Coronary artery bypass surgery pulmonary artery catheterization

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Patient Information

Overview

Pathophysiology

Saphenous Vein Graft Disease
Other Non-Atherosclerotic Saphenous Vein Graft Diseases

Indications for CABG

Prognosis

Diagnosis

Imaging in the Patient Undergoing CABG

Chest X Ray

Angiography

CT Angiography
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Treatment

Goals of Treatment

Perioperative Management

Perioperative Monitoring

Electrocardiographic Monitoring
Pulmonary Artery Catheterization
Central Nervous System Monitoring

Surgical Procedure

Anesthetic Considerations
Intervention in left main coronary artery disease
The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)
Minimally Invasive CABG
Hybrid coronary revascularization
Conduits Used for Bypass
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Post-Operative Care and Complications

Pharmacotherapy in patients undergoing CABG CABG

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Anomalous Coronary Arteries
COPD/Respiratory Insufficiency
Existing Renal Disease
Concomitant Valvular Disease
Previous Cardiac Surgery
Menopause
Carotid Disease evaluation before surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2] Anahita Deylamsalehi, M.D.[3]

CABG Pulmonary Artery Catheterization

2021 ACA Revascularization Guideline [1][2][3][4][5]

High-risk Surgery Highly selective use of pulmonary artery catheters may be safe for high-risk patients, such as elderies, or those with congestive heart failure, pulmonary hypertension, or numerous histories of valve procedures may be safe and may potentially help in the surveillance and treatment of hemodynamic instability.
Isolated CABG Use of pulmonary artery catheters is discouraged in low risk patients who are stable since there is no evidence of benefits or improvement in the outcome.

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[6]

Class I
"1. Placement of a pulmonary artery catheter is indicated, preferably before the induction of anesthesia or surgical incision, in patients in cardiogenic shock undergoing CABG. (Level of Evidence: C)"
Class IIa
"1. Placement of a pulmonary artery catheter can be useful in the intraoperative or early postoperative period in patients with acute hemodynamic instability.[7][8][5][2][9] (Level of Evidence: B)"
Class IIb
"1. Placement of a pulmonary artery catheter may be reasonable in clinically stable patients undergoing CABG after consideration of baseline patient risk, the planned surgical procedure, and the practice setting.[7][8][5][2][9] (Level of Evidence: B)"

Guidelines Resources

  • 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[6]
  • 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.[10]

References

  1. Chiang Y, Hosseinian L, Rhee A, Itagaki S, Cavallaro P, Chikwe J (2015). "Questionable benefit of the pulmonary artery catheter after cardiac surgery in high-risk patients". J Cardiothorac Vasc Anesth. 29 (1): 76–81. doi:10.1053/j.jvca.2014.07.017. PMID 25620141.
  2. 2.0 2.1 2.2 Schwann TA, Zacharias A, Riordan CJ, Durham SJ, Engoren M, Habib RH (2002). "Safe, highly selective use of pulmonary artery catheters in coronary artery bypass grafting: an objective patient selection method". Ann Thorac Surg. 73 (5): 1394–401, discussion 1401-2. doi:10.1016/s0003-4975(02)03422-7. PMID 12022523.
  3. Schwann NM, Hillel Z, Hoeft A, Barash P, Möhnle P, Miao Y; et al. (2011). "Lack of effectiveness of the pulmonary artery catheter in cardiac surgery". Anesth Analg. 113 (5): 994–1002. doi:10.1213/ANE.0b013e31822c94a8. PMID 21918165.
  4. Ramsey SD, Saint S, Sullivan SD, Dey L, Kelley K, Bowdle A (2000). "Clinical and economic effects of pulmonary artery catheterization in nonemergent coronary artery bypass graft surgery". J Cardiothorac Vasc Anesth. 14 (2): 113–8. doi:10.1016/s1053-0770(00)90001-6. PMID 10794325.
  5. 5.0 5.1 5.2 Resano FG, Kapetanakis EI, Hill PC, Haile E, Corso PJ (2006). "Clinical outcomes of low-risk patients undergoing beating-heart surgery with or without pulmonary artery catheterization". J Cardiothorac Vasc Anesth. 20 (3): 300–6. doi:10.1053/j.jvca.2006.01.017. PMID 16750726.
  6. 6.0 6.1 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "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". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  7. 7.0 7.1 "Practice guidelines for pulmonary artery catheterization: an updated report by the American Society of Anesthesiologists Task Force on Pulmonary Artery Catheterization". Anesthesiology. 99 (4): 988–1014. 2003. PMID 14508336. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  8. 8.0 8.1 Pearson KS, Gomez MN, Moyers JR, Carter JG, Tinker JH (1989). "A cost/benefit analysis of randomized invasive monitoring for patients undergoing cardiac surgery". Anesthesia and Analgesia. 69 (3): 336–41. PMID 2505641. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  9. 9.0 9.1 Stewart RD, Psyhojos T, Lahey SJ, Levitsky S, Campos CT (1998). "Central venous catheter use in low-risk coronary artery bypass grafting". The Annals of Thoracic Surgery. 66 (4): 1306–11. PMID 9800825. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  10. Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "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". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).

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