanyl on the incidence of postoperative cognitive dysfunction after coronary artery bypass surgery in the elderly. | journal=Anesthesiology | year= 2006 | volume= 104 | issue= 6 | pages= 1137-45 | pmid=16732083 | doi=10.1097/00000542-200606000-00007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16732083 }} </ref><ref name="pmid18580173">{{cite journal| author=Ender J, Borger MA, Scholz M, Funkat AK, Anwar N, Sommer M | display-authors=etal| title=Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the Leipzig fast-track concept. | journal=Anesthesiology | year= 2008 | volume= 109 | issue= 1 | pages= 61-6 | pmid=18580173 | doi=10.1097/ALN.0b013e31817881b3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18580173 }} </ref><ref name="pmid14508335">{{cite journal| author=Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC| title=A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. | journal=Anesthesiology | year= 2003 | volume= 99 | issue= 4 | pages= 982-7 | pmid=14508335 | doi=10.1097/00000542-200310000-00035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14508335 }} </ref><ref name="pmid27616189">{{cite journal| author=Wong WT, Lai VK, Chee YE, Lee A| title=Fast-track cardiac care for adult cardiac surgical patients. | journal=Cochrane Database Syst Rev | year= 2016 | volume= 9 | issue= | pages= CD003587 | pmid=27616189 | doi=10.1002/14651858.CD003587.pub3 | pmc=6457798 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27616189 }} </ref><ref name="pmid27939574">{{cite journal| author=Borde DP, Futane SS, Asegaonkar B, Apsingekar P, Khade S, Khodve B | display-authors=etal| title=Effect of Perioperative Pregabalin on Postoperative Quality of Recovery in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting (OPCABG): A Prospective, Randomized, Double-Blind Trial. | journal=J Cardiothorac Vasc Anesth | year= 2017 | volume= 31 | issue= 4 | pages= 1241-1245 | pmid=27939574 | doi=10.1053/j.jvca.2016.09.029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27939574 }} </ref><ref name="pmid27521969">{{cite journal| author=Jelacic S, Bollag L, Bowdle A, Rivat C, Cain KC, Richebe P| title=Intravenous Acetaminophen as an Adjunct Analgesic in Cardiac Surgery Reduces Opioid Consumption But Not Opioid-Related Adverse Effects: A Randomized Controlled Trial. | journal=J Cardiothorac Vasc Anesth | year= 2016 | volume= 30 | issue= 4 | pages= 997-1004 | pmid=27521969 | doi=10.1053/j.jvca.2016.02.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27521969 }} </ref><ref name="pmid23816671">{{cite journal| author=Joshi SS, Jagadeesh AM| title=Efficacy of perioperative pregabalin in acute and chronic post-operative pain after off-pump coronary artery bypass surgery: a randomized, double-blind placebo controlled trial. | journal=Ann Card Anaesth | year= 2013 | volume= 16 | issue= 3 | pages= 180-5 | pmid=23816671 | doi=10.4103/0971-9784.114239 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23816671 }} </ref><ref name="pmid23108415">{{cite journal| author=Khalil MA, Abdel Azeem MS| title=The impact of dexmedetomidine infusion in sparing morphine consumption in off-pump coronary artery bypass grafting. | journal=Semin Cardiothorac Vasc Anesth | year= 2013 | volume= 17 | issue= 1 | pages= 66-71 | pmid=23108415 | doi=10.1177/1089253212463969 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23108415 }} </ref><ref name="pmid20056448">{{cite journal| author=Menda F, Köner O, Sayın M, Ergenoğlu M, Küçükaksu S, Aykaç B| title=Effects of single-dose gabapentin on postoperative pain and morphine consumption after cardiac surgery. | journal=J Cardiothorac Vasc Anesth | year= 2010 | volume= 24 | issue= 5 | pages= 808-13 | pmid=20056448 | doi=10.1053/j.jvca.2009.10.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20056448 }} </ref><ref name="pmid15502020">{{cite journal| author=Lahtinen P, Kokki H, Hakala T, Hynynen M| title=S(+)-ketamine as an analgesic adjunct reduces opioid consumption after cardiac surgery. | journal=Anesth Analg | year= 2004 | volume= 99 | issue= 5 | pages= 1295-1301 | pmid=15502020 | doi=10.1213/01.ANE.0000133913.07342.B9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15502020 }} </ref><ref name="pmid30778597">{{cite journal| author=Subramaniam B, Shankar P, Shaefi S, Mueller A, O'Gara B, Banner-Goodspeed V | display-authors=etal| title=Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. | journal=JAMA | year= 2019 | volume= 321 | issue= 7 | pages= 686-696 | pmid=30778597 | doi=10.1001/jama.2019.0234 | pmc=6439609 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30778597 }} </ref><ref name="pmid32889848">{{cite journal| author=Grant MC, Isada T, Ruzankin P, Gottschalk A, Whitman G, Lawton JS | display-authors=etal| title=Opioid-Sparing Cardiac Anesthesia: Secondary Analysis of an Enhanced Recovery Program for Cardiac Surgery. | journal=Anesth Analg | year= 2020 | volume= 131 | issue= 6 | pages= 1852-1861 | pmid=32889848 | doi=10.1213/ANE.0000000000005152 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32889848 }} </ref><ref name="pmid17678775">{{cite journal| author=Landoni G, Biondi-Zoccai GG, Zangrillo A, Bignami E, D'Avolio S, Marchetti C | display-authors=etal| title=Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials. | journal=J Cardiothorac Vasc Anesth | year= 2007 | volume= 21 | issue= 4 | pages= 502-11 | pmid=17678775 | doi=10.1053/j.jvca.2007.02.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17678775 }} </ref><ref name="pmid25186820">{{cite journal| author=Landoni G, Guarracino F, Cariello C, Franco A, Baldassarri R, Borghi G | display-authors=etal| title=Volatile compared with total intravenous anaesthesia in patients undergoing high-risk cardiac surgery: a randomized multicentre study. | journal=Br J Anaesth | year= 2014 | volume= 113 | issue= 6 | pages= 955-63 | pmid=25186820 | doi=10.1093/bja/aeu290 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25186820 }} </ref><ref name="pmid23852263">{{cite journal| author=Landoni G, Greco T, Biondi-Zoccai G, Nigro Neto C, Febres D, Pintaudi M | display-authors=etal| title=Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery. | journal=Br J Anaesth | year= 2013 | volume= 111 | issue= 6 | pages= 886-96 | pmid=23852263 | doi=10.1093/bja/aet231 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23852263 }} </ref><ref name="pmid30888743">{{cite journal| author=Landoni G, Lomivorotov VV, Nigro Neto C, Monaco F, Pasyuga VV, Bradic N | display-authors=etal| title=Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 13 | pages= 1214-1225 | pmid=30888743 | doi=10.1056/NEJMoa1816476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30888743 }} </ref><ref name="pmid16793778">{{cite journal| author=Symons JA, Myles PS| title=Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis. | journal=Br J Anaesth | year= 2006 | volume= 97 | issue= 2 | pages= 127-36 | pmid=16793778 | doi=10.1093/bja/ael149 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16793778 }} </ref><ref name="pmid29391936">{{cite journal| author=Zamani MM, Najafi A, Sehat S, Janforooz Z, Derakhshan P, Rokhtabnak F | display-authors=etal| title=The effect of intraoperative lung protective ventilation vs conventional ventilation, on postoperative pulmonary complications after cardiopulmonary bypass. | journal=J Cardiovasc Thorac Res | year= 2017 | volume= 9 | issue= 4 | pages= 221-228 | pmid=29391936 | doi=10.15171/jcvtr.2017.38 | pmc=5787335 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29391936 }} </ref><ref name="pmid29199052">{{cite journal| author=Zochios V, Klein AA, Gao F| title=Protective Invasive Ventilation in Cardiac Surgery: A Systematic Review With a Focus on Acute Lung Injury in Adult Cardiac Surgical Patients. | journal=J Cardiothorac Vasc Anesth | year= 2018 | volume= 32 | issue= 4 | pages= 1922-1936 | pmid=29199052 | doi=10.1053/j.jvca.2017.10.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29199052 }} </ref><ref name="pmid21430518">{{cite journal| author=Sundar S, Novack V, Jervis K, Bender SP, Lerner A, Panzica P | display-authors=etal| title=Influence of low tidal volume ventilation on time to extubation in cardiac surgical patients. | journal=Anesthesiology | year= 2011 | volume= 114 | issue= 5 | pages= 1102-10 | pmid=21430518 | doi=10.1097/ALN.0b013e318215e254 | pmc=3500383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21430518 }} </ref><ref name="pmid26720429">{{cite journal| author=Yang D, Grant MC, Stone A, Wu CL, Wick EC| title=A Meta-analysis of Intraoperative Ventilation Strategies to Prevent Pulmonary Complications: Is Low Tidal Volume Alone Sufficient to Protect Healthy Lungs? | journal=Ann Surg | year= 2016 | volume= 263 | issue= 5 | pages= 881-7 | pmid=26720429 | doi=10.1097/SLA.0000000000001443 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26720429 }} </ref><ref name="pmid23447502">{{cite journal| author=Aya HD, Cecconi M, Hamilton M, Rhodes A| title=Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. | journal=Br J Anaesth | year= 2013 | volume= 110 | issue= 4 | pages= 510-7 | pmid=23447502 | doi=10.1093/bja/aet020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23447502 }} </ref><ref name="pmid27936959">{{cite journal| author=Li P, Qu LP, Qi D, Shen B, Wang YM, Xu JR | display-authors=etal| title=Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review. | journal=Ann Med | year= 2017 | volume= 49 | issue= 4 | pages= 343-351 | pmid=27936959 | doi=10.1080/07853890.2016.1271956 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27936959 }} </ref>
{| class="wikitable" style="background-color:#fffc9e;"
|-
| Perioperative Analgesia
| style="background-color:#efefef;" | Usage of non [[opioid]] [[medications]] such as [[acetaminophen]], [[ketamine]], and [[dexmedetomidine]], and/or [[Regional anesthesia|regional techniques]] such as truncal [[nerve]] blocks (especially as part of a multimodal analgesic approach) have been shown to reduce [[surgery|perioperative]] [[opioid use]].
|-
| Maintenance Analgesia
| style="background-color:#efefef;" | Currently evidences are reporting that choice of [[anesthesia|maintenance anesthetic]] likely does not impact [[mortality rate]]. On the other hand, there is evidence supporting that [[Volatile anaesthetic]] may facilitate earlier [[extubation]] compared to [[intraveous]] choices.
|-
| Mechanical Ventilation
| style="background-color:#efefef;" | An [[surgery|intraoperative]] [[lung]]-protective [[ventilation]] strategy has been shown to be associated with better [[lung|pulmonary mechanics]] and reduce [[surgery|postoperative]] [[lung|pulmonary]] [[complications]]. This strategy consists of a [[tidal volume]] of 6–8 mL/kg predicted body weight plus [[positive end-expiratory pressure]].
|-
| Goal-directed Therapy
| style="background-color:#efefef;" | This protocol which is for [[fluids]] and [[vasopressors]] usage with a specific hemodynamic goal showed different results in different studies, therefore, more studies are required.
|}

===2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>===

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Anesthetic management directed toward early postoperative extubation and accelerated recovery of low to medium-risk patients undergoing uncomplicated [[CABG]] is recommended.<ref name="pmid14583985">{{cite journal| author=Hawkes CA, Dhileepan S, Foxcroft D| title=Early extubation for adult cardiac surgical patients. | journal=Cochrane Database Syst Rev | year= 2003 | volume= | issue= 4 | pages= CD003587 | pmid=14583985 | doi=10.1002/14651858.CD003587 | pmc= | url= }} </ref><ref name="pmid14508335">{{cite journal| author=Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC| title=A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. | journal=Anesthesiology | year= 2003 | volume= 99 | issue= 4 | pages= 982-7 | pmid=14508335 | doi= | pmc= | url= }} </ref><ref name="pmid16614584">{{cite journal| author=van Mastrigt GA, Maessen JG, Heijmans J, Severens JL, Prins MH| title=Does fast-track treatment lead to a decrease of intensive care unit and hospital length of stay in coronary artery bypass patients? A meta-regression of randomized clinical trials. | journal=Crit Care Med | year= 2006 | volume= 34 | issue= 6 | pages= 1624-34 | pmid=16614584 | doi=10.1097/01.CCM.0000217963.87227.7B | pmc= | url= }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Multidisciplinary efforts are indicated to ensure an optimal level of [[analgesia]] and patient comfort throughout the perioperative period.<ref name="pmid16636035">{{cite journal| author=Bainbridge D, Martin JE, Cheng DC| title=Patient-controlled versus nurse-controlled analgesia after cardiac surgery--a meta-analysis. | journal=Can J Anaesth | year= 2006 | volume= 53 | issue= 5 | pages= 492-9 | pmid=16636035 | doi=10.1007/BF03022623 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16636035 }} </ref><ref name="pmid17578977">{{cite journal| author=Brennan F, Carr DB, Cousins M| title=Pain management: a fundamental human right. | journal=Anesth Analg | year= 2007 | volume= 105 | issue= 1 | pages= 205-21 | pmid=17578977 | doi=10.1213/01.ane.0000268145.52345.55 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17578977 }} </ref><ref name="pmid19949325">{{cite journal| author=Serfontein L| title=Awareness in cardiac anesthesia. | journal=Curr Opin Anaesthesiol | year= 2010 | volume= 23 | issue= 1 | pages= 103-8 | pmid=19949325 | doi=10.1097/ACO.0b013e328334cb75 | pmc= | url= }} </ref><ref name="pmid17006079">{{cite journal| author=Lahtinen P, Kokki H, Hynynen M| title=Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. | journal=Anesthesiology | year= 2006 | volume= 105 | issue= 4 | pages= 794-800 | pmid=17006079 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17006079 }} </ref><ref name="pmid16733157">{{cite journal| author=Taillefer MC, Carrier M, Bélisle S, Levesque S, Lanctôt H, Boisvert AM et al.| title=Prevalence, characteristics, and predictors of chronic nonanginal postoperative pain after a cardiac operation: a cross-sectional study. | journal=J Thorac Cardiovasc Surg | year= 2006 | volume= 131 | issue= 6 | pages= 1274-80 | pmid=16733157 | doi=10.1016/j.jtcvs.2006.02.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16733157 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Efforts are recommended to improve interdisciplinary communication and patient safety in the perioperative environment (eg, formalized checklist-guided multidisciplinary communication).<ref name="pmid20081130">{{cite journal| author=Martinez EA, Marsteller JA, Thompson DA, Gurses AP, Goeschel CA, Lubomski LH et al.| title=The Society of Cardiovascular Anesthesiologists' FOCUS initiative: Locating Errors through Networked Surveillance (LENS) project vision. | journal=Anesth Analg | year= 2010 | volume= 110 | issue= 2 | pages= 307-11 | pmid=20081130 | doi=10.1213/ANE.0b013e3181c92b9c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20081130 }} </ref><ref name="pmid20106395">{{cite journal| author=Wadhera RK, Parker SH, Burkhart HM, Greason KL, Neal JR, Levenick KM et al.| title=Is the "sterile cockpit" concept applicable to cardiovascular surgery critical intervals or critical events? The impact of protocol-driven communication during cardiopulmonary bypass. | journal=J Thorac Cardiovasc Surg | year= 2010 | volume= 139 | issue= 2 | pages= 312-9 | pmid=20106395 | doi=10.1016/j.jtcvs.2009.10.048 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20106395 }} </ref><ref name="pmid20959579">{{cite journal| author=Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH et al.| title=Association between implementation of a medical team training program and surgical mortality. | journal=JAMA | year= 2010 | volume= 304 | issue= 15 | pages= 1693-700 | pmid=20959579 | doi=10.1001/jama.2010.1506 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20959579 }} </ref><ref name="pmid19144931">{{cite journal| author=Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP et al.| title=A surgical safety checklist to reduce morbidity and mortality in a global population. | journal=N Engl J Med | year= 2009 | volume= 360 | issue= 5 | pages= 491-9 | pmid=19144931 | doi=10.1056/NEJMsa0810119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19144931 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' A fellowship-trained cardiac anesthesiologist (or experienced board-certified practitioner) credentialed in the use of perioperative transesophageal [[echocardiography]] (TEE) is recommended to provide or supervise anesthetic care of patients who are considered to be at high risk.<ref name="pmid12050607">{{cite journal| author=Cahalan MK, Stewart W, Pearlman A, Goldman M, Sears-Rogan P, Abel M et al.| title=American Society of Echocardiography and Society of Cardiovascular Anesthesiologists task force guidelines for training in perioperative echocardiography. | journal=J Am Soc Echocardiogr | year= 2002 | volume= 15 | issue= 6 | pages= 647-52 | pmid=12050607 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12050607 }} </ref><ref name="pmid17098131">{{cite journal| author=Mathew JP, Glas K, Troianos CA, Sears-Rogan P, Savage R, Shanewise J et al.| title=American Society of Echocardiography/Society of Cardiovascular Anesthesiologists recommendations and guidelines for continuous quality improvement in perioperative echocardiography. | journal=J Am Soc Echocardiogr | year= 2006 | volume= 19 | issue= 11 | pages= 1303-13 | pmid=17098131 | doi=10.1016/j.echo.2006.08.039 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17098131 }} </ref><ref name="pmid19923503">{{cite journal| author=Thys DM| title=Cardiac anesthesia: thirty years later--the second annual Arthur E. Weyman lecture. | journal=Anesth Analg | year= 2009 | volume= 109 | issue= 6 | pages= 1782-90 | pmid=19923503 | doi=10.1213/ANE.0b013e3181be4002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19923503 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III: HARM]]
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Cyclooxygenase-2 inhibitors]] are not recommended for pain relief in the postoperative period after [[CABG]].<ref name="pmid15713945">{{cite journal| author=Nussmeier NA, Whelton AA, Brown MT, Langford RM, Hoeft A, Parlow JL et al.| title=Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 11 | pages= 1081-91 | pmid=15713945 | doi=10.1056/NEJMoa050330 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15713945 }} </ref><ref name="pmid12830070">{{cite journal| author=Ott E, Nussmeier NA, Duke PC, Feneck RO, Alston RP, Snabes MC et al.| title=Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib in patients undergoing coronary artery bypass surgery. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 6 | pages= 1481-92 | pmid=12830070 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12830070 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Routine use of early extubation strategies in facilities with limited backup for airway emergencies or advanced respiratory support is potentially harmful. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Volatile anesthetic-based regimens can be useful in facilitating early extubation and reducing patient recall.<ref name="pmid14508335">{{cite journal| author=Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC| title=A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. | journal=Anesthesiology | year= 2003 | volume= 99 | issue= 4 | pages= 982-7 | pmid=14508335 | doi= | pmc= | url= }} </ref><ref name="pmid9821994">{{cite journal| author=Dowd NP, Cheng DC, Karski JM, Wong DT, Munro JA, Sandler AN| title=Intraoperative awareness in fast-track cardiac anesthesia. | journal=Anesthesiology | year= 1998 | volume= 89 | issue= 5 | pages= 1068-73; discussion 9A | pmid=9821994 | doi= | pmc= | url= }} </ref><ref name="pmid20537922">{{cite journal| author=Groesdonk HV, Pietzner J, Borger MA, Fassl J, Haentschel D, Paarmann H et al.| title=The incidence of intraoperative awareness in cardiac surgery fast-track treatment. | journal=J Cardiothorac Vasc Anesth | year= 2010 | volume= 24 | issue= 5 | pages= 785-9 | pmid=20537922 | doi=10.1053/j.jvca.2010.03.018 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20537922 }} </ref><ref name="pmid8968177">{{cite journal| author=Cheng DC, Karski J, Peniston C, Raveendran G, Asokumar B, Carroll J et al.| title=Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use. A prospective, randomized, controlled trial. | journal=Anesthesiology | year= 1996 | volume= 85 | issue= 6 | pages= 1300-10 | pmid=8968177 | doi= | pmc= | url= }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The effectiveness of high thoracic epidural anesthesia/analgesia for routine analgesic use is uncertain.<ref name="pmid20052816">{{cite journal| author=Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT et al.| title=Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). | journal=Reg Anesth Pain Med | year= 2010 | volume= 35 | issue= 1 | pages= 64-101 | pmid=20052816 | doi= | pmc= | url= }} </ref><ref name="pmid12707123">{{cite journal| author=Murphy GS, Szokol JW, Marymont JH, Vender JS, Avram MJ, Rosengart TK et al.| title=Recovery of neuromuscular function after cardiac surgery: pancuronium versus rocuronium. | journal=Anesth Analg | year= 2003 | volume= 96 | issue= 5 | pages= 1301-7, table of contents | pmid=12707123 | doi= | pmc= | url= }} </ref><ref name="pmid15851604">{{cite journal| author=Nygård E, Kofoed KF, Freiberg J, Holm S, Aldershvile J, Eliasen K et al.| title=Effects of high thoracic epidural analgesia on myocardial blood flow in patients with ischemic heart disease. | journal=Circulation | year= 2005 | volume= 111 | issue= 17 | pages= 2165-70 | pmid=15851604 | doi=10.1161/01.CIR.0000163551.33812.1A | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15851604 }} </ref><ref name="pmid18566197">{{cite journal| author=Tenenbein PK, Debrouwere R, Maguire D, Duke PC, Muirhead B, Enns J et al.| title=Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery. | journal=Can J Anaesth | year= 2008 | volume= 55 | issue= 6 | pages= 344-50 | pmid=18566197 | doi=10.1007/BF03021489 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18566197 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==Sources==
*2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>.
*2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]

Coronary artery bypass surgery conduits used for bypass

2022-08-29T06:27:01Z

Anahita: /* Overview */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}, [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] {{Anahita}}
==Overview==
The choice of conduits ([[artery|arteries]] and/or [[veins]] from elsewhere in the body) to [[bypass]] the blockages is highly [[surgery|surgeon]] and institution dependent. To choose the proper conduits for [[CABG]] both clinical and technical factors such as [[life expectancy]], presence of [[diabetes]], chronic renal failure, and degree of the target [[stenosis]] must be considered. [[Saphenous vein]], [[internal thoracic artery]], and [[radial artery]] are the most used [[vessels]] to harvest for [[grafting]]. The [[saphenous vein]] can be harvested by either direct visualization or via an [[endoscopy|endoscopic approach]]. Among these two methods the [[endoscopy|endoscopic approach]] has been associated with lower rates of [[wound]] [[infection]], greater [[patient]] satisfaction, and earlier mobilization. However, non-[[randomized]] data from a much larger multicenter study does suggest that [[endoscopyendoscopic harvesting]] may be associated with a higher rate of failure and adverse events such as death and [[MI]]. [[Veins]] that are used either have their valves removed or are turned around so that the [[valves]] in them do not occlude [[blood flow]] in the [[graft]]. On the other hand, numerous studies support the use of the [[Internal thoracic artery|left internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also known as the [[Internal thoracic artery|left internal mammary artery]] ([[Internal thoracic artery|LIMA]])) to [[graft]] the [[LAD]] in order to improve survival unless [[contraindications|contraindicated]]. Evidence shows that the right [[IMA]] can be used to [[graft]] the [[LAD]] if the [[LIMA]] is impractical and unusable. Furthermore, the right [[IMA]] can be used in conjunction with the [[LIMA]] which is called bilateral [[internal mammary artery]] (BIMA) [[grafting]]. The latter method showed a better outcome based on multiple studies. In multiple [[artery|arterial]] [[revascularization]] during [[Coronary artery bypass surgery]], the [[Internal thoracic artery|right internal thoracic artery]] ([[Internal thoracic artery|RITA]]) has been proofed to be a better choice as a conduit than the [[radial artery]]. On the other hand, numerous [[clinical trials]] have demonstrated better patency rates (in mid- and long-term) when the [[radial artery]] is used in comparison with the [[saphenous vein]].

==Conduits used for bypass==
*The choice of conduits ([[artery|arteries]] and/or [[veins]] from elsewhere in the body) to [[bypass]] the blockages is highly [[surgery|surgeon]] and institution dependent.
*To choose the proper conduits for [[CABG]] both clinical and technical factors such as [[life expectancy]], presence of [[diabetes]], chronic renal failure, and degree of the target [[stenosis]] must be considered.<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
*The following table published by 2021 ACA Revascularization Guideline presents the best practices for the Use of [[bypass]] [[conduits]] in [[CABG]]:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
{| class="wikitable"
|-
| Assessing [[Anatomical terms of location|palmar arch]] completeness and [[ulna|ulnar]] compensation before harvesting the [[radial artery]]. If [[radial artery]] harvesting is considered it is recommended to use the [[arm]] with the best [[ulna|ulnar compensation]].
|-
| It is recommended to use [[radial artery]] [[grafts]] to target [[vessels]] with [[stenosis|subocclusive stenosis]].
|-
| It is recommended to avoid [[radial artery]] use after [[Radial artery catheterization|transradial catheterization]].
|-
| It is recommended to avoid [[radial artery]] use in [[chronic kidney disease]] [[patients]] and in those with a high likelihood of rapid progression to [[hemodialysis]].
|-
| It is recommended to avoid [[oral]] [[calcium channel blockers]] for the first [[surgery|postoperative]] year after [[radial artery]] [[grafting]].
|-
| It is recommended to avoid bilateral [[percutaneous]] or [[surgery|surgical]] [[radial artery]] procedures in [[patients]] with [[coronary artery disease]] with a goal to preserve the [[artery]] for future use.
|-
| It is recommended to use the [[internal mammary artery]] (using the skeletonization technique) to reduce the risk of [[Sternum|sternal]] [[wound]] [[complications]].
|-
| It is recommended to use an [[endoscopy|endoscopic]] [[saphenous vein]] harvest technique in [[patients]] at risk of [[wound]] [[complications]].
|-
| For [[patients]] at low risk of [[wound]] [[complications]], it is recommended to use a no-touch [[saphenous vein]] harvest technique.
|-
| It is recommended to use the skeletonized [[right gastroepiploic artery]] to [[graft]] [[right coronary artery]] target [[vessels]] with subocclusive [[stenosis]] if the operator is experienced with the use of the [[artery]].
|}
*Typically, the left [[internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also referred to as the ''[[left internal mammary artery]]'' or ''[[LIMA]]'') is grafted to the [[Left Anterior Descending]] [[artery]] and a combination of other [[artery|arteries]] and [[veins]] is used for other [[coronary arteries]].
*The right [[internal thoracic artery]] ([[Internal thoracic artery|RITA]]), the [[great saphenous vein]] from the [[leg]] and the [[radial artery]] from the forearm are frequently used.
*The [[right gastroepiploic artery]] from the [[stomach]] is infrequently used given the difficult mobilization from the [[abdomen]].

==Saphenous vein==
===Saphenous vein anatomy===
*The [[great saphenous vein]] ([[GSV]]) is frequently used as a conduit for [[CABG]]. It originates from where the dorsal [[vein]] of the [[first digit]] (the large [[toe]]) merges with the [[dorsal venous arch of the foot]].
*After passing [[Anatomical terms of location|anterior]] to the [[medial malleolus]] (where it often can be visualized and [[Palpation|palpated]]), it runs up the [[medial]] side of the [[leg]]. At [[knee]], it runs over the [[Anatomical terms of location|posterior border]] of the [[medial epicondyle]] of the [[femur]] bone.
*The [[great saphenous vein]] then courses [[Anatomical terms of location|laterally]] to lie on the [[Anatomical terms of location|anterior surface]] of the [[thigh]] before entering an opening in the [[fascia lata]] called the [[saphenous opening]]. It joins with the [[femoral vein]] in the region of the [[femoral triangle]] at the saphenofemoral junction.
*The '''small [[saphenous vein]]''' (also '''lesser [[saphenous vein]]''') originates where the [[Anatomical terms of location|dorsal]] [[vein]] from the [[fifth digit]] (smallest [[toe]]) merges with the [[dorsal [[venous]] arch of the [[foot]], which attaches to the [[great saphenous vein]]. It is considered a [[superficial vein]] and is [[subcutaneous]] (just under the [[skin]]). From its origin, it courses around the lateral aspect of the [[foot]] ([[Anatomical terms of location|inferior]] and [[Anatomical terms of location|posterior]] to the [[lateral malleolus]]) and runs along the [[Anatomical terms of location|posterior]] aspect of the [[leg]] (with the [[sural nerve]]), passes between the heads of the [[gastrocnemius muscle]], and drains into the [[popliteal vein]], approximately at or above the level of the [[knee]] [[joint]].

<gallery perRow="3">
Image:Gray432 color.png|Cross-section through the middle of the [[thigh]].
Image:Gray440_color.png|Cross-section through the middle of the [[leg]].
Image:Great_saphenous_vein.png|The [[great saphenous vein]] and landmarks along its course
Image:Gray580.png|The [[great saphenous vein]] and its tributaries at the [[Saphenous opening|fossa ovalis]] in the [[groin]].
Image:Gray582.png|Small [[saphenous vein]] and its tributaries.
</gallery>

====Saphenous vein harvesting====
*The [[saphenous vein]] can be harvested by either direct visualization or via an [[endoscopy|endoscopic approach]]. [[Veins]] that are used either have their valves removed or are turned around so that the [[valves]] in them do not occlude [[blood flow]] in the [[graft]]. The technique of [[saphenous vein]] harvesting may influence later [[SVG]] patency. The process of harvesting the [[vein]] and [[pressure]] testing the [[vein]] for a leak may damage the [[endothelium]].<ref>Lawrie GM, Weilbacher DE, Henry PD. Endothelium-dependent relaxation in human saphenous vein grafts. Effects of preparation and clinicopathologic correlations. J Thorac Cardiovasc Surg 1990;100:612—20.</ref><ref>Souza DS, Johansson B, Bojo¨ L, Karlsson R, Geijer H, Filbey D, Bodin L, Arbeus M, Dashwood MR. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg 2006;132:373—8.</ref>
*The [[endoscopy|endoscopic approach]] has been associated with lower rates of [[wound]] [[infection]], greater [[patient]] satisfaction, and earlier mobilization.<ref name="pmid11828277">{{cite journal |author=Kiaii B, Moon BC, Massel D, Langlois Y, Austin TW, Willoughby A, Guiraudon C, Howard CR, Guo LR |title=A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=123 |issue=2 |pages=204–12 |year=2002 |month=February |pmid=11828277 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522302096046 |issn= |accessdate=2010-07-23}}</ref><ref name="pmid19605828">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA, Mehta RH, Gibson CM, Mack MJ, Kouchoukos NT, Califf RM, Alexander JH |title=Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery |journal=[[The New England Journal of Medicine]] |volume=361 |issue=3 |pages=235–44 |year=2009 |month=July |pmid=19605828 |doi=10.1056/NEJMoa0900708 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19605828&promo=ONFLNS19 |issn= |accessdate=2010-07-12}}</ref><ref name="pmid15746730">{{cite journal |author=Yun KL, Wu Y, Aharonian V, Mansukhani P, Pfeffer TA, Sintek CF, Kochamba GS, Grunkemeier G, Khonsari S |title=Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=129 |issue=3 |pages=496–503 |year=2005 |month=March |pmid=15746730 |doi=10.1016/j.jtcvs.2004.08.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522304015855 |issn= |accessdate=2010-07-23}}</ref><ref name="pmid15115999">{{cite journal |author=Perrault LP, Jeanmart H, Bilodeau L, Lespérance J, Tanguay JF, Bouchard D, Pagé P, Carrier M |title=Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=127 |issue=5 |pages=1402–7 |year=2004 |month=May |pmid=15115999 |doi=10.1016/j.jtcvs.2003.10.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303018798 |issn= |accessdate=2010-07-23}}</ref> One small randomized study of 144 patients showed no difference in histologic findings between the traditional and endoscopic techniques.<ref name="pmid11828277">{{cite journal |author=Kiaii B, Moon BC, Massel D, Langlois Y, Austin TW, Willoughby A, Guiraudon C, Howard CR, Guo LR |title=A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=123 |issue=2 |pages=204–12 |year=2002 |month=February |pmid=11828277|doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0022522302096046 |issn= |accessdate=2010-07-23}}</ref>In another small study of 40 patients randomized to the two techniques, no difference was seen in angiographic patency at 3 months.<ref name="pmid15115999">{{cite journal |author=Perrault LP, Jeanmart H, Bilodeau L, Lespérance J, Tanguay JF, Bouchard D, Pagé P, Carrier M |title=Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=127 |issue=5 |pages=1402–7 |year=2004 |month=May |pmid=15115999 |doi=10.1016/j.jtcvs.2003.10.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303018798 |issn= |accessdate=2010-07-23}}</ref>Another small randomized study of 144 patients who returned for angiography demonstrated an occlusion rate of 21.7% for the endoscopic approach vs 17.6% for the open approach.<ref name="pmid15746730">{{cite journal |author=Yun KL, Wu Y, Aharonian V, Mansukhani P, Pfeffer TA, Sintek CF, Kochamba GS, Grunkemeier G, Khonsari S |title=Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=129 |issue=3 |pages=496–503 |year=2005 |month=March |pmid=15746730 |doi=10.1016/j.jtcvs.2004.08.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522304015855 |issn= |accessdate=2010-07-23}}</ref>
*However, non-[[randomized]] data from a much larger multicenter study does suggest that [[endoscopyendoscopic harvesting]] may be associated with a higher rate of failure and adverse events such as death and [[MI]].<ref name="pmid19605828">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA, Mehta RH, Gibson CM, Mack MJ, Kouchoukos NT, Califf RM, Alexander JH |title=Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery |journal=[[The New England Journal of Medicine]] |volume=361 |issue=3 |pages=235–44 |year=2009 |month=July |pmid=19605828 |doi=10.1056/NEJMoa0900708 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19605828&promo=ONFLNS19 |issn= |accessdate=2010-07-12}}</ref>
*[[Complications]] associated with [[Saphenous vein graft|saphenous vein harvesting]] include the following:
** [[Saphenous nerve]] [[injury]]
** [[Infection]] at [[incision]] sites or [[sepsis]].
** [[Deep vein thrombosis]] ([[DVT]])
** [[Keloid|Keloid scarring]]
** [[Chronic pain]] at [[incision]] sites

==The Internal Thoracic Artery==
*Numerous studies support the use of the [[Internal thoracic artery|left internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also known as the [[Internal thoracic artery|left internal mammary artery]] ([[Internal thoracic artery|LIMA]])) to [[graft]] the [[LAD]] in order to improve survival unless [[contraindications|contraindicated]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531997 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref>
*In a study evaluating almost 6,000 [[patients]], [[LIMA]] [[grafting]] was able to reduce the rate of [[heart|cardiac]]-related [[hospital|rehospitalization]] and [[revascularization]]. In addition, this study showed a lower rate of death and recurrent [[infarction]] in those who undergone [[LIMA]] [[grafting]].<ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref>
*Evidence shows that the right [[IMA]] can be used to [[graft]] the [[LAD]] if the [[LIMA]] is impractical and unusable. Furthermore, the right [[IMA]] can be used in conjunction with the [[LIMA]] which is called bilateral [[internal mammary artery]] (BIMA) [[grafting]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**Based on observational studies, BIMA [[grafting]] has a survival advantage when compared with [[CABG]] with a single [[IMA]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref><ref name="pmid24916209">{{cite journal| author=Yi G, Shine B, Rehman SM, Altman DG, Taggart DP| title=Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. | journal=Circulation | year= 2014 | volume= 130 | issue= 7 | pages= 539-45 | pmid=24916209 | doi=10.1161/CIRCULATIONAHA.113.004255 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24916209 }} </ref><ref name="pmid24521973">{{cite journal| author=Takagi H, Goto SN, Watanabe T, Mizuno Y, Kawai N, Umemoto T| title=A meta-analysis of adjusted hazard ratios from 20 observational studies of bilateral versus single internal thoracic artery coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 4 | pages= 1282-90 | pmid=24521973 | doi=10.1016/j.jtcvs.2014.01.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24521973 }} </ref><ref name="pmid29306899">{{cite journal| author=Gaudino M, Di Franco A, Rahouma M, Tam DY, Iannaccone M, Deb S | display-authors=etal| title=Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta-Analysis. | journal=J Am Heart Assoc | year= 2018 | volume= 7 | issue= 1 | pages= | pmid=29306899 | doi=10.1161/JAHA.117.008010 | pmc=5778975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29306899 }} </ref>
**Reports from a [[meta-analysis]] of 38 studies, including 174,205 [[patients]] demonstrated a decreased [[mortality rate]] at 7.25 years follow up among [[patients]] who had BIMA [[grafting]].<ref name="pmid29306899">{{cite journal| author=Gaudino M, Di Franco A, Rahouma M, Tam DY, Iannaccone M, Deb S | display-authors=etal| title=Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta-Analysis. | journal=J Am Heart Assoc | year= 2018 | volume= 7 | issue= 1 | pages= | pmid=29306899 | doi=10.1161/JAHA.117.008010 | pmc=5778975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29306899 }} </ref>
**On the other hand, a single large [[randomized controlled trial]] reported no difference in 10-year all-cause [[mortality rate|mortality]] when BIMA was compared with single [[IMA]]. Furthermore, this study highlighted the importance of [[surgery|surgical expertise]] in BIMA [[grafting]].<ref name="pmid30699314">{{cite journal| author=Taggart DP, Benedetto U, Gerry S, Altman DG, Gray AM, Lees B | display-authors=etal| title=Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 5 | pages= 437-446 | pmid=30699314 | doi=10.1056/NEJMoa1808783 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30699314 }} </ref>
**It is critical to consider the higher risk of [[sternum|sternal]] [[infection]] with BIMA [[grafting]].<ref name="pmid29453002">{{cite journal| author=Schwann TA, Habib RH, Wallace A, Shahian DM, O'Brien S, Jacobs JP | display-authors=etal| title=Operative Outcomes of Multiple-Arterial Versus Single-Arterial Coronary Bypass Grafting. | journal=Ann Thorac Surg | year= 2018 | volume= 105 | issue= 4 | pages= 1109-1119 | pmid=29453002 | doi=10.1016/j.athoracsur.2017.10.058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29453002 }} </ref>
*In multiple [[artery|arterial]] [[revascularization]] during [[Coronary artery bypass surgery]], the [[Internal thoracic artery|right internal thoracic artery]] ([[Internal thoracic artery|RITA]]) has been proofed to be a better choice as a conduit than the [[radial artery]]. This has been published at the European Society of Cardiology (ESC) 2011 Congress, after a [[clinical trial|trial]] on more than 1000 [[patients]] who had the operation in 10 years [[clinical trial|trial]].
*The [[Internal thoracic artery|left internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also known as the [[Internal thoracic artery|left internal mammary artery]] ([[Internal thoracic artery|LIMA]])) is the best [[vessel]] to use for [[coronary artery bypass surgery]] when only one [[artery]] is required.
**It was known that the long-term outcomes of the [[artery|arterial]] [[graft]]s are much better than [[saphenous vein grafts]] (SVGs) and has less [[morbidity]] and [[mortality rates]].<ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref>
**The [[right internal thoracic artery]] (RITA) is the best second conduit for the [[bypass]] and has better long-term outcomes than the [[radial artery]]. The use of the [[Internal thoracic artery|RITA]] results in the following in comparison with [[SVG]]:
***Less major adverse [[heart|cardiac]] and cerebrovascular events.
***Less [[surgery|perioperative]] [[myocardial infarction]] rates.
***Less [[surgery|perioperative]] [[stroke]] rates.
***Less [[heart|cardiac]]-related deaths.
*There have been good clinical results with the single left [[internal thoracic artery]] [[grafting]] compared with [[saphenous vein]] [[grafting]]. This prompted surgeons to use both ITAs. Bilateral ITA [[grafting]] could improve long-term survival. Late [[Complication (medicine)|complications]] like [[myocardial infarction]] and need to [[surgery|reoperate]] may be avoided. However, mathematical modeling is required to assist in developing a strategy for use of such [[grafts]].<ref name="pmid9852872">{{cite journal| author=Buxton BF, Komeda M, Fuller JA, Gordon I| title=Bilateral internal thoracic artery grafting may improve the outcome of coronary artery surgery. Risk-adjusted survival. | journal=Circulation | year= 1998 | volume= 98 | issue= 19 Suppl | pages= II1-6 | pmid=9852872 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9852872 }} </ref>
*In a [[cohort study]] of 8123 [[patients]] who received single [[internal thoracic artery]] [[grafts]] and 2001 who received bilateral [[internal thoracic artery]] [[grafts]] for [[multivessel coronary artery disease]] for a duration of 20 years, it was found that the latter produces improved survival compared with single [[internal thoracic artery]] [[grafting]] during the second [[surgery|postoperative]] decade, and the magnitude of that benefit increases through 20 [[surgery|postoperative]] years.<ref name="pmid15561021">{{cite journal| author=Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM| title=The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 6 | pages= 2005-12; discussion 2012-4 | pmid=15561021 | doi=10.1016/j.athoracsur.2004.05.070 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15561021 }} </ref>
*It's easy to harvest the [[radial artery]], but it has a higher risk for [[vasospasm]] and [[atherosclerosis]] than the [[right internal thoracic artery]] ([[RITA]]). Some institution solves this problem ([[vasospasm]]) by preparing the [[radial artery|radial arteries]] with [[phenoxybenzamine]].
*Although the fact that using both [[internal thoracic arteries]] for [[coronary artery bypass surgery]] takes a longer time, it has better long-term results and [[surgery|perioperative]] outcomes. This has to be proofed and confirmed by more [[randomized]] and controlled trials.

==Radial Artery==
*Numerous [[clinical trials]] have demonstrated better patency rates (in mid- and long-term) when the [[radial artery]] is used in comparison with the [[saphenous vein]].<ref name="pmid32662861">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A | display-authors=etal| title=Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis. | journal=JAMA | year= 2020 | volume= 324 | issue= 2 | pages= 179-187 | pmid=32662861 | doi=10.1001/jama.2020.8228 | pmc=7361649 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32662861 }} </ref><ref name="pmid22871565">{{cite journal| author=Cao C, Manganas C, Horton M, Bannon P, Munkholm-Larsen S, Ang SC | display-authors=etal| title=Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 146 | issue= 2 | pages= 255-61 | pmid=22871565 | doi=10.1016/j.jtcvs.2012.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22871565 }} </ref><ref name="pmid24686003">{{cite journal| author=Benedetto U, Raja SG, Albanese A, Amrani M, Biondi-Zoccai G, Frati G| title=Searching for the second best graft for coronary artery bypass surgery: a network meta-analysis of randomized controlled trials†. | journal=Eur J Cardiothorac Surg | year= 2015 | volume= 47 | issue= 1 | pages= 59-65; discussion 65 | pmid=24686003 | doi=10.1093/ejcts/ezu111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686003 }} </ref>
*Furthermore, several [[observational studies]] reported a better survival rate when the [[radial artery]] is used instead of the [[saphenous vein]] for [[CABG]].<ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref><ref name="pmid29708851">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Biondi-Zoccai G, Sedrakyan A, Puskas JD | display-authors=etal| title=Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. | journal=N Engl J Med | year= 2018 | volume= 378 | issue= 22 | pages= 2069-2077 | pmid=29708851 | doi=10.1056/NEJMoa1716026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29708851 }} </ref><ref name="pmid32662861">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A | display-authors=etal| title=Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis. | journal=JAMA | year= 2020 | volume= 324 | issue= 2 | pages= 179-187 | pmid=32662861 | doi=10.1001/jama.2020.8228 | pmc=7361649 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32662861 }} </ref>
*Based on the 2021 ACA Revascularization guideline, the following [[patients]] benefit the most from the [[radial artery]] use:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Patients]] younger than 75 years old
**[[Females]]
**[[Patients]] with preserved [[renal function]]
*There is some limited data regarding the vulnerability to the effect of [[Chronic (medical)|chronic]] native competitive flow in composite [[radial artery]] [[grafts]].<ref name="pmid14726046">{{cite journal| author=Abu-Omar Y, Mussa S, Anastasiadis K, Steel S, Hands L, Taggart DP| title=Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test. | journal=Ann Thorac Surg | year= 2004 | volume= 77 | issue= 1 | pages= 116-9 | pmid=14726046 | doi=10.1016/s0003-4975(03)01515-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14726046 }} </ref>

==Conduit Nomenclature==
*The terms ''single bypass'', ''double bypass'', ''triple bypass'', ''quadruple bypass'' and ''quintuple bypass'' refer to the number of [[coronary arteries]] [[Coronary artery bypass surgery|bypassed]] in the procedure. In other words, a double [[bypass]] means two [[coronary arteries]] are [[bypass|bypassed]] (such as [[left anterior descending|left anterior descending (LAD)]] [[coronary artery]] and [[right coronary artery|right coronary artery (RCA)]]); a triple [[bypass]] means three [[vessels]] are [[bypass|bypassed]] (such as [[LAD]], [[RCA]], and [[left circumflex artery|left circumflex artery (LCX)]]); a quadruple [[bypass]] means four vessels are bypassed (such as [[LAD]], [[RCA]], [[LCX]], first [[Left coronary artery|diagonal artery]] of the [[LAD]]). Less commonly more than four [[coronary arteries]] may be bypassed.
*A greater number of bypasses does not imply a [[patient]] is "sicker," nor does a lesser number imply a [[patient]] is "healthier".<ref>{{cite journal |author=Ohki S, Kaneko T, Satoh Y, ''et al'' |title=[Coronary artery bypass grafting in octogenarian] |language=Japanese |journal=Kyobu geka. The Japanese journal of thoracic surgery |volume=55 |issue=10 |pages=829–33; discussion 833–6 |year=2002 |pmid=12233100 |doi=}}</ref>
*A [[patient]] with a large amount of [[coronary artery disease|coronary artery disease]] ([[coronary artery disease|CAD]]) may receive fewer [[bypass]] [[grafts]] owing to the lack of suitable "target" [[vessels]].
*A [[patient]] with a single [[stenosis]] of the [[Left coronary artery|left main]] [[coronary artery]] often requires only two [[bypasses]] (to the [[LAD]] and the [[LCX]]). However, depending upon the [[anatomy]], grafts may also need to be placed to a large [[diagonal artery]], or to additional large [[obtuse marginal]] branches.

==Assessment of Target Vessels for Bypass Grafting==
A [[coronary artery]] may be unsuitable for [[bypass]] [[grafting]] for the following reasons:
*'''Size:''' If the native target [[artery]] it is small (< 1 mm or < 1.5 mm depending on surgeon preference)
*'''Location:''' Some [[Anatomical terms of location|distal locations]] of the native target [[artery]] may not be accessible, or a conduit may not reach far down the native [[artery]].
*'''Native artery calcification:''' Heavily [[calcification|calcified]] native [[arteries]] are sometimes technically not amenable to [[anastomosis]] of a conduit.
*'''Diffuse disease:''' The native [[artery]] may not have a section of the [[vessel]] that has a minimal [[disease]] where a conduit can be [[grafting|grafted]] to.
*'''The native [[artery]] lies in the [[heart]] [[muscle]] or is intramyocardial:''' In this scenario, the native [[coronary artery]] is located within the [[heart]] [[muscle]] rather than on the surface of the [[heart]] and a [[graft]] cannot be attached to it.

Although the cardiothoracic surgeon reviews the [[coronary angiogram]] prior to [[surgery]] and identifies the [[lesions]] (or "blockages") in the [[coronary arteries]] and will estimate the number of [[bypass]] [[grafts]] prior to [[surgery]], the final decision is made in the [[surgery|operating room]] based upon the direct examination of the [[heart]] and the suitability of the native target [[vessel]] for [[bypass|bypassing]].

==2021 ACA Revascularization Guideline==
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid29708851">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Biondi-Zoccai G, Sedrakyan A, Puskas JD | display-authors=etal| title=Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. | journal=N Engl J Med | year= 2018 | volume= 378 | issue= 22 | pages= 2069-2077 | pmid=29708851 | doi=10.1056/NEJMoa1716026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29708851 }} </ref><ref name="pmid22871565">{{cite journal| author=Cao C, Manganas C, Horton M, Bannon P, Munkholm-Larsen S, Ang SC | display-authors=etal| title=Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 146 | issue= 2 | pages= 255-61 | pmid=22871565 | doi=10.1016/j.jtcvs.2012.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22871565 }} </ref><ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref>
|-
| bgcolor="LightGreen"| To improve long-term [[heart|cardiac]] outcomes, using a [[radial artery]] is recommended in preference to a [[saphenous vein]] conduit to graft the second most important, significantly stenosed non–[[LAD]] vessel.
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531997 }} </ref><ref name="pmid27343909">{{cite journal| author=Magruder JT, Young A, Grimm JC, Conte JV, Shah AS, Mandal K | display-authors=etal| title=Bilateral internal thoracic artery grafting: Does graft configuration affect outcome? | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 1 | pages= 120-7 | pmid=27343909 | doi=10.1016/j.jtcvs.2016.03.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27343909 }} </ref>
|-
| bgcolor="yellow"| When [[bypass]] of the [[LAD]] is indicated to improve survival and reduce recurrent [[ischemia|ischemic events]], an [[internal thoracic artery]] ([[IMA]]), preferably the left, should be used to [[bypass]] the [[LAD]].
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2a Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
|-
| bgcolor="lightblue"| Among [[patients]] undergoing [[CABG]], grafting the bilateral [[IMA]] (BIMA) by experienced operators is beneficial in improving long-term [[heart|cardiac]] outcomes (only if [[patients]] are selected appropriately).

|}

==2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>==

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' If possible, the left [[internal mammary artery]] ([[LIMA]]) should be used to bypass the left anterior descending ([[LAD]]) artery when bypass of the LAD artery is indicated.<ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M et al.| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url= }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW et al.| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url= }} </ref><ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III: HARM]]
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' An arterial graft should not be used to bypass the right [[coronary artery]] with less than a critical stenosis (<90%).<ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The right [[internal mammary artery]] is probably indicated to bypass the [[LAD]] artery when the [[LIMA]] is unavailable or unsuitable as a bypass conduit. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' When anatomically and clinically suitable, use of a second [[internal mammary artery]] to graft the left circumflex or [[right coronary artery]] (when critically stenosed and perfusing LV myocardium) is reasonable to improve the likelihood of survival and to decrease reintervention.<ref name="pmid10220677">{{cite journal| author=Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R et al.| title=Two internal thoracic artery grafts are better than one. | journal=J Thorac Cardiovasc Surg | year= 1999 | volume= 117 | issue= 5 | pages= 855-72 | pmid=10220677 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10220677 }} </ref><ref name="pmid15561021">{{cite journal| author=Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM| title=The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 6 | pages= 2005-12; discussion 2012-4 | pmid=15561021 | doi=10.1016/j.athoracsur.2004.05.070 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15561021 }} </ref><ref name="pmid16399299">{{cite journal| author=Sabik JF, Blackstone EH, Gillinov AM, Banbury MK, Smedira NG, Lytle BW| title=Influence of patient characteristics and arterial grafts on freedom from coronary reoperation. | journal=J Thorac Cardiovasc Surg | year= 2006 | volume= 131 | issue= 1 | pages= 90-8 | pmid=16399299 | doi=10.1016/j.jtcvs.2005.05.024 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16399299 }} </ref><ref name="pmid18824756">{{cite journal| author=Sabik JF, Stockins A, Nowicki ER, Blackstone EH, Houghtaling PL, Lytle BW et al.| title=Does location of the second internal thoracic artery graft influence outcome of coronary artery bypass grafting? | journal=Circulation | year= 2008 | volume= 118 | issue= 14 Suppl | pages= S210-5 | pmid=18824756 | doi=10.1161/CIRCULATIONAHA.107.760827 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18824756 }} </ref><ref name="pmid15116000">{{cite journal| author=Stevens LM, Carrier M, Perrault LP, Hébert Y, Cartier R, Bouchard D et al.| title=Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting: effects on mortality and event-free survival. | journal=J Thorac Cardiovasc Surg | year= 2004 | volume= 127 | issue= 5 | pages= 1408-15 | pmid=15116000 | doi=10.1016/j.jtcvs.2003.10.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15116000 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Complete arterial revascularization may be reasonable in patients less than or equal to 60 years of age with few or no comorbidities. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Arterial grafting of the [[right coronary artery]] may be reasonable when a critical (≥90%) stenosis is present.<ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref><ref name="pmid18824756">{{cite journal| author=Sabik JF, Stockins A, Nowicki ER, Blackstone EH, Houghtaling PL, Lytle BW et al.| title=Does location of the second internal thoracic artery graft influence outcome of coronary artery bypass grafting? | journal=Circulation | year= 2008 | volume= 118 | issue= 14 Suppl | pages= S210-5 | pmid=18824756 | doi=10.1161/CIRCULATIONAHA.107.760827 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18824756 }} </ref><ref name="pmid14602274">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Khan M, Houghtaling PL, Cosgrove DM| title=Does competitive flow reduce internal thoracic artery graft patency? | journal=Ann Thorac Surg | year= 2003 | volume= 76 | issue= 5 | pages= 1490-6; discussion 1497 | pmid=14602274 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14602274 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Use of a [[radial artery]] graft may be reasonable when grafting left-sided coronary arteries with severe stenoses (>70%) and right-sided arteries with critical stenoses (≥90%) that perfuse LV myocardium.<ref name="pmid9832690">{{cite journal| author=Acar C, Ramsheyi A, Pagny JY, Jebara V, Barrier P, Fabiani JN et al.| title=The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. | journal=J Thorac Cardiovasc Surg | year= 1998 | volume= 116 | issue= 6 | pages= 981-9 | pmid=9832690 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9832690 }} </ref><ref name="pmid11782755">{{cite journal| author=Maniar HS, Sundt TM, Barner HB, Prasad SM, Peterson L, Absi T et al.| title=Effect of target stenosis and location on radial artery graft patency. | journal=J Thorac Cardiovasc Surg | year= 2002 | volume= 123 | issue= 1 | pages= 45-52 | pmid=11782755 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11782755 }} </ref><ref name="pmid11722042">{{cite journal| author=Moran SV, Baeza R, Guarda E, Zalaquett R, Irarrazaval MJ, Marchant E et al.| title=Predictors of radial artery patency for coronary bypass operations. | journal=Ann Thorac Surg | year= 2001 | volume= 72 | issue= 5 | pages= 1552-6 | pmid=11722042 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11722042 }} </ref><ref name="pmid9832694">{{cite journal| author=Possati G, Gaudino M, Alessandrini F, Luciani N, Glieca F, Trani C et al.| title=Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization. | journal=J Thorac Cardiovasc Surg | year= 1998 | volume= 116 | issue= 6 | pages= 1015-21 | pmid=9832694 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9832694 }} </ref><ref name="pmid10758391">{{cite journal| author=Royse AG, Royse CF, Tatoulis J, Grigg LE, Shah P, Hunt D et al.| title=Postoperative radial artery angiography for coronary artery bypass surgery. | journal=Eur J Cardiothorac Surg | year= 2000 | volume= 17 | issue= 3 | pages= 294-304 | pmid=10758391 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10758391 }} </ref><ref name="pmid15564545">{{cite journal| author=Desai ND, Cohen EA, Naylor CD, Fremes SE, Radial Artery Patency Study Investigators| title=A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 22 | pages= 2302-9 | pmid=15564545 | doi=10.1056/NEJMoa040982 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15564545 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]

Coronary artery bypass surgery conduits used for bypass

2022-08-29T06:26:56Z

Anahita:

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}, [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] {{Anahita}}
==Overview==

==Conduits used for bypass==
*The choice of conduits ([[artery|arteries]] and/or [[veins]] from elsewhere in the body) to [[bypass]] the blockages is highly [[surgery|surgeon]] and institution dependent.
*To choose the proper conduits for [[CABG]] both clinical and technical factors such as [[life expectancy]], presence of [[diabetes]], chronic renal failure, and degree of the target [[stenosis]] must be considered.<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
*The following table published by 2021 ACA Revascularization Guideline presents the best practices for the Use of [[bypass]] [[conduits]] in [[CABG]]:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
{| class="wikitable"
|-
| Assessing [[Anatomical terms of location|palmar arch]] completeness and [[ulna|ulnar]] compensation before harvesting the [[radial artery]]. If [[radial artery]] harvesting is considered it is recommended to use the [[arm]] with the best [[ulna|ulnar compensation]].
|-
| It is recommended to use [[radial artery]] [[grafts]] to target [[vessels]] with [[stenosis|subocclusive stenosis]].
|-
| It is recommended to avoid [[radial artery]] use after [[Radial artery catheterization|transradial catheterization]].
|-
| It is recommended to avoid [[radial artery]] use in [[chronic kidney disease]] [[patients]] and in those with a high likelihood of rapid progression to [[hemodialysis]].
|-
| It is recommended to avoid [[oral]] [[calcium channel blockers]] for the first [[surgery|postoperative]] year after [[radial artery]] [[grafting]].
|-
| It is recommended to avoid bilateral [[percutaneous]] or [[surgery|surgical]] [[radial artery]] procedures in [[patients]] with [[coronary artery disease]] with a goal to preserve the [[artery]] for future use.
|-
| It is recommended to use the [[internal mammary artery]] (using the skeletonization technique) to reduce the risk of [[Sternum|sternal]] [[wound]] [[complications]].
|-
| It is recommended to use an [[endoscopy|endoscopic]] [[saphenous vein]] harvest technique in [[patients]] at risk of [[wound]] [[complications]].
|-
| For [[patients]] at low risk of [[wound]] [[complications]], it is recommended to use a no-touch [[saphenous vein]] harvest technique.
|-
| It is recommended to use the skeletonized [[right gastroepiploic artery]] to [[graft]] [[right coronary artery]] target [[vessels]] with subocclusive [[stenosis]] if the operator is experienced with the use of the [[artery]].
|}
*Typically, the left [[internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also referred to as the ''[[left internal mammary artery]]'' or ''[[LIMA]]'') is grafted to the [[Left Anterior Descending]] [[artery]] and a combination of other [[artery|arteries]] and [[veins]] is used for other [[coronary arteries]].
*The right [[internal thoracic artery]] ([[Internal thoracic artery|RITA]]), the [[great saphenous vein]] from the [[leg]] and the [[radial artery]] from the forearm are frequently used.
*The [[right gastroepiploic artery]] from the [[stomach]] is infrequently used given the difficult mobilization from the [[abdomen]].

==Saphenous vein==
===Saphenous vein anatomy===
*The [[great saphenous vein]] ([[GSV]]) is frequently used as a conduit for [[CABG]]. It originates from where the dorsal [[vein]] of the [[first digit]] (the large [[toe]]) merges with the [[dorsal venous arch of the foot]].
*After passing [[Anatomical terms of location|anterior]] to the [[medial malleolus]] (where it often can be visualized and [[Palpation|palpated]]), it runs up the [[medial]] side of the [[leg]]. At [[knee]], it runs over the [[Anatomical terms of location|posterior border]] of the [[medial epicondyle]] of the [[femur]] bone.
*The [[great saphenous vein]] then courses [[Anatomical terms of location|laterally]] to lie on the [[Anatomical terms of location|anterior surface]] of the [[thigh]] before entering an opening in the [[fascia lata]] called the [[saphenous opening]]. It joins with the [[femoral vein]] in the region of the [[femoral triangle]] at the saphenofemoral junction.
*The '''small [[saphenous vein]]''' (also '''lesser [[saphenous vein]]''') originates where the [[Anatomical terms of location|dorsal]] [[vein]] from the [[fifth digit]] (smallest [[toe]]) merges with the [[dorsal [[venous]] arch of the [[foot]], which attaches to the [[great saphenous vein]]. It is considered a [[superficial vein]] and is [[subcutaneous]] (just under the [[skin]]). From its origin, it courses around the lateral aspect of the [[foot]] ([[Anatomical terms of location|inferior]] and [[Anatomical terms of location|posterior]] to the [[lateral malleolus]]) and runs along the [[Anatomical terms of location|posterior]] aspect of the [[leg]] (with the [[sural nerve]]), passes between the heads of the [[gastrocnemius muscle]], and drains into the [[popliteal vein]], approximately at or above the level of the [[knee]] [[joint]].

<gallery perRow="3">
Image:Gray432 color.png|Cross-section through the middle of the [[thigh]].
Image:Gray440_color.png|Cross-section through the middle of the [[leg]].
Image:Great_saphenous_vein.png|The [[great saphenous vein]] and landmarks along its course
Image:Gray580.png|The [[great saphenous vein]] and its tributaries at the [[Saphenous opening|fossa ovalis]] in the [[groin]].
Image:Gray582.png|Small [[saphenous vein]] and its tributaries.
</gallery>

====Saphenous vein harvesting====
*The [[saphenous vein]] can be harvested by either direct visualization or via an [[endoscopy|endoscopic approach]]. [[Veins]] that are used either have their valves removed or are turned around so that the [[valves]] in them do not occlude [[blood flow]] in the [[graft]]. The technique of [[saphenous vein]] harvesting may influence later [[SVG]] patency. The process of harvesting the [[vein]] and [[pressure]] testing the [[vein]] for a leak may damage the [[endothelium]].<ref>Lawrie GM, Weilbacher DE, Henry PD. Endothelium-dependent relaxation in human saphenous vein grafts. Effects of preparation and clinicopathologic correlations. J Thorac Cardiovasc Surg 1990;100:612—20.</ref><ref>Souza DS, Johansson B, Bojo¨ L, Karlsson R, Geijer H, Filbey D, Bodin L, Arbeus M, Dashwood MR. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg 2006;132:373—8.</ref>
*The [[endoscopy|endoscopic approach]] has been associated with lower rates of [[wound]] [[infection]], greater [[patient]] satisfaction, and earlier mobilization.<ref name="pmid11828277">{{cite journal |author=Kiaii B, Moon BC, Massel D, Langlois Y, Austin TW, Willoughby A, Guiraudon C, Howard CR, Guo LR |title=A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=123 |issue=2 |pages=204–12 |year=2002 |month=February |pmid=11828277 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522302096046 |issn= |accessdate=2010-07-23}}</ref><ref name="pmid19605828">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA, Mehta RH, Gibson CM, Mack MJ, Kouchoukos NT, Califf RM, Alexander JH |title=Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery |journal=[[The New England Journal of Medicine]] |volume=361 |issue=3 |pages=235–44 |year=2009 |month=July |pmid=19605828 |doi=10.1056/NEJMoa0900708 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19605828&promo=ONFLNS19 |issn= |accessdate=2010-07-12}}</ref><ref name="pmid15746730">{{cite journal |author=Yun KL, Wu Y, Aharonian V, Mansukhani P, Pfeffer TA, Sintek CF, Kochamba GS, Grunkemeier G, Khonsari S |title=Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=129 |issue=3 |pages=496–503 |year=2005 |month=March |pmid=15746730 |doi=10.1016/j.jtcvs.2004.08.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522304015855 |issn= |accessdate=2010-07-23}}</ref><ref name="pmid15115999">{{cite journal |author=Perrault LP, Jeanmart H, Bilodeau L, Lespérance J, Tanguay JF, Bouchard D, Pagé P, Carrier M |title=Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=127 |issue=5 |pages=1402–7 |year=2004 |month=May |pmid=15115999 |doi=10.1016/j.jtcvs.2003.10.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303018798 |issn= |accessdate=2010-07-23}}</ref> One small randomized study of 144 patients showed no difference in histologic findings between the traditional and endoscopic techniques.<ref name="pmid11828277">{{cite journal |author=Kiaii B, Moon BC, Massel D, Langlois Y, Austin TW, Willoughby A, Guiraudon C, Howard CR, Guo LR |title=A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=123 |issue=2 |pages=204–12 |year=2002 |month=February |pmid=11828277|doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0022522302096046 |issn= |accessdate=2010-07-23}}</ref>In another small study of 40 patients randomized to the two techniques, no difference was seen in angiographic patency at 3 months.<ref name="pmid15115999">{{cite journal |author=Perrault LP, Jeanmart H, Bilodeau L, Lespérance J, Tanguay JF, Bouchard D, Pagé P, Carrier M |title=Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=127 |issue=5 |pages=1402–7 |year=2004 |month=May |pmid=15115999 |doi=10.1016/j.jtcvs.2003.10.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303018798 |issn= |accessdate=2010-07-23}}</ref>Another small randomized study of 144 patients who returned for angiography demonstrated an occlusion rate of 21.7% for the endoscopic approach vs 17.6% for the open approach.<ref name="pmid15746730">{{cite journal |author=Yun KL, Wu Y, Aharonian V, Mansukhani P, Pfeffer TA, Sintek CF, Kochamba GS, Grunkemeier G, Khonsari S |title=Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=129 |issue=3 |pages=496–503 |year=2005 |month=March |pmid=15746730 |doi=10.1016/j.jtcvs.2004.08.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522304015855 |issn= |accessdate=2010-07-23}}</ref>
*However, non-[[randomized]] data from a much larger multicenter study does suggest that [[endoscopyendoscopic harvesting]] may be associated with a higher rate of failure and adverse events such as death and [[MI]].<ref name="pmid19605828">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA, Mehta RH, Gibson CM, Mack MJ, Kouchoukos NT, Califf RM, Alexander JH |title=Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery |journal=[[The New England Journal of Medicine]] |volume=361 |issue=3 |pages=235–44 |year=2009 |month=July |pmid=19605828 |doi=10.1056/NEJMoa0900708 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19605828&promo=ONFLNS19 |issn= |accessdate=2010-07-12}}</ref>
*[[Complications]] associated with [[Saphenous vein graft|saphenous vein harvesting]] include the following:
** [[Saphenous nerve]] [[injury]]
** [[Infection]] at [[incision]] sites or [[sepsis]].
** [[Deep vein thrombosis]] ([[DVT]])
** [[Keloid|Keloid scarring]]
** [[Chronic pain]] at [[incision]] sites

==The Internal Thoracic Artery==
*Numerous studies support the use of the [[Internal thoracic artery|left internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also known as the [[Internal thoracic artery|left internal mammary artery]] ([[Internal thoracic artery|LIMA]])) to [[graft]] the [[LAD]] in order to improve survival unless [[contraindications|contraindicated]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531997 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref>
*In a study evaluating almost 6,000 [[patients]], [[LIMA]] [[grafting]] was able to reduce the rate of [[heart|cardiac]]-related [[hospital|rehospitalization]] and [[revascularization]]. In addition, this study showed a lower rate of death and recurrent [[infarction]] in those who undergone [[LIMA]] [[grafting]].<ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref>
*Evidence shows that the right [[IMA]] can be used to [[graft]] the [[LAD]] if the [[LIMA]] is impractical and unusable. Furthermore, the right [[IMA]] can be used in conjunction with the [[LIMA]] which is called bilateral [[internal mammary artery]] (BIMA) [[grafting]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**Based on observational studies, BIMA [[grafting]] has a survival advantage when compared with [[CABG]] with a single [[IMA]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref><ref name="pmid24916209">{{cite journal| author=Yi G, Shine B, Rehman SM, Altman DG, Taggart DP| title=Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. | journal=Circulation | year= 2014 | volume= 130 | issue= 7 | pages= 539-45 | pmid=24916209 | doi=10.1161/CIRCULATIONAHA.113.004255 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24916209 }} </ref><ref name="pmid24521973">{{cite journal| author=Takagi H, Goto SN, Watanabe T, Mizuno Y, Kawai N, Umemoto T| title=A meta-analysis of adjusted hazard ratios from 20 observational studies of bilateral versus single internal thoracic artery coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 4 | pages= 1282-90 | pmid=24521973 | doi=10.1016/j.jtcvs.2014.01.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24521973 }} </ref><ref name="pmid29306899">{{cite journal| author=Gaudino M, Di Franco A, Rahouma M, Tam DY, Iannaccone M, Deb S | display-authors=etal| title=Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta-Analysis. | journal=J Am Heart Assoc | year= 2018 | volume= 7 | issue= 1 | pages= | pmid=29306899 | doi=10.1161/JAHA.117.008010 | pmc=5778975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29306899 }} </ref>
**Reports from a [[meta-analysis]] of 38 studies, including 174,205 [[patients]] demonstrated a decreased [[mortality rate]] at 7.25 years follow up among [[patients]] who had BIMA [[grafting]].<ref name="pmid29306899">{{cite journal| author=Gaudino M, Di Franco A, Rahouma M, Tam DY, Iannaccone M, Deb S | display-authors=etal| title=Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta-Analysis. | journal=J Am Heart Assoc | year= 2018 | volume= 7 | issue= 1 | pages= | pmid=29306899 | doi=10.1161/JAHA.117.008010 | pmc=5778975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29306899 }} </ref>
**On the other hand, a single large [[randomized controlled trial]] reported no difference in 10-year all-cause [[mortality rate|mortality]] when BIMA was compared with single [[IMA]]. Furthermore, this study highlighted the importance of [[surgery|surgical expertise]] in BIMA [[grafting]].<ref name="pmid30699314">{{cite journal| author=Taggart DP, Benedetto U, Gerry S, Altman DG, Gray AM, Lees B | display-authors=etal| title=Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 5 | pages= 437-446 | pmid=30699314 | doi=10.1056/NEJMoa1808783 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30699314 }} </ref>
**It is critical to consider the higher risk of [[sternum|sternal]] [[infection]] with BIMA [[grafting]].<ref name="pmid29453002">{{cite journal| author=Schwann TA, Habib RH, Wallace A, Shahian DM, O'Brien S, Jacobs JP | display-authors=etal| title=Operative Outcomes of Multiple-Arterial Versus Single-Arterial Coronary Bypass Grafting. | journal=Ann Thorac Surg | year= 2018 | volume= 105 | issue= 4 | pages= 1109-1119 | pmid=29453002 | doi=10.1016/j.athoracsur.2017.10.058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29453002 }} </ref>
*In multiple [[artery|arterial]] [[revascularization]] during [[Coronary artery bypass surgery]], the [[Internal thoracic artery|right internal thoracic artery]] ([[Internal thoracic artery|RITA]]) has been proofed to be a better choice as a conduit than the [[radial artery]]. This has been published at the European Society of Cardiology (ESC) 2011 Congress, after a [[clinical trial|trial]] on more than 1000 [[patients]] who had the operation in 10 years [[clinical trial|trial]].
*The [[Internal thoracic artery|left internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also known as the [[Internal thoracic artery|left internal mammary artery]] ([[Internal thoracic artery|LIMA]])) is the best [[vessel]] to use for [[coronary artery bypass surgery]] when only one [[artery]] is required.
**It was known that the long-term outcomes of the [[artery|arterial]] [[graft]]s are much better than [[saphenous vein grafts]] (SVGs) and has less [[morbidity]] and [[mortality rates]].<ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref>
**The [[right internal thoracic artery]] (RITA) is the best second conduit for the [[bypass]] and has better long-term outcomes than the [[radial artery]]. The use of the [[Internal thoracic artery|RITA]] results in the following in comparison with [[SVG]]:
***Less major adverse [[heart|cardiac]] and cerebrovascular events.
***Less [[surgery|perioperative]] [[myocardial infarction]] rates.
***Less [[surgery|perioperative]] [[stroke]] rates.
***Less [[heart|cardiac]]-related deaths.
*There have been good clinical results with the single left [[internal thoracic artery]] [[grafting]] compared with [[saphenous vein]] [[grafting]]. This prompted surgeons to use both ITAs. Bilateral ITA [[grafting]] could improve long-term survival. Late [[Complication (medicine)|complications]] like [[myocardial infarction]] and need to [[surgery|reoperate]] may be avoided. However, mathematical modeling is required to assist in developing a strategy for use of such [[grafts]].<ref name="pmid9852872">{{cite journal| author=Buxton BF, Komeda M, Fuller JA, Gordon I| title=Bilateral internal thoracic artery grafting may improve the outcome of coronary artery surgery. Risk-adjusted survival. | journal=Circulation | year= 1998 | volume= 98 | issue= 19 Suppl | pages= II1-6 | pmid=9852872 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9852872 }} </ref>
*In a [[cohort study]] of 8123 [[patients]] who received single [[internal thoracic artery]] [[grafts]] and 2001 who received bilateral [[internal thoracic artery]] [[grafts]] for [[multivessel coronary artery disease]] for a duration of 20 years, it was found that the latter produces improved survival compared with single [[internal thoracic artery]] [[grafting]] during the second [[surgery|postoperative]] decade, and the magnitude of that benefit increases through 20 [[surgery|postoperative]] years.<ref name="pmid15561021">{{cite journal| author=Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM| title=The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 6 | pages= 2005-12; discussion 2012-4 | pmid=15561021 | doi=10.1016/j.athoracsur.2004.05.070 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15561021 }} </ref>
*It's easy to harvest the [[radial artery]], but it has a higher risk for [[vasospasm]] and [[atherosclerosis]] than the [[right internal thoracic artery]] ([[RITA]]). Some institution solves this problem ([[vasospasm]]) by preparing the [[radial artery|radial arteries]] with [[phenoxybenzamine]].
*Although the fact that using both [[internal thoracic arteries]] for [[coronary artery bypass surgery]] takes a longer time, it has better long-term results and [[surgery|perioperative]] outcomes. This has to be proofed and confirmed by more [[randomized]] and controlled trials.

==Radial Artery==
*Numerous [[clinical trials]] have demonstrated better patency rates (in mid- and long-term) when the [[radial artery]] is used in comparison with the [[saphenous vein]].<ref name="pmid32662861">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A | display-authors=etal| title=Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis. | journal=JAMA | year= 2020 | volume= 324 | issue= 2 | pages= 179-187 | pmid=32662861 | doi=10.1001/jama.2020.8228 | pmc=7361649 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32662861 }} </ref><ref name="pmid22871565">{{cite journal| author=Cao C, Manganas C, Horton M, Bannon P, Munkholm-Larsen S, Ang SC | display-authors=etal| title=Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 146 | issue= 2 | pages= 255-61 | pmid=22871565 | doi=10.1016/j.jtcvs.2012.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22871565 }} </ref><ref name="pmid24686003">{{cite journal| author=Benedetto U, Raja SG, Albanese A, Amrani M, Biondi-Zoccai G, Frati G| title=Searching for the second best graft for coronary artery bypass surgery: a network meta-analysis of randomized controlled trials†. | journal=Eur J Cardiothorac Surg | year= 2015 | volume= 47 | issue= 1 | pages= 59-65; discussion 65 | pmid=24686003 | doi=10.1093/ejcts/ezu111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686003 }} </ref>
*Furthermore, several [[observational studies]] reported a better survival rate when the [[radial artery]] is used instead of the [[saphenous vein]] for [[CABG]].<ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref><ref name="pmid29708851">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Biondi-Zoccai G, Sedrakyan A, Puskas JD | display-authors=etal| title=Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. | journal=N Engl J Med | year= 2018 | volume= 378 | issue= 22 | pages= 2069-2077 | pmid=29708851 | doi=10.1056/NEJMoa1716026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29708851 }} </ref><ref name="pmid32662861">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A | display-authors=etal| title=Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis. | journal=JAMA | year= 2020 | volume= 324 | issue= 2 | pages= 179-187 | pmid=32662861 | doi=10.1001/jama.2020.8228 | pmc=7361649 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32662861 }} </ref>
*Based on the 2021 ACA Revascularization guideline, the following [[patients]] benefit the most from the [[radial artery]] use:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Patients]] younger than 75 years old
**[[Females]]
**[[Patients]] with preserved [[renal function]]
*There is some limited data regarding the vulnerability to the effect of [[Chronic (medical)|chronic]] native competitive flow in composite [[radial artery]] [[grafts]].<ref name="pmid14726046">{{cite journal| author=Abu-Omar Y, Mussa S, Anastasiadis K, Steel S, Hands L, Taggart DP| title=Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test. | journal=Ann Thorac Surg | year= 2004 | volume= 77 | issue= 1 | pages= 116-9 | pmid=14726046 | doi=10.1016/s0003-4975(03)01515-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14726046 }} </ref>

==Conduit Nomenclature==
*The terms ''single bypass'', ''double bypass'', ''triple bypass'', ''quadruple bypass'' and ''quintuple bypass'' refer to the number of [[coronary arteries]] [[Coronary artery bypass surgery|bypassed]] in the procedure. In other words, a double [[bypass]] means two [[coronary arteries]] are [[bypass|bypassed]] (such as [[left anterior descending|left anterior descending (LAD)]] [[coronary artery]] and [[right coronary artery|right coronary artery (RCA)]]); a triple [[bypass]] means three [[vessels]] are [[bypass|bypassed]] (such as [[LAD]], [[RCA]], and [[left circumflex artery|left circumflex artery (LCX)]]); a quadruple [[bypass]] means four vessels are bypassed (such as [[LAD]], [[RCA]], [[LCX]], first [[Left coronary artery|diagonal artery]] of the [[LAD]]). Less commonly more than four [[coronary arteries]] may be bypassed.
*A greater number of bypasses does not imply a [[patient]] is "sicker," nor does a lesser number imply a [[patient]] is "healthier".<ref>{{cite journal |author=Ohki S, Kaneko T, Satoh Y, ''et al'' |title=[Coronary artery bypass grafting in octogenarian] |language=Japanese |journal=Kyobu geka. The Japanese journal of thoracic surgery |volume=55 |issue=10 |pages=829–33; discussion 833–6 |year=2002 |pmid=12233100 |doi=}}</ref>
*A [[patient]] with a large amount of [[coronary artery disease|coronary artery disease]] ([[coronary artery disease|CAD]]) may receive fewer [[bypass]] [[grafts]] owing to the lack of suitable "target" [[vessels]].
*A [[patient]] with a single [[stenosis]] of the [[Left coronary artery|left main]] [[coronary artery]] often requires only two [[bypasses]] (to the [[LAD]] and the [[LCX]]). However, depending upon the [[anatomy]], grafts may also need to be placed to a large [[diagonal artery]], or to additional large [[obtuse marginal]] branches.

==Assessment of Target Vessels for Bypass Grafting==
A [[coronary artery]] may be unsuitable for [[bypass]] [[grafting]] for the following reasons:
*'''Size:''' If the native target [[artery]] it is small (< 1 mm or < 1.5 mm depending on surgeon preference)
*'''Location:''' Some [[Anatomical terms of location|distal locations]] of the native target [[artery]] may not be accessible, or a conduit may not reach far down the native [[artery]].
*'''Native artery calcification:''' Heavily [[calcification|calcified]] native [[arteries]] are sometimes technically not amenable to [[anastomosis]] of a conduit.
*'''Diffuse disease:''' The native [[artery]] may not have a section of the [[vessel]] that has a minimal [[disease]] where a conduit can be [[grafting|grafted]] to.
*'''The native [[artery]] lies in the [[heart]] [[muscle]] or is intramyocardial:''' In this scenario, the native [[coronary artery]] is located within the [[heart]] [[muscle]] rather than on the surface of the [[heart]] and a [[graft]] cannot be attached to it.

Although the cardiothoracic surgeon reviews the [[coronary angiogram]] prior to [[surgery]] and identifies the [[lesions]] (or "blockages") in the [[coronary arteries]] and will estimate the number of [[bypass]] [[grafts]] prior to [[surgery]], the final decision is made in the [[surgery|operating room]] based upon the direct examination of the [[heart]] and the suitability of the native target [[vessel]] for [[bypass|bypassing]].

==2021 ACA Revascularization Guideline==
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid29708851">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Biondi-Zoccai G, Sedrakyan A, Puskas JD | display-authors=etal| title=Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. | journal=N Engl J Med | year= 2018 | volume= 378 | issue= 22 | pages= 2069-2077 | pmid=29708851 | doi=10.1056/NEJMoa1716026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29708851 }} </ref><ref name="pmid22871565">{{cite journal| author=Cao C, Manganas C, Horton M, Bannon P, Munkholm-Larsen S, Ang SC | display-authors=etal| title=Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 146 | issue= 2 | pages= 255-61 | pmid=22871565 | doi=10.1016/j.jtcvs.2012.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22871565 }} </ref><ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref>
|-
| bgcolor="LightGreen"| To improve long-term [[heart|cardiac]] outcomes, using a [[radial artery]] is recommended in preference to a [[saphenous vein]] conduit to graft the second most important, significantly stenosed non–[[LAD]] vessel.
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531997 }} </ref><ref name="pmid27343909">{{cite journal| author=Magruder JT, Young A, Grimm JC, Conte JV, Shah AS, Mandal K | display-authors=etal| title=Bilateral internal thoracic artery grafting: Does graft configuration affect outcome? | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 1 | pages= 120-7 | pmid=27343909 | doi=10.1016/j.jtcvs.2016.03.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27343909 }} </ref>
|-
| bgcolor="yellow"| When [[bypass]] of the [[LAD]] is indicated to improve survival and reduce recurrent [[ischemia|ischemic events]], an [[internal thoracic artery]] ([[IMA]]), preferably the left, should be used to [[bypass]] the [[LAD]].
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2a Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
|-
| bgcolor="lightblue"| Among [[patients]] undergoing [[CABG]], grafting the bilateral [[IMA]] (BIMA) by experienced operators is beneficial in improving long-term [[heart|cardiac]] outcomes (only if [[patients]] are selected appropriately).

|}

==2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>==

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' If possible, the left [[internal mammary artery]] ([[LIMA]]) should be used to bypass the left anterior descending ([[LAD]]) artery when bypass of the LAD artery is indicated.<ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M et al.| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url= }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW et al.| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url= }} </ref><ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III: HARM]]
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' An arterial graft should not be used to bypass the right [[coronary artery]] with less than a critical stenosis (<90%).<ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The right [[internal mammary artery]] is probably indicated to bypass the [[LAD]] artery when the [[LIMA]] is unavailable or unsuitable as a bypass conduit. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' When anatomically and clinically suitable, use of a second [[internal mammary artery]] to graft the left circumflex or [[right coronary artery]] (when critically stenosed and perfusing LV myocardium) is reasonable to improve the likelihood of survival and to decrease reintervention.<ref name="pmid10220677">{{cite journal| author=Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R et al.| title=Two internal thoracic artery grafts are better than one. | journal=J Thorac Cardiovasc Surg | year= 1999 | volume= 117 | issue= 5 | pages= 855-72 | pmid=10220677 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10220677 }} </ref><ref name="pmid15561021">{{cite journal| author=Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM| title=The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 6 | pages= 2005-12; discussion 2012-4 | pmid=15561021 | doi=10.1016/j.athoracsur.2004.05.070 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15561021 }} </ref><ref name="pmid16399299">{{cite journal| author=Sabik JF, Blackstone EH, Gillinov AM, Banbury MK, Smedira NG, Lytle BW| title=Influence of patient characteristics and arterial grafts on freedom from coronary reoperation. | journal=J Thorac Cardiovasc Surg | year= 2006 | volume= 131 | issue= 1 | pages= 90-8 | pmid=16399299 | doi=10.1016/j.jtcvs.2005.05.024 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16399299 }} </ref><ref name="pmid18824756">{{cite journal| author=Sabik JF, Stockins A, Nowicki ER, Blackstone EH, Houghtaling PL, Lytle BW et al.| title=Does location of the second internal thoracic artery graft influence outcome of coronary artery bypass grafting? | journal=Circulation | year= 2008 | volume= 118 | issue= 14 Suppl | pages= S210-5 | pmid=18824756 | doi=10.1161/CIRCULATIONAHA.107.760827 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18824756 }} </ref><ref name="pmid15116000">{{cite journal| author=Stevens LM, Carrier M, Perrault LP, Hébert Y, Cartier R, Bouchard D et al.| title=Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting: effects on mortality and event-free survival. | journal=J Thorac Cardiovasc Surg | year= 2004 | volume= 127 | issue= 5 | pages= 1408-15 | pmid=15116000 | doi=10.1016/j.jtcvs.2003.10.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15116000 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Complete arterial revascularization may be reasonable in patients less than or equal to 60 years of age with few or no comorbidities. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Arterial grafting of the [[right coronary artery]] may be reasonable when a critical (≥90%) stenosis is present.<ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref><ref name="pmid18824756">{{cite journal| author=Sabik JF, Stockins A, Nowicki ER, Blackstone EH, Houghtaling PL, Lytle BW et al.| title=Does location of the second internal thoracic artery graft influence outcome of coronary artery bypass grafting? | journal=Circulation | year= 2008 | volume= 118 | issue= 14 Suppl | pages= S210-5 | pmid=18824756 | doi=10.1161/CIRCULATIONAHA.107.760827 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18824756 }} </ref><ref name="pmid14602274">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Khan M, Houghtaling PL, Cosgrove DM| title=Does competitive flow reduce internal thoracic artery graft patency? | journal=Ann Thorac Surg | year= 2003 | volume= 76 | issue= 5 | pages= 1490-6; discussion 1497 | pmid=14602274 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14602274 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Use of a [[radial artery]] graft may be reasonable when grafting left-sided coronary arteries with severe stenoses (>70%) and right-sided arteries with critical stenoses (≥90%) that perfuse LV myocardium.<ref name="pmid9832690">{{cite journal| author=Acar C, Ramsheyi A, Pagny JY, Jebara V, Barrier P, Fabiani JN et al.| title=The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. | journal=J Thorac Cardiovasc Surg | year= 1998 | volume= 116 | issue= 6 | pages= 981-9 | pmid=9832690 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9832690 }} </ref><ref name="pmid11782755">{{cite journal| author=Maniar HS, Sundt TM, Barner HB, Prasad SM, Peterson L, Absi T et al.| title=Effect of target stenosis and location on radial artery graft patency. | journal=J Thorac Cardiovasc Surg | year= 2002 | volume= 123 | issue= 1 | pages= 45-52 | pmid=11782755 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11782755 }} </ref><ref name="pmid11722042">{{cite journal| author=Moran SV, Baeza R, Guarda E, Zalaquett R, Irarrazaval MJ, Marchant E et al.| title=Predictors of radial artery patency for coronary bypass operations. | journal=Ann Thorac Surg | year= 2001 | volume= 72 | issue= 5 | pages= 1552-6 | pmid=11722042 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11722042 }} </ref><ref name="pmid9832694">{{cite journal| author=Possati G, Gaudino M, Alessandrini F, Luciani N, Glieca F, Trani C et al.| title=Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization. | journal=J Thorac Cardiovasc Surg | year= 1998 | volume= 116 | issue= 6 | pages= 1015-21 | pmid=9832694 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9832694 }} </ref><ref name="pmid10758391">{{cite journal| author=Royse AG, Royse CF, Tatoulis J, Grigg LE, Shah P, Hunt D et al.| title=Postoperative radial artery angiography for coronary artery bypass surgery. | journal=Eur J Cardiothorac Surg | year= 2000 | volume= 17 | issue= 3 | pages= 294-304 | pmid=10758391 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10758391 }} </ref><ref name="pmid15564545">{{cite journal| author=Desai ND, Cohen EA, Naylor CD, Fremes SE, Radial Artery Patency Study Investigators| title=A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 22 | pages= 2302-9 | pmid=15564545 | doi=10.1056/NEJMoa040982 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15564545 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]

Coronary artery bypass surgery conduits used for bypass

2022-08-29T06:15:10Z

Anahita: /* The Internal Thoracic Artery */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}, [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] {{Anahita}}
==Overview==

==Conduits used for bypass==
*The choice of conduits ([[artery|arteries]] and/or [[veins]] from elsewhere in the body) to [[bypass]] the blockages is highly [[surgery|surgeon]] and institution dependent.
*To choose the proper conduits for [[CABG]] both clinical and technical factors such as [[life expectancy]], presence of [[diabetes]], chronic renal failure, degree of the target [[stenosis]] must be considered.<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
*The following table published by 2021 ACA Revascularization Guideline presents the best practices for the Use of [[bypass]] [[conduits]] in [[CABG]]:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
{| class="wikitable"
|-
| Assessing [[Anatomical terms of location|palmar arch]] completeness and [[ulna|ulnar]] compensation before harvesting the [[radial artery]]. If [[radial artery]] harvesting is considered it is recommended to use the [[arm]] with the best [[ulna|ulnar compensation]].
|-
| It is recommended to use [[radial artery]] [[grafts]] to target [[vessels]] with [[stenosis|subocclusive stenosis]].
|-
| It is recommended to avoid [[radial artery]] use after [[Radial artery catheterization|transradial catheterization]].
|-
| It is recommended to avoid [[radial artery]] use in [[chronic kidney disease]] [[patients]] and in those with a high likelihood of rapid progression to [[hemodialysis]].
|-
| It is recommended to avoid [[oral]] [[calcium channel blockers]] for the first [[surgery|postoperative]] year after [[radial artery]] [[grafting]].
|-
| It is recommended to avoid bilateral [[percutaneous]] or [[surgery|surgical]] [[radial artery]] procedures in [[patients]] with [[coronary artery disease]] with a goal to preserve the [[artery]] for future use.
|-
| It is recommended to use the [[internal mammary artery]] (using the skeletonization technique) to reduce the risk of [[Sternum|sternal]] [[wound]] [[complications]].
|-
| It is recommended to use an [[endoscopy|endoscopic]] [[saphenous vein]] harvest technique in [[patients]] at risk of [[wound]] [[complications]].
|-
| For [[patients]] at low risk of [[wound]] [[complications]], it is recommended to use a no-touch [[saphenous vein]] harvest technique.
|-
| It is recommended to use the skeletonized [[right gastroepiploic artery]] to [[graft]] [[right coronary artery]] target [[vessels]] with subocclusive [[stenosis]] if the operator is experienced with the use of the [[artery]].
|}
*Typically, the left [[internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also referred to as the ''[[left internal mammary artery]]'' or ''[[LIMA]]'') is grafted to the [[Left Anterior Descending]] [[artery]] and a combination of other [[artery|arteries]] and [[veins]] is used for other [[coronary arteries]].
*The right [[internal thoracic artery]] ([[Internal thoracic artery|RITA]]), the [[great saphenous vein]] from the [[leg]] and the [[radial artery]] from the forearm are frequently used.
*The [[right gastroepiploic artery]] from the [[stomach]] is infrequently used given the difficult mobilization from the [[abdomen]].

==Saphenous vein==
===Saphenous vein anatomy===
*The [[great saphenous vein]] ([[GSV]]) is frequently used as a conduit for [[CABG]]. It originates from where the dorsal [[vein]] of the [[first digit]] (the large [[toe]]) merges with the [[dorsal venous arch of the foot]].
*After passing [[Anatomical terms of location|anterior]] to the [[medial malleolus]] (where it often can be visualized and [[Palpation|palpated]]), it runs up the [[medial]] side of the [[leg]]. At [[knee]], it runs over the [[Anatomical terms of location|posterior border]] of the [[medial epicondyle]] of the [[femur]] bone.
*The [[great saphenous vein]] then courses [[Anatomical terms of location|laterally]] to lie on the [[Anatomical terms of location|anterior surface]] of the [[thigh]] before entering an opening in the [[fascia lata]] called the [[saphenous opening]]. It joins with the [[femoral vein]] in the region of the [[femoral triangle]] at the saphenofemoral junction.
*The '''small [[saphenous vein]]''' (also '''lesser [[saphenous vein]]''') originates where the [[Anatomical terms of location|dorsal]] [[vein]] from the [[fifth digit]] (smallest [[toe]]) merges with the [[dorsal [[venous]] arch of the [[foot]], which attaches to the [[great saphenous vein]]. It is considered a [[superficial vein]] and is [[subcutaneous]] (just under the [[skin]]). From its origin, it courses around the lateral aspect of the [[foot]] ([[Anatomical terms of location|inferior]] and [[Anatomical terms of location|posterior]] to the [[lateral malleolus]]) and runs along the [[Anatomical terms of location|posterior]] aspect of the [[leg]] (with the [[sural nerve]]), passes between the heads of the [[gastrocnemius muscle]], and drains into the [[popliteal vein]], approximately at or above the level of the [[knee]] [[joint]].

<gallery perRow="3">
Image:Gray432 color.png|Cross-section through the middle of the [[thigh]].
Image:Gray440_color.png|Cross-section through the middle of the [[leg]].
Image:Great_saphenous_vein.png|The [[great saphenous vein]] and landmarks along its course
Image:Gray580.png|The [[great saphenous vein]] and its tributaries at the [[Saphenous opening|fossa ovalis]] in the [[groin]].
Image:Gray582.png|Small [[saphenous vein]] and its tributaries.
</gallery>

====Saphenous vein harvesting====
*The [[saphenous vein]] can be harvested by either direct visualization or via an [[endoscopy|endoscopic approach]]. [[Veins]] that are used either have their valves removed or are turned around so that the [[valves]] in them do not occlude [[blood flow]] in the [[graft]]. The technique of [[saphenous vein]] harvesting may influence later [[SVG]] patency. The process of harvesting the [[vein]] and [[pressure]] testing the [[vein]] for a leak may damage the [[endothelium]].<ref>Lawrie GM, Weilbacher DE, Henry PD. Endothelium-dependent relaxation in human saphenous vein grafts. Effects of preparation and clinicopathologic correlations. J Thorac Cardiovasc Surg 1990;100:612—20.</ref><ref>Souza DS, Johansson B, Bojo¨ L, Karlsson R, Geijer H, Filbey D, Bodin L, Arbeus M, Dashwood MR. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg 2006;132:373—8.</ref>
*The [[endoscopy|endoscopic approach]] has been associated with lower rates of [[wound]] [[infection]], greater [[patient]] satisfaction, and earlier mobilization.<ref name="pmid11828277">{{cite journal |author=Kiaii B, Moon BC, Massel D, Langlois Y, Austin TW, Willoughby A, Guiraudon C, Howard CR, Guo LR |title=A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=123 |issue=2 |pages=204–12 |year=2002 |month=February |pmid=11828277 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522302096046 |issn= |accessdate=2010-07-23}}</ref><ref name="pmid19605828">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA, Mehta RH, Gibson CM, Mack MJ, Kouchoukos NT, Califf RM, Alexander JH |title=Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery |journal=[[The New England Journal of Medicine]] |volume=361 |issue=3 |pages=235–44 |year=2009 |month=July |pmid=19605828 |doi=10.1056/NEJMoa0900708 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19605828&promo=ONFLNS19 |issn= |accessdate=2010-07-12}}</ref><ref name="pmid15746730">{{cite journal |author=Yun KL, Wu Y, Aharonian V, Mansukhani P, Pfeffer TA, Sintek CF, Kochamba GS, Grunkemeier G, Khonsari S |title=Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=129 |issue=3 |pages=496–503 |year=2005 |month=March |pmid=15746730 |doi=10.1016/j.jtcvs.2004.08.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522304015855 |issn= |accessdate=2010-07-23}}</ref><ref name="pmid15115999">{{cite journal |author=Perrault LP, Jeanmart H, Bilodeau L, Lespérance J, Tanguay JF, Bouchard D, Pagé P, Carrier M |title=Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=127 |issue=5 |pages=1402–7 |year=2004 |month=May |pmid=15115999 |doi=10.1016/j.jtcvs.2003.10.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303018798 |issn= |accessdate=2010-07-23}}</ref> One small randomized study of 144 patients showed no difference in histologic findings between the traditional and endoscopic techniques.<ref name="pmid11828277">{{cite journal |author=Kiaii B, Moon BC, Massel D, Langlois Y, Austin TW, Willoughby A, Guiraudon C, Howard CR, Guo LR |title=A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=123 |issue=2 |pages=204–12 |year=2002 |month=February |pmid=11828277|doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0022522302096046 |issn= |accessdate=2010-07-23}}</ref>In another small study of 40 patients randomized to the two techniques, no difference was seen in angiographic patency at 3 months.<ref name="pmid15115999">{{cite journal |author=Perrault LP, Jeanmart H, Bilodeau L, Lespérance J, Tanguay JF, Bouchard D, Pagé P, Carrier M |title=Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=127 |issue=5 |pages=1402–7 |year=2004 |month=May |pmid=15115999 |doi=10.1016/j.jtcvs.2003.10.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303018798 |issn= |accessdate=2010-07-23}}</ref>Another small randomized study of 144 patients who returned for angiography demonstrated an occlusion rate of 21.7% for the endoscopic approach vs 17.6% for the open approach.<ref name="pmid15746730">{{cite journal |author=Yun KL, Wu Y, Aharonian V, Mansukhani P, Pfeffer TA, Sintek CF, Kochamba GS, Grunkemeier G, Khonsari S |title=Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=129 |issue=3 |pages=496–503 |year=2005 |month=March |pmid=15746730 |doi=10.1016/j.jtcvs.2004.08.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522304015855 |issn= |accessdate=2010-07-23}}</ref>
*However, non-[[randomized]] data from a much larger multicenter study does suggest that [[endoscopyendoscopic harvesting]] may be associated with a higher rate of failure and adverse events such as death and [[MI]].<ref name="pmid19605828">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA, Mehta RH, Gibson CM, Mack MJ, Kouchoukos NT, Califf RM, Alexander JH |title=Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery |journal=[[The New England Journal of Medicine]] |volume=361 |issue=3 |pages=235–44 |year=2009 |month=July |pmid=19605828 |doi=10.1056/NEJMoa0900708 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19605828&promo=ONFLNS19 |issn= |accessdate=2010-07-12}}</ref>
*[[Complications]] associated with [[Saphenous vein graft|saphenous vein harvesting]] include the following:
** [[Saphenous nerve]] [[injury]]
** [[Infection]] at [[incision]] sites or [[sepsis]].
** [[Deep vein thrombosis]] ([[DVT]])
** [[Keloid|Keloid scarring]]
** [[Chronic pain]] at [[incision]] sites

==The Internal Thoracic Artery==
*Numerous studies support the use of the [[Internal thoracic artery|left internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also known as the [[Internal thoracic artery|left internal mammary artery]] ([[Internal thoracic artery|LIMA]])) to [[graft]] the [[LAD]] in order to improve survival unless [[contraindications|contraindicated]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531997 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref>
*In a study evaluating almost 6,000 [[patients]], [[LIMA]] [[grafting]] was able to reduce the rate of [[heart|cardiac]]-related [[hospital|rehospitalization]] and [[revascularization]]. In addition, this study showed a lower rate of death and recurrent [[infarction]] in those who undergone [[LIMA]] [[grafting]].<ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref>
*Evidence shows that the right [[IMA]] can be used to [[graft]] the [[LAD]] if the [[LIMA]] is impractical and unusable. Furthermore, the right [[IMA]] can be used in conjunction with the [[LIMA]] which is called bilateral [[internal mammary artery]] (BIMA) [[grafting]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**Based on observational studies, BIMA [[grafting]] has a survival advantage when compared with [[CABG]] with a single [[IMA]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref><ref name="pmid24916209">{{cite journal| author=Yi G, Shine B, Rehman SM, Altman DG, Taggart DP| title=Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. | journal=Circulation | year= 2014 | volume= 130 | issue= 7 | pages= 539-45 | pmid=24916209 | doi=10.1161/CIRCULATIONAHA.113.004255 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24916209 }} </ref><ref name="pmid24521973">{{cite journal| author=Takagi H, Goto SN, Watanabe T, Mizuno Y, Kawai N, Umemoto T| title=A meta-analysis of adjusted hazard ratios from 20 observational studies of bilateral versus single internal thoracic artery coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 4 | pages= 1282-90 | pmid=24521973 | doi=10.1016/j.jtcvs.2014.01.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24521973 }} </ref><ref name="pmid29306899">{{cite journal| author=Gaudino M, Di Franco A, Rahouma M, Tam DY, Iannaccone M, Deb S | display-authors=etal| title=Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta-Analysis. | journal=J Am Heart Assoc | year= 2018 | volume= 7 | issue= 1 | pages= | pmid=29306899 | doi=10.1161/JAHA.117.008010 | pmc=5778975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29306899 }} </ref>
**Reports from a [[meta-analysis]] of 38 studies, including 174,205 [[patients]] demonstrated a decreased [[mortality rate]] at 7.25 years follow up among [[patients]] who had BIMA [[grafting]].<ref name="pmid29306899">{{cite journal| author=Gaudino M, Di Franco A, Rahouma M, Tam DY, Iannaccone M, Deb S | display-authors=etal| title=Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta-Analysis. | journal=J Am Heart Assoc | year= 2018 | volume= 7 | issue= 1 | pages= | pmid=29306899 | doi=10.1161/JAHA.117.008010 | pmc=5778975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29306899 }} </ref>
**On the other hand, a single large [[randomized controlled trial]] reported no difference in 10-year all-cause [[mortality rate|mortality]] when BIMA was compared with single [[IMA]]. Furthermore, this study highlighted the importance of [[surgery|surgical expertise]] in BIMA [[grafting]].<ref name="pmid30699314">{{cite journal| author=Taggart DP, Benedetto U, Gerry S, Altman DG, Gray AM, Lees B | display-authors=etal| title=Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 5 | pages= 437-446 | pmid=30699314 | doi=10.1056/NEJMoa1808783 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30699314 }} </ref>
**It is critical to consider the higher risk of [[sternum|sternal]] [[infection]] with BIMA [[grafting]].<ref name="pmid29453002">{{cite journal| author=Schwann TA, Habib RH, Wallace A, Shahian DM, O'Brien S, Jacobs JP | display-authors=etal| title=Operative Outcomes of Multiple-Arterial Versus Single-Arterial Coronary Bypass Grafting. | journal=Ann Thorac Surg | year= 2018 | volume= 105 | issue= 4 | pages= 1109-1119 | pmid=29453002 | doi=10.1016/j.athoracsur.2017.10.058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29453002 }} </ref>
*In multiple [[artery|arterial]] [[revascularization]] during [[Coronary artery bypass surgery]], the [[Internal thoracic artery|right internal thoracic artery]] ([[Internal thoracic artery|RITA]]) has been proofed to be a better choice as a conduit than the [[radial artery]]. This has been published at the European Society of Cardiology (ESC) 2011 Congress, after a [[clinical trial|trial]] on more than 1000 [[patients]] who had the operation in 10 years [[clinical trial|trial]].
*The [[Internal thoracic artery|left internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also known as the [[Internal thoracic artery|left internal mammary artery]] ([[Internal thoracic artery|LIMA]])) is the best [[vessel]] to use for [[coronary artery bypass surgery]] when only one [[artery]] is required.
**It was known that the long-term outcomes of the [[artery|arterial]] [[graft]]s are much better than [[saphenous vein grafts]] (SVGs) and has less [[morbidity]] and [[mortality rates]].<ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref>
**The [[right internal thoracic artery]] (RITA) is the best second conduit for the [[bypass]] and has better long-term outcomes than the [[radial artery]]. The use of the [[Internal thoracic artery|RITA]] results in the following in comparison with [[SVG]]:
***Less major adverse [[heart|cardiac]] and cerebrovascular events.
***Less [[surgery|perioperative]] [[myocardial infarction]] rates.
***Less [[surgery|perioperative]] [[stroke]] rates.
***Less [[heart|cardiac]]-related deaths.
*There have been good clinical results with the single left [[internal thoracic artery]] [[grafting]] compared with [[saphenous vein]] [[grafting]]. This prompted surgeons to use both ITAs. Bilateral ITA [[grafting]] could improve long-term survival. Late [[Complication (medicine)|complications]] like [[myocardial infarction]] and need to [[surgery|reoperate]] may be avoided. However, mathematical modeling is required to assist in developing a strategy for use of such [[grafts]].<ref name="pmid9852872">{{cite journal| author=Buxton BF, Komeda M, Fuller JA, Gordon I| title=Bilateral internal thoracic artery grafting may improve the outcome of coronary artery surgery. Risk-adjusted survival. | journal=Circulation | year= 1998 | volume= 98 | issue= 19 Suppl | pages= II1-6 | pmid=9852872 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9852872 }} </ref>
*In a [[cohort study]] of 8123 [[patients]] who received single [[internal thoracic artery]] [[grafts]] and 2001 who received bilateral [[internal thoracic artery]] [[grafts]] for [[multivessel coronary artery disease]] for a duration of 20 years, it was found that the latter produces improved survival compared with single [[internal thoracic artery]] [[grafting]] during the second [[surgery|postoperative]] decade, and the magnitude of that benefit increases through 20 [[surgery|postoperative]] years.<ref name="pmid15561021">{{cite journal| author=Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM| title=The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 6 | pages= 2005-12; discussion 2012-4 | pmid=15561021 | doi=10.1016/j.athoracsur.2004.05.070 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15561021 }} </ref>
*It's easy to harvest the [[radial artery]], but it has a higher risk for [[vasospasm]] and [[atherosclerosis]] than the [[right internal thoracic artery]] ([[RITA]]). Some institution solves this problem ([[vasospasm]]) by preparing the [[radial artery|radial arteries]] with [[phenoxybenzamine]].
*Although the fact that using both [[internal thoracic arteries]] for [[coronary artery bypass surgery]] takes a longer time, it has better long-term results and [[surgery|perioperative]] outcomes. This has to be proofed and confirmed by more [[randomized]] and controlled trials.

==Radial Artery==
*Numerous [[clinical trials]] have demonstrated better patency rates (in mid- and long-term) when the [[radial artery]] is used in comparison with the [[saphenous vein]].<ref name="pmid32662861">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A | display-authors=etal| title=Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis. | journal=JAMA | year= 2020 | volume= 324 | issue= 2 | pages= 179-187 | pmid=32662861 | doi=10.1001/jama.2020.8228 | pmc=7361649 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32662861 }} </ref><ref name="pmid22871565">{{cite journal| author=Cao C, Manganas C, Horton M, Bannon P, Munkholm-Larsen S, Ang SC | display-authors=etal| title=Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 146 | issue= 2 | pages= 255-61 | pmid=22871565 | doi=10.1016/j.jtcvs.2012.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22871565 }} </ref><ref name="pmid24686003">{{cite journal| author=Benedetto U, Raja SG, Albanese A, Amrani M, Biondi-Zoccai G, Frati G| title=Searching for the second best graft for coronary artery bypass surgery: a network meta-analysis of randomized controlled trials†. | journal=Eur J Cardiothorac Surg | year= 2015 | volume= 47 | issue= 1 | pages= 59-65; discussion 65 | pmid=24686003 | doi=10.1093/ejcts/ezu111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686003 }} </ref>
*Furthermore, several [[observational studies]] reported a better survival rate when the [[radial artery]] is used instead of the [[saphenous vein]] for [[CABG]].<ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref><ref name="pmid29708851">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Biondi-Zoccai G, Sedrakyan A, Puskas JD | display-authors=etal| title=Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. | journal=N Engl J Med | year= 2018 | volume= 378 | issue= 22 | pages= 2069-2077 | pmid=29708851 | doi=10.1056/NEJMoa1716026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29708851 }} </ref><ref name="pmid32662861">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A | display-authors=etal| title=Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis. | journal=JAMA | year= 2020 | volume= 324 | issue= 2 | pages= 179-187 | pmid=32662861 | doi=10.1001/jama.2020.8228 | pmc=7361649 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32662861 }} </ref>
*Based on the 2021 ACA Revascularization guideline, the following [[patients]] benefit the most from the [[radial artery]] use:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Patients]] younger than 75 years old
**[[Females]]
**[[Patients]] with preserved [[renal function]]
*There are some limited data regarding the vulnerability to the effect of [[Chronic (medical)|chronic]] native competitive flow in composite [[radial artery]] [[grafts]].<ref name="pmid14726046">{{cite journal| author=Abu-Omar Y, Mussa S, Anastasiadis K, Steel S, Hands L, Taggart DP| title=Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test. | journal=Ann Thorac Surg | year= 2004 | volume= 77 | issue= 1 | pages= 116-9 | pmid=14726046 | doi=10.1016/s0003-4975(03)01515-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14726046 }} </ref>

==Conduit Nomenclature==
*The terms ''single bypass'', ''double bypass'', ''triple bypass'', ''quadruple bypass'' and ''quintuple bypass'' refer to the number of [[coronary arteries]] [[Coronary artery bypass surgery|bypassed]] in the procedure. In other words, a double [[bypass]] means two [[coronary arteries]] are [[bypass|bypassed]] (such as [[left anterior descending|left anterior descending (LAD)]] [[coronary artery]] and [[right coronary artery|right coronary artery (RCA)]]); a triple [[bypass]] means three [[vessels]] are [[bypass|bypassed]] (such as [[LAD]], [[RCA]], and [[left circumflex artery|left circumflex artery (LCX)]]); a quadruple [[bypass]] means four vessels are bypassed (such as [[LAD]], [[RCA]], [[LCX]], first [[Left coronary artery|diagonal artery]] of the [[LAD]]). Less commonly more than four [[coronary arteries]] may be bypassed.
*A greater number of bypasses does not imply a [[patient]] is "sicker," nor does a lesser number imply a [[patient]] is "healthier".<ref>{{cite journal |author=Ohki S, Kaneko T, Satoh Y, ''et al'' |title=[Coronary artery bypass grafting in octogenarian] |language=Japanese |journal=Kyobu geka. The Japanese journal of thoracic surgery |volume=55 |issue=10 |pages=829–33; discussion 833–6 |year=2002 |pmid=12233100 |doi=}}</ref>
*A [[patient]] with a large amount of [[coronary artery disease|coronary artery disease]] ([[coronary artery disease|CAD]]) may receive fewer [[bypass]] [[grafts]] owing to the lack of suitable "target" [[vessels]].
*A [[patient]] with a single [[stenosis]] of the [[Left coronary artery|left main]] [[coronary artery]] often requires only two [[bypasses]] (to the [[LAD]] and the [[LCX]]). However, depending upon the [[anatomy]], grafts may also need to be placed to a large [[diagonal artery]], or to additional large [[obtuse marginal]] branches.

==Assessment of Target Vessels for Bypass Grafting==
A [[coronary artery]] may be unsuitable for [[bypass]] [[grafting]] for the following reasons:
*'''Size:''' If the native target [[artery]] it is small (< 1 mm or < 1.5 mm depending on surgeon preference)
*'''Location:''' Some [[Anatomical terms of location|distal locations]] of the native target [[artery]] may not be accessible, or a conduit may not reach far down the native [[artery]].
*'''Native artery calcification:''' Heavily [[calcification|calcified]] native [[arteries]] are sometimes technically not amenable to [[anastomosis]] of a conduit.
*'''Diffuse disease:''' The native [[artery]] may not have a section of the [[vessel]] that has a minimal [[disease]] where a conduit can be [[grafting|grafted]] to.
*'''The native [[artery]] lies in the [[heart]] [[muscle]] or is intramyocardial:''' In this scenario, the native [[coronary artery]] is located within the [[heart]] [[muscle]] rather than on the surface of the [[heart]] and a [[graft]] cannot be attached to it.

Although the cardiothoracic surgeon reviews the [[coronary angiogram]] prior to [[surgery]] and identifies the [[lesions]] (or "blockages") in the [[coronary arteries]] and will estimate the number of [[bypass]] [[grafts]] prior to [[surgery]], the final decision is made in the [[surgery|operating room]] based upon the direct examination of the [[heart]] and the suitability of the native target [[vessel]] for [[bypass|bypassing]].

==2021 ACA Revascularization Guideline==
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid29708851">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Biondi-Zoccai G, Sedrakyan A, Puskas JD | display-authors=etal| title=Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. | journal=N Engl J Med | year= 2018 | volume= 378 | issue= 22 | pages= 2069-2077 | pmid=29708851 | doi=10.1056/NEJMoa1716026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29708851 }} </ref><ref name="pmid22871565">{{cite journal| author=Cao C, Manganas C, Horton M, Bannon P, Munkholm-Larsen S, Ang SC | display-authors=etal| title=Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 146 | issue= 2 | pages= 255-61 | pmid=22871565 | doi=10.1016/j.jtcvs.2012.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22871565 }} </ref><ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref>
|-
| bgcolor="LightGreen"| To improve long-term [[heart|cardiac]] outcomes, using a [[radial artery]] is recommended in preference to a [[saphenous vein]] conduit to graft the second most important, significantly stenosed non–[[LAD]] vessel.
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531997 }} </ref><ref name="pmid27343909">{{cite journal| author=Magruder JT, Young A, Grimm JC, Conte JV, Shah AS, Mandal K | display-authors=etal| title=Bilateral internal thoracic artery grafting: Does graft configuration affect outcome? | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 1 | pages= 120-7 | pmid=27343909 | doi=10.1016/j.jtcvs.2016.03.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27343909 }} </ref>
|-
| bgcolor="yellow"| When [[bypass]] of the [[LAD]] is indicated to improve survival and reduce recurrent [[ischemia|ischemic events]], an [[internal thoracic artery]] ([[IMA]]), preferably the left, should be used to [[bypass]] the [[LAD]].
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2a Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
|-
| bgcolor="lightblue"| Among [[patients]] undergoing [[CABG]], grafting the bilateral [[IMA]] (BIMA) by experienced operators is beneficial in improving long-term [[heart|cardiac]] outcomes (only if [[patients]] are selected appropriately).

|}

==2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>==

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' If possible, the left [[internal mammary artery]] ([[LIMA]]) should be used to bypass the left anterior descending ([[LAD]]) artery when bypass of the LAD artery is indicated.<ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M et al.| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url= }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW et al.| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url= }} </ref><ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III: HARM]]
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' An arterial graft should not be used to bypass the right [[coronary artery]] with less than a critical stenosis (<90%).<ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The right [[internal mammary artery]] is probably indicated to bypass the [[LAD]] artery when the [[LIMA]] is unavailable or unsuitable as a bypass conduit. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' When anatomically and clinically suitable, use of a second [[internal mammary artery]] to graft the left circumflex or [[right coronary artery]] (when critically stenosed and perfusing LV myocardium) is reasonable to improve the likelihood of survival and to decrease reintervention.<ref name="pmid10220677">{{cite journal| author=Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R et al.| title=Two internal thoracic artery grafts are better than one. | journal=J Thorac Cardiovasc Surg | year= 1999 | volume= 117 | issue= 5 | pages= 855-72 | pmid=10220677 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10220677 }} </ref><ref name="pmid15561021">{{cite journal| author=Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM| title=The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 6 | pages= 2005-12; discussion 2012-4 | pmid=15561021 | doi=10.1016/j.athoracsur.2004.05.070 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15561021 }} </ref><ref name="pmid16399299">{{cite journal| author=Sabik JF, Blackstone EH, Gillinov AM, Banbury MK, Smedira NG, Lytle BW| title=Influence of patient characteristics and arterial grafts on freedom from coronary reoperation. | journal=J Thorac Cardiovasc Surg | year= 2006 | volume= 131 | issue= 1 | pages= 90-8 | pmid=16399299 | doi=10.1016/j.jtcvs.2005.05.024 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16399299 }} </ref><ref name="pmid18824756">{{cite journal| author=Sabik JF, Stockins A, Nowicki ER, Blackstone EH, Houghtaling PL, Lytle BW et al.| title=Does location of the second internal thoracic artery graft influence outcome of coronary artery bypass grafting? | journal=Circulation | year= 2008 | volume= 118 | issue= 14 Suppl | pages= S210-5 | pmid=18824756 | doi=10.1161/CIRCULATIONAHA.107.760827 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18824756 }} </ref><ref name="pmid15116000">{{cite journal| author=Stevens LM, Carrier M, Perrault LP, Hébert Y, Cartier R, Bouchard D et al.| title=Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting: effects on mortality and event-free survival. | journal=J Thorac Cardiovasc Surg | year= 2004 | volume= 127 | issue= 5 | pages= 1408-15 | pmid=15116000 | doi=10.1016/j.jtcvs.2003.10.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15116000 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Complete arterial revascularization may be reasonable in patients less than or equal to 60 years of age with few or no comorbidities. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Arterial grafting of the [[right coronary artery]] may be reasonable when a critical (≥90%) stenosis is present.<ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref><ref name="pmid18824756">{{cite journal| author=Sabik JF, Stockins A, Nowicki ER, Blackstone EH, Houghtaling PL, Lytle BW et al.| title=Does location of the second internal thoracic artery graft influence outcome of coronary artery bypass grafting? | journal=Circulation | year= 2008 | volume= 118 | issue= 14 Suppl | pages= S210-5 | pmid=18824756 | doi=10.1161/CIRCULATIONAHA.107.760827 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18824756 }} </ref><ref name="pmid14602274">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Khan M, Houghtaling PL, Cosgrove DM| title=Does competitive flow reduce internal thoracic artery graft patency? | journal=Ann Thorac Surg | year= 2003 | volume= 76 | issue= 5 | pages= 1490-6; discussion 1497 | pmid=14602274 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14602274 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Use of a [[radial artery]] graft may be reasonable when grafting left-sided coronary arteries with severe stenoses (>70%) and right-sided arteries with critical stenoses (≥90%) that perfuse LV myocardium.<ref name="pmid9832690">{{cite journal| author=Acar C, Ramsheyi A, Pagny JY, Jebara V, Barrier P, Fabiani JN et al.| title=The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. | journal=J Thorac Cardiovasc Surg | year= 1998 | volume= 116 | issue= 6 | pages= 981-9 | pmid=9832690 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9832690 }} </ref><ref name="pmid11782755">{{cite journal| author=Maniar HS, Sundt TM, Barner HB, Prasad SM, Peterson L, Absi T et al.| title=Effect of target stenosis and location on radial artery graft patency. | journal=J Thorac Cardiovasc Surg | year= 2002 | volume= 123 | issue= 1 | pages= 45-52 | pmid=11782755 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11782755 }} </ref><ref name="pmid11722042">{{cite journal| author=Moran SV, Baeza R, Guarda E, Zalaquett R, Irarrazaval MJ, Marchant E et al.| title=Predictors of radial artery patency for coronary bypass operations. | journal=Ann Thorac Surg | year= 2001 | volume= 72 | issue= 5 | pages= 1552-6 | pmid=11722042 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11722042 }} </ref><ref name="pmid9832694">{{cite journal| author=Possati G, Gaudino M, Alessandrini F, Luciani N, Glieca F, Trani C et al.| title=Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization. | journal=J Thorac Cardiovasc Surg | year= 1998 | volume= 116 | issue= 6 | pages= 1015-21 | pmid=9832694 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9832694 }} </ref><ref name="pmid10758391">{{cite journal| author=Royse AG, Royse CF, Tatoulis J, Grigg LE, Shah P, Hunt D et al.| title=Postoperative radial artery angiography for coronary artery bypass surgery. | journal=Eur J Cardiothorac Surg | year= 2000 | volume= 17 | issue= 3 | pages= 294-304 | pmid=10758391 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10758391 }} </ref><ref name="pmid15564545">{{cite journal| author=Desai ND, Cohen EA, Naylor CD, Fremes SE, Radial Artery Patency Study Investigators| title=A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 22 | pages= 2302-9 | pmid=15564545 | doi=10.1056/NEJMoa040982 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15564545 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]

Coronary artery bypass surgery conduits used for bypass

2022-08-29T06:13:10Z

Anahita: /* The Internal Thoracic Artery */

__NOTOC__
{{Coronary artery bypass surgery}}
{{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}, [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] {{Anahita}}
==Overview==

==Conduits used for bypass==
*The choice of conduits ([[artery|arteries]] and/or [[veins]] from elsewhere in the body) to [[bypass]] the blockages is highly [[surgery|surgeon]] and institution dependent.
*To choose the proper conduits for [[CABG]] both clinical and technical factors such as [[life expectancy]], presence of [[diabetes]], chronic renal failure, degree of the target [[stenosis]] must be considered.<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
*The following table published by 2021 ACA Revascularization Guideline presents the best practices for the Use of [[bypass]] [[conduits]] in [[CABG]]:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
{| class="wikitable"
|-
| Assessing [[Anatomical terms of location|palmar arch]] completeness and [[ulna|ulnar]] compensation before harvesting the [[radial artery]]. If [[radial artery]] harvesting is considered it is recommended to use the [[arm]] with the best [[ulna|ulnar compensation]].
|-
| It is recommended to use [[radial artery]] [[grafts]] to target [[vessels]] with [[stenosis|subocclusive stenosis]].
|-
| It is recommended to avoid [[radial artery]] use after [[Radial artery catheterization|transradial catheterization]].
|-
| It is recommended to avoid [[radial artery]] use in [[chronic kidney disease]] [[patients]] and in those with a high likelihood of rapid progression to [[hemodialysis]].
|-
| It is recommended to avoid [[oral]] [[calcium channel blockers]] for the first [[surgery|postoperative]] year after [[radial artery]] [[grafting]].
|-
| It is recommended to avoid bilateral [[percutaneous]] or [[surgery|surgical]] [[radial artery]] procedures in [[patients]] with [[coronary artery disease]] with a goal to preserve the [[artery]] for future use.
|-
| It is recommended to use the [[internal mammary artery]] (using the skeletonization technique) to reduce the risk of [[Sternum|sternal]] [[wound]] [[complications]].
|-
| It is recommended to use an [[endoscopy|endoscopic]] [[saphenous vein]] harvest technique in [[patients]] at risk of [[wound]] [[complications]].
|-
| For [[patients]] at low risk of [[wound]] [[complications]], it is recommended to use a no-touch [[saphenous vein]] harvest technique.
|-
| It is recommended to use the skeletonized [[right gastroepiploic artery]] to [[graft]] [[right coronary artery]] target [[vessels]] with subocclusive [[stenosis]] if the operator is experienced with the use of the [[artery]].
|}
*Typically, the left [[internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also referred to as the ''[[left internal mammary artery]]'' or ''[[LIMA]]'') is grafted to the [[Left Anterior Descending]] [[artery]] and a combination of other [[artery|arteries]] and [[veins]] is used for other [[coronary arteries]].
*The right [[internal thoracic artery]] ([[Internal thoracic artery|RITA]]), the [[great saphenous vein]] from the [[leg]] and the [[radial artery]] from the forearm are frequently used.
*The [[right gastroepiploic artery]] from the [[stomach]] is infrequently used given the difficult mobilization from the [[abdomen]].

==Saphenous vein==
===Saphenous vein anatomy===
*The [[great saphenous vein]] ([[GSV]]) is frequently used as a conduit for [[CABG]]. It originates from where the dorsal [[vein]] of the [[first digit]] (the large [[toe]]) merges with the [[dorsal venous arch of the foot]].
*After passing [[Anatomical terms of location|anterior]] to the [[medial malleolus]] (where it often can be visualized and [[Palpation|palpated]]), it runs up the [[medial]] side of the [[leg]]. At [[knee]], it runs over the [[Anatomical terms of location|posterior border]] of the [[medial epicondyle]] of the [[femur]] bone.
*The [[great saphenous vein]] then courses [[Anatomical terms of location|laterally]] to lie on the [[Anatomical terms of location|anterior surface]] of the [[thigh]] before entering an opening in the [[fascia lata]] called the [[saphenous opening]]. It joins with the [[femoral vein]] in the region of the [[femoral triangle]] at the saphenofemoral junction.
*The '''small [[saphenous vein]]''' (also '''lesser [[saphenous vein]]''') originates where the [[Anatomical terms of location|dorsal]] [[vein]] from the [[fifth digit]] (smallest [[toe]]) merges with the [[dorsal [[venous]] arch of the [[foot]], which attaches to the [[great saphenous vein]]. It is considered a [[superficial vein]] and is [[subcutaneous]] (just under the [[skin]]). From its origin, it courses around the lateral aspect of the [[foot]] ([[Anatomical terms of location|inferior]] and [[Anatomical terms of location|posterior]] to the [[lateral malleolus]]) and runs along the [[Anatomical terms of location|posterior]] aspect of the [[leg]] (with the [[sural nerve]]), passes between the heads of the [[gastrocnemius muscle]], and drains into the [[popliteal vein]], approximately at or above the level of the [[knee]] [[joint]].

<gallery perRow="3">
Image:Gray432 color.png|Cross-section through the middle of the [[thigh]].
Image:Gray440_color.png|Cross-section through the middle of the [[leg]].
Image:Great_saphenous_vein.png|The [[great saphenous vein]] and landmarks along its course
Image:Gray580.png|The [[great saphenous vein]] and its tributaries at the [[Saphenous opening|fossa ovalis]] in the [[groin]].
Image:Gray582.png|Small [[saphenous vein]] and its tributaries.
</gallery>

====Saphenous vein harvesting====
*The [[saphenous vein]] can be harvested by either direct visualization or via an [[endoscopy|endoscopic approach]]. [[Veins]] that are used either have their valves removed or are turned around so that the [[valves]] in them do not occlude [[blood flow]] in the [[graft]]. The technique of [[saphenous vein]] harvesting may influence later [[SVG]] patency. The process of harvesting the [[vein]] and [[pressure]] testing the [[vein]] for a leak may damage the [[endothelium]].<ref>Lawrie GM, Weilbacher DE, Henry PD. Endothelium-dependent relaxation in human saphenous vein grafts. Effects of preparation and clinicopathologic correlations. J Thorac Cardiovasc Surg 1990;100:612—20.</ref><ref>Souza DS, Johansson B, Bojo¨ L, Karlsson R, Geijer H, Filbey D, Bodin L, Arbeus M, Dashwood MR. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg 2006;132:373—8.</ref>
*The [[endoscopy|endoscopic approach]] has been associated with lower rates of [[wound]] [[infection]], greater [[patient]] satisfaction, and earlier mobilization.<ref name="pmid11828277">{{cite journal |author=Kiaii B, Moon BC, Massel D, Langlois Y, Austin TW, Willoughby A, Guiraudon C, Howard CR, Guo LR |title=A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=123 |issue=2 |pages=204–12 |year=2002 |month=February |pmid=11828277 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522302096046 |issn= |accessdate=2010-07-23}}</ref><ref name="pmid19605828">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA, Mehta RH, Gibson CM, Mack MJ, Kouchoukos NT, Califf RM, Alexander JH |title=Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery |journal=[[The New England Journal of Medicine]] |volume=361 |issue=3 |pages=235–44 |year=2009 |month=July |pmid=19605828 |doi=10.1056/NEJMoa0900708 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19605828&promo=ONFLNS19 |issn= |accessdate=2010-07-12}}</ref><ref name="pmid15746730">{{cite journal |author=Yun KL, Wu Y, Aharonian V, Mansukhani P, Pfeffer TA, Sintek CF, Kochamba GS, Grunkemeier G, Khonsari S |title=Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=129 |issue=3 |pages=496–503 |year=2005 |month=March |pmid=15746730 |doi=10.1016/j.jtcvs.2004.08.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522304015855 |issn= |accessdate=2010-07-23}}</ref><ref name="pmid15115999">{{cite journal |author=Perrault LP, Jeanmart H, Bilodeau L, Lespérance J, Tanguay JF, Bouchard D, Pagé P, Carrier M |title=Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=127 |issue=5 |pages=1402–7 |year=2004 |month=May |pmid=15115999 |doi=10.1016/j.jtcvs.2003.10.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303018798 |issn= |accessdate=2010-07-23}}</ref> One small randomized study of 144 patients showed no difference in histologic findings between the traditional and endoscopic techniques.<ref name="pmid11828277">{{cite journal |author=Kiaii B, Moon BC, Massel D, Langlois Y, Austin TW, Willoughby A, Guiraudon C, Howard CR, Guo LR |title=A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=123 |issue=2 |pages=204–12 |year=2002 |month=February |pmid=11828277|doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0022522302096046 |issn= |accessdate=2010-07-23}}</ref>In another small study of 40 patients randomized to the two techniques, no difference was seen in angiographic patency at 3 months.<ref name="pmid15115999">{{cite journal |author=Perrault LP, Jeanmart H, Bilodeau L, Lespérance J, Tanguay JF, Bouchard D, Pagé P, Carrier M |title=Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=127 |issue=5 |pages=1402–7 |year=2004 |month=May |pmid=15115999 |doi=10.1016/j.jtcvs.2003.10.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522303018798 |issn= |accessdate=2010-07-23}}</ref>Another small randomized study of 144 patients who returned for angiography demonstrated an occlusion rate of 21.7% for the endoscopic approach vs 17.6% for the open approach.<ref name="pmid15746730">{{cite journal |author=Yun KL, Wu Y, Aharonian V, Mansukhani P, Pfeffer TA, Sintek CF, Kochamba GS, Grunkemeier G, Khonsari S |title=Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: six-month patency rates |journal=[[J. Thorac. Cardiovasc. Surg.]] |volume=129 |issue=3 |pages=496–503 |year=2005 |month=March |pmid=15746730 |doi=10.1016/j.jtcvs.2004.08.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022522304015855 |issn= |accessdate=2010-07-23}}</ref>
*However, non-[[randomized]] data from a much larger multicenter study does suggest that [[endoscopyendoscopic harvesting]] may be associated with a higher rate of failure and adverse events such as death and [[MI]].<ref name="pmid19605828">{{cite journal |author=Lopes RD, Hafley GE, Allen KB, Ferguson TB, Peterson ED, Harrington RA, Mehta RH, Gibson CM, Mack MJ, Kouchoukos NT, Califf RM, Alexander JH |title=Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery |journal=[[The New England Journal of Medicine]] |volume=361 |issue=3 |pages=235–44 |year=2009 |month=July |pmid=19605828 |doi=10.1056/NEJMoa0900708 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=19605828&promo=ONFLNS19 |issn= |accessdate=2010-07-12}}</ref>
*[[Complications]] associated with [[Saphenous vein graft|saphenous vein harvesting]] include the following:
** [[Saphenous nerve]] [[injury]]
** [[Infection]] at [[incision]] sites or [[sepsis]].
** [[Deep vein thrombosis]] ([[DVT]])
** [[Keloid|Keloid scarring]]
** [[Chronic pain]] at [[incision]] sites

==The Internal Thoracic Artery==
*Numerous studies support the use of the [[Internal thoracic artery|left internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also known as the [[Internal thoracic artery|left internal mammary artery]] ([[Internal thoracic artery|LIMA]])) to [[graft]] the [[LAD]] in order to improve survival unless [[contraindications|contraindicated]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531997 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref>
*In a study evaluating almost 6,000 [[patients]], [[LIMA]] [[grafting]] was able to reduce the rate of [[heart|cardiac]]-related [[hospital|rehospitalization]] and [[revascularization]]. In addition, this study showed a lower rate of death and recurrent [[infarction]] in those who undergone [[LIMA]] [[grafting]].<ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref>
*Evidence shows that the right [[IMA]] can be used to [[graft]] the [[LAD]] if the [[LIMA]] is impractical and unusable. Furthermore, the right [[IMA]] can be used in conjunction with the [[LIMA]] which is called bilateral [[internal mammary artery]] (BIMA) [[grafting]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**Based on observational studies, BIMA [[grafting]] has a survival advantage when compared with [[CABG]] with a single [[IMA]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref><ref name="pmid24916209">{{cite journal| author=Yi G, Shine B, Rehman SM, Altman DG, Taggart DP| title=Effect of bilateral internal mammary artery grafts on long-term survival: a meta-analysis approach. | journal=Circulation | year= 2014 | volume= 130 | issue= 7 | pages= 539-45 | pmid=24916209 | doi=10.1161/CIRCULATIONAHA.113.004255 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24916209 }} </ref><ref name="pmid24521973">{{cite journal| author=Takagi H, Goto SN, Watanabe T, Mizuno Y, Kawai N, Umemoto T| title=A meta-analysis of adjusted hazard ratios from 20 observational studies of bilateral versus single internal thoracic artery coronary artery bypass grafting. | journal=J Thorac Cardiovasc Surg | year= 2014 | volume= 148 | issue= 4 | pages= 1282-90 | pmid=24521973 | doi=10.1016/j.jtcvs.2014.01.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24521973 }} </ref><ref name="pmid29306899">{{cite journal| author=Gaudino M, Di Franco A, Rahouma M, Tam DY, Iannaccone M, Deb S | display-authors=etal| title=Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta-Analysis. | journal=J Am Heart Assoc | year= 2018 | volume= 7 | issue= 1 | pages= | pmid=29306899 | doi=10.1161/JAHA.117.008010 | pmc=5778975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29306899 }} </ref>
**Reports from a [[meta-analysis]] of 38 studies, including 174,205 [[patients]] demonstrated a decreased [[mortality rate]] at 7.25 years follow up among [[patients]] who had BIMA [[grafting]].<ref name="pmid29306899">{{cite journal| author=Gaudino M, Di Franco A, Rahouma M, Tam DY, Iannaccone M, Deb S | display-authors=etal| title=Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta-Analysis. | journal=J Am Heart Assoc | year= 2018 | volume= 7 | issue= 1 | pages= | pmid=29306899 | doi=10.1161/JAHA.117.008010 | pmc=5778975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29306899 }} </ref>
**On the other hand, a single large [[randomized controlled trial]] reported no difference in 10-year all-cause [[mortality rate|mortality]] when BIMA was compared with single [[IMA]]. Furthermore, this study highlighted the importance of [[surgery|surgical expertise]] in BIMA [[grafting]].<ref name="pmid30699314">{{cite journal| author=Taggart DP, Benedetto U, Gerry S, Altman DG, Gray AM, Lees B | display-authors=etal| title=Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 5 | pages= 437-446 | pmid=30699314 | doi=10.1056/NEJMoa1808783 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30699314 }} </ref>
*In multiple [[artery|arterial]] [[revascularization]] during [[Coronary artery bypass surgery]], the [[Internal thoracic artery|right internal thoracic artery]] ([[Internal thoracic artery|RITA]]) has been proofed to be a better choice as a conduit than the [[radial artery]]. This has been published at the European Society of Cardiology (ESC) 2011 Congress, after a [[clinical trial|trial]] on more than 1000 [[patients]] who had the operation in 10 years [[clinical trial|trial]].
*The [[Internal thoracic artery|left internal thoracic artery]] ([[Internal thoracic artery|LITA]]) (also known as the [[Internal thoracic artery|left internal mammary artery]] ([[Internal thoracic artery|LIMA]])) is the best [[vessel]] to use for [[coronary artery bypass surgery]] when only one [[artery]] is required.
**It was known that the long-term outcomes of the [[artery|arterial]] [[graft]]s are much better than [[saphenous vein grafts]] (SVGs) and has less [[morbidity]] and [[mortality rates]].<ref name="pmid23428216">{{cite journal| author=Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B | display-authors=etal| title=Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 8 | pages= 837-48 | pmid=23428216 | doi=10.1016/j.jacc.2012.10.049 | pmc=4262244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23428216 }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref>
**The [[right internal thoracic artery]] (RITA) is the best second conduit for the [[bypass]] and has better long-term outcomes than the [[radial artery]]. The use of the [[Internal thoracic artery|RITA]] results in the following in comparison with [[SVG]]:
***Less major adverse [[heart|cardiac]] and cerebrovascular events.
***Less [[surgery|perioperative]] [[myocardial infarction]] rates.
***Less [[surgery|perioperative]] [[stroke]] rates.
***Less [[heart|cardiac]]-related deaths.
*There have been good clinical results with the single left [[internal thoracic artery]] [[grafting]] compared with [[saphenous vein]] [[grafting]]. This prompted surgeons to use both ITAs. Bilateral ITA [[grafting]] could improve long-term survival. Late [[Complication (medicine)|complications]] like [[myocardial infarction]] and need to [[surgery|reoperate]] may be avoided. However, mathematical modeling is required to assist in developing a strategy for use of such [[grafts]].<ref name="pmid9852872">{{cite journal| author=Buxton BF, Komeda M, Fuller JA, Gordon I| title=Bilateral internal thoracic artery grafting may improve the outcome of coronary artery surgery. Risk-adjusted survival. | journal=Circulation | year= 1998 | volume= 98 | issue= 19 Suppl | pages= II1-6 | pmid=9852872 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9852872 }} </ref>
*In a [[cohort study]] of 8123 [[patients]] who received single [[internal thoracic artery]] [[grafts]] and 2001 who received bilateral [[internal thoracic artery]] [[grafts]] for [[multivessel coronary artery disease]] for a duration of 20 years, it was found that the latter produces improved survival compared with single [[internal thoracic artery]] [[grafting]] during the second [[surgery|postoperative]] decade, and the magnitude of that benefit increases through 20 [[surgery|postoperative]] years.<ref name="pmid15561021">{{cite journal| author=Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM| title=The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 6 | pages= 2005-12; discussion 2012-4 | pmid=15561021 | doi=10.1016/j.athoracsur.2004.05.070 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15561021 }} </ref>
*It's easy to harvest the [[radial artery]], but it has a higher risk for [[vasospasm]] and [[atherosclerosis]] than the [[right internal thoracic artery]] ([[RITA]]). Some institution solves this problem ([[vasospasm]]) by preparing the [[radial artery|radial arteries]] with [[phenoxybenzamine]].
*Although the fact that using both [[internal thoracic arteries]] for [[coronary artery bypass surgery]] takes a longer time, it has better long-term results and [[surgery|perioperative]] outcomes. This has to be proofed and confirmed by more [[randomized]] and controlled trials.

==Radial Artery==
*Numerous [[clinical trials]] have demonstrated better patency rates (in mid- and long-term) when the [[radial artery]] is used in comparison with the [[saphenous vein]].<ref name="pmid32662861">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A | display-authors=etal| title=Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis. | journal=JAMA | year= 2020 | volume= 324 | issue= 2 | pages= 179-187 | pmid=32662861 | doi=10.1001/jama.2020.8228 | pmc=7361649 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32662861 }} </ref><ref name="pmid22871565">{{cite journal| author=Cao C, Manganas C, Horton M, Bannon P, Munkholm-Larsen S, Ang SC | display-authors=etal| title=Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 146 | issue= 2 | pages= 255-61 | pmid=22871565 | doi=10.1016/j.jtcvs.2012.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22871565 }} </ref><ref name="pmid24686003">{{cite journal| author=Benedetto U, Raja SG, Albanese A, Amrani M, Biondi-Zoccai G, Frati G| title=Searching for the second best graft for coronary artery bypass surgery: a network meta-analysis of randomized controlled trials†. | journal=Eur J Cardiothorac Surg | year= 2015 | volume= 47 | issue= 1 | pages= 59-65; discussion 65 | pmid=24686003 | doi=10.1093/ejcts/ezu111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686003 }} </ref>
*Furthermore, several [[observational studies]] reported a better survival rate when the [[radial artery]] is used instead of the [[saphenous vein]] for [[CABG]].<ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref><ref name="pmid29708851">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Biondi-Zoccai G, Sedrakyan A, Puskas JD | display-authors=etal| title=Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. | journal=N Engl J Med | year= 2018 | volume= 378 | issue= 22 | pages= 2069-2077 | pmid=29708851 | doi=10.1056/NEJMoa1716026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29708851 }} </ref><ref name="pmid32662861">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Ballman K, Biondi-Zoccai G, Sedrakyan A | display-authors=etal| title=Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis. | journal=JAMA | year= 2020 | volume= 324 | issue= 2 | pages= 179-187 | pmid=32662861 | doi=10.1001/jama.2020.8228 | pmc=7361649 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32662861 }} </ref>
*Based on the 2021 ACA Revascularization guideline, the following [[patients]] benefit the most from the [[radial artery]] use:<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
**[[Patients]] younger than 75 years old
**[[Females]]
**[[Patients]] with preserved [[renal function]]
*There are some limited data regarding the vulnerability to the effect of [[Chronic (medical)|chronic]] native competitive flow in composite [[radial artery]] [[grafts]].<ref name="pmid14726046">{{cite journal| author=Abu-Omar Y, Mussa S, Anastasiadis K, Steel S, Hands L, Taggart DP| title=Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test. | journal=Ann Thorac Surg | year= 2004 | volume= 77 | issue= 1 | pages= 116-9 | pmid=14726046 | doi=10.1016/s0003-4975(03)01515-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14726046 }} </ref>

==Conduit Nomenclature==
*The terms ''single bypass'', ''double bypass'', ''triple bypass'', ''quadruple bypass'' and ''quintuple bypass'' refer to the number of [[coronary arteries]] [[Coronary artery bypass surgery|bypassed]] in the procedure. In other words, a double [[bypass]] means two [[coronary arteries]] are [[bypass|bypassed]] (such as [[left anterior descending|left anterior descending (LAD)]] [[coronary artery]] and [[right coronary artery|right coronary artery (RCA)]]); a triple [[bypass]] means three [[vessels]] are [[bypass|bypassed]] (such as [[LAD]], [[RCA]], and [[left circumflex artery|left circumflex artery (LCX)]]); a quadruple [[bypass]] means four vessels are bypassed (such as [[LAD]], [[RCA]], [[LCX]], first [[Left coronary artery|diagonal artery]] of the [[LAD]]). Less commonly more than four [[coronary arteries]] may be bypassed.
*A greater number of bypasses does not imply a [[patient]] is "sicker," nor does a lesser number imply a [[patient]] is "healthier".<ref>{{cite journal |author=Ohki S, Kaneko T, Satoh Y, ''et al'' |title=[Coronary artery bypass grafting in octogenarian] |language=Japanese |journal=Kyobu geka. The Japanese journal of thoracic surgery |volume=55 |issue=10 |pages=829–33; discussion 833–6 |year=2002 |pmid=12233100 |doi=}}</ref>
*A [[patient]] with a large amount of [[coronary artery disease|coronary artery disease]] ([[coronary artery disease|CAD]]) may receive fewer [[bypass]] [[grafts]] owing to the lack of suitable "target" [[vessels]].
*A [[patient]] with a single [[stenosis]] of the [[Left coronary artery|left main]] [[coronary artery]] often requires only two [[bypasses]] (to the [[LAD]] and the [[LCX]]). However, depending upon the [[anatomy]], grafts may also need to be placed to a large [[diagonal artery]], or to additional large [[obtuse marginal]] branches.

==Assessment of Target Vessels for Bypass Grafting==
A [[coronary artery]] may be unsuitable for [[bypass]] [[grafting]] for the following reasons:
*'''Size:''' If the native target [[artery]] it is small (< 1 mm or < 1.5 mm depending on surgeon preference)
*'''Location:''' Some [[Anatomical terms of location|distal locations]] of the native target [[artery]] may not be accessible, or a conduit may not reach far down the native [[artery]].
*'''Native artery calcification:''' Heavily [[calcification|calcified]] native [[arteries]] are sometimes technically not amenable to [[anastomosis]] of a conduit.
*'''Diffuse disease:''' The native [[artery]] may not have a section of the [[vessel]] that has a minimal [[disease]] where a conduit can be [[grafting|grafted]] to.
*'''The native [[artery]] lies in the [[heart]] [[muscle]] or is intramyocardial:''' In this scenario, the native [[coronary artery]] is located within the [[heart]] [[muscle]] rather than on the surface of the [[heart]] and a [[graft]] cannot be attached to it.

Although the cardiothoracic surgeon reviews the [[coronary angiogram]] prior to [[surgery]] and identifies the [[lesions]] (or "blockages") in the [[coronary arteries]] and will estimate the number of [[bypass]] [[grafts]] prior to [[surgery]], the final decision is made in the [[surgery|operating room]] based upon the direct examination of the [[heart]] and the suitability of the native target [[vessel]] for [[bypass|bypassing]].

==2021 ACA Revascularization Guideline==
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid29708851">{{cite journal| author=Gaudino M, Benedetto U, Fremes S, Biondi-Zoccai G, Sedrakyan A, Puskas JD | display-authors=etal| title=Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. | journal=N Engl J Med | year= 2018 | volume= 378 | issue= 22 | pages= 2069-2077 | pmid=29708851 | doi=10.1056/NEJMoa1716026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29708851 }} </ref><ref name="pmid22871565">{{cite journal| author=Cao C, Manganas C, Horton M, Bannon P, Munkholm-Larsen S, Ang SC | display-authors=etal| title=Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials. | journal=J Thorac Cardiovasc Surg | year= 2013 | volume= 146 | issue= 2 | pages= 255-61 | pmid=22871565 | doi=10.1016/j.jtcvs.2012.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22871565 }} </ref><ref name="pmid30636525">{{cite journal| author=Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C | display-authors=etal| title=Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta-Analysis of Clinical Outcomes. | journal=J Am Heart Assoc | year= 2019 | volume= 8 | issue= 2 | pages= e010839 | pmid=30636525 | doi=10.1161/JAHA.118.010839 | pmc=6497341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636525 }} </ref>
|-
| bgcolor="LightGreen"| To improve long-term [[heart|cardiac]] outcomes, using a [[radial artery]] is recommended in preference to a [[saphenous vein]] conduit to graft the second most important, significantly stenosed non–[[LAD]] vessel.
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:yellow"|Class 1 Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid3259128">{{cite journal| author=Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ | display-authors=etal| title=Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. | journal=Ann Thorac Surg | year= 1988 | volume= 45 | issue= 5 | pages= 533-6 | pmid=3259128 | doi=10.1016/s0003-4975(10)64526-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3259128 }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW | display-authors=etal| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484393 }} </ref><ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M | display-authors=etal| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531997 }} </ref><ref name="pmid27343909">{{cite journal| author=Magruder JT, Young A, Grimm JC, Conte JV, Shah AS, Mandal K | display-authors=etal| title=Bilateral internal thoracic artery grafting: Does graft configuration affect outcome? | journal=J Thorac Cardiovasc Surg | year= 2016 | volume= 152 | issue= 1 | pages= 120-7 | pmid=27343909 | doi=10.1016/j.jtcvs.2016.03.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27343909 }} </ref>
|-
| bgcolor="yellow"| When [[bypass]] of the [[LAD]] is indicated to improve survival and reduce recurrent [[ischemia|ischemic events]], an [[internal thoracic artery]] ([[IMA]]), preferably the left, should be used to [[bypass]] the [[LAD]].
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2a Recommendation, Level of Evidence: B-NR <ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref>
|-
| bgcolor="lightblue"| Among [[patients]] undergoing [[CABG]], grafting the bilateral [[IMA]] (BIMA) by experienced operators is beneficial in improving long-term [[heart|cardiac]] outcomes (only if [[patients]] are selected appropriately).

|}

==2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>==

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' If possible, the left [[internal mammary artery]] ([[LIMA]]) should be used to bypass the left anterior descending ([[LAD]]) artery when bypass of the LAD artery is indicated.<ref name="pmid8127094">{{cite journal| author=Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M et al.| title=Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. | journal=J Thorac Cardiovasc Surg | year= 1994 | volume= 107 | issue= 3 | pages= 657-62 | pmid=8127094 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8127094 }} </ref><ref name="pmid8531997">{{cite journal| author=Cameron A, Davis KB, Green G, Schaff HV| title=Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 4 | pages= 216-9 | pmid=8531997 | doi=10.1056/NEJM199601253340402 | pmc= | url= }} </ref><ref name="pmid3484393">{{cite journal| author=Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW et al.| title=Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. | journal=N Engl J Med | year= 1986 | volume= 314 | issue= 1 | pages= 1-6 | pmid=3484393 | doi=10.1056/NEJM198601023140101 | pmc= | url= }} </ref><ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III: HARM]]
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' An arterial graft should not be used to bypass the right [[coronary artery]] with less than a critical stenosis (<90%).<ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The right [[internal mammary artery]] is probably indicated to bypass the [[LAD]] artery when the [[LIMA]] is unavailable or unsuitable as a bypass conduit. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' When anatomically and clinically suitable, use of a second [[internal mammary artery]] to graft the left circumflex or [[right coronary artery]] (when critically stenosed and perfusing LV myocardium) is reasonable to improve the likelihood of survival and to decrease reintervention.<ref name="pmid10220677">{{cite journal| author=Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R et al.| title=Two internal thoracic artery grafts are better than one. | journal=J Thorac Cardiovasc Surg | year= 1999 | volume= 117 | issue= 5 | pages= 855-72 | pmid=10220677 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10220677 }} </ref><ref name="pmid15561021">{{cite journal| author=Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM| title=The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 6 | pages= 2005-12; discussion 2012-4 | pmid=15561021 | doi=10.1016/j.athoracsur.2004.05.070 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15561021 }} </ref><ref name="pmid16399299">{{cite journal| author=Sabik JF, Blackstone EH, Gillinov AM, Banbury MK, Smedira NG, Lytle BW| title=Influence of patient characteristics and arterial grafts on freedom from coronary reoperation. | journal=J Thorac Cardiovasc Surg | year= 2006 | volume= 131 | issue= 1 | pages= 90-8 | pmid=16399299 | doi=10.1016/j.jtcvs.2005.05.024 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16399299 }} </ref><ref name="pmid18824756">{{cite journal| author=Sabik JF, Stockins A, Nowicki ER, Blackstone EH, Houghtaling PL, Lytle BW et al.| title=Does location of the second internal thoracic artery graft influence outcome of coronary artery bypass grafting? | journal=Circulation | year= 2008 | volume= 118 | issue= 14 Suppl | pages= S210-5 | pmid=18824756 | doi=10.1161/CIRCULATIONAHA.107.760827 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18824756 }} </ref><ref name="pmid15116000">{{cite journal| author=Stevens LM, Carrier M, Perrault LP, Hébert Y, Cartier R, Bouchard D et al.| title=Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting: effects on mortality and event-free survival. | journal=J Thorac Cardiovasc Surg | year= 2004 | volume= 127 | issue= 5 | pages= 1408-15 | pmid=15116000 | doi=10.1016/j.jtcvs.2003.10.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15116000 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Complete arterial revascularization may be reasonable in patients less than or equal to 60 years of age with few or no comorbidities. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Arterial grafting of the [[right coronary artery]] may be reasonable when a critical (≥90%) stenosis is present.<ref name="pmid15680832">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM| title=Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. | journal=Ann Thorac Surg | year= 2005 | volume= 79 | issue= 2 | pages= 544-51; discussion 544-51 | pmid=15680832 | doi=10.1016/j.athoracsur.2004.07.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15680832 }} </ref><ref name="pmid18824756">{{cite journal| author=Sabik JF, Stockins A, Nowicki ER, Blackstone EH, Houghtaling PL, Lytle BW et al.| title=Does location of the second internal thoracic artery graft influence outcome of coronary artery bypass grafting? | journal=Circulation | year= 2008 | volume= 118 | issue= 14 Suppl | pages= S210-5 | pmid=18824756 | doi=10.1161/CIRCULATIONAHA.107.760827 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18824756 }} </ref><ref name="pmid14602274">{{cite journal| author=Sabik JF, Lytle BW, Blackstone EH, Khan M, Houghtaling PL, Cosgrove DM| title=Does competitive flow reduce internal thoracic artery graft patency? | journal=Ann Thorac Surg | year= 2003 | volume= 76 | issue= 5 | pages= 1490-6; discussion 1497 | pmid=14602274 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14602274 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Use of a [[radial artery]] graft may be reasonable when grafting left-sided coronary arteries with severe stenoses (>70%) and right-sided arteries with critical stenoses (≥90%) that perfuse LV myocardium.<ref name="pmid9832690">{{cite journal| author=Acar C, Ramsheyi A, Pagny JY, Jebara V, Barrier P, Fabiani JN et al.| title=The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. | journal=J Thorac Cardiovasc Surg | year= 1998 | volume= 116 | issue= 6 | pages= 981-9 | pmid=9832690 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9832690 }} </ref><ref name="pmid11782755">{{cite journal| author=Maniar HS, Sundt TM, Barner HB, Prasad SM, Peterson L, Absi T et al.| title=Effect of target stenosis and location on radial artery graft patency. | journal=J Thorac Cardiovasc Surg | year= 2002 | volume= 123 | issue= 1 | pages= 45-52 | pmid=11782755 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11782755 }} </ref><ref name="pmid11722042">{{cite journal| author=Moran SV, Baeza R, Guarda E, Zalaquett R, Irarrazaval MJ, Marchant E et al.| title=Predictors of radial artery patency for coronary bypass operations. | journal=Ann Thorac Surg | year= 2001 | volume= 72 | issue= 5 | pages= 1552-6 | pmid=11722042 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11722042 }} </ref><ref name="pmid9832694">{{cite journal| author=Possati G, Gaudino M, Alessandrini F, Luciani N, Glieca F, Trani C et al.| title=Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization. | journal=J Thorac Cardiovasc Surg | year= 1998 | volume= 116 | issue= 6 | pages= 1015-21 | pmid=9832694 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9832694 }} </ref><ref name="pmid10758391">{{cite journal| author=Royse AG, Royse CF, Tatoulis J, Grigg LE, Shah P, Hunt D et al.| title=Postoperative radial artery angiography for coronary artery bypass surgery. | journal=Eur J Cardiothorac Surg | year= 2000 | volume= 17 | issue= 3 | pages= 294-304 | pmid=10758391 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10758391 }} </ref><ref name="pmid15564545">{{cite journal| author=Desai ND, Cohen EA, Naylor CD, Fremes SE, Radial Artery Patency Study Investigators| title=A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 22 | pages= 2302-9 | pmid=15564545 | doi=10.1056/NEJMoa040982 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15564545 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}

==References==
{{reflist|2}}

{{WH}}
{{WS}}
[[Category:Cardiac surgery]]
[[Category:Cardiology]]
[[Category:Surgery]]
[[Category:Surgical procedures]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]