Coronary heart disease surgery: Difference between revisions
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===Revascularization in Patients with Diabetes=== | ===Revascularization in Patients with Diabetes=== | ||
Patients with diabetes and advanced three-vessel coronary artery disease have shown lower mortality and myocardial infarction rates and higher risk of strokes when undergoing [[CABG]] compared to [[PCI]] with drug eluting stents.<ref name="pmid23121323">{{cite journal| author=Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M et al.| title=Strategies for Multivessel Revascularization in Patients with Diabetes. | journal=N Engl J Med | year= 2012 | volume= | issue= | pages= | pmid=23121323 | doi=10.1056/NEJMoa1211585 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23121323 }} </ref> | Patients with diabetes and advanced three-vessel coronary artery disease have shown lower mortality and myocardial infarction rates and higher risk of strokes when undergoing [[CABG]] compared to [[PCI]] with drug eluting stents.<ref name="pmid23121323">{{cite journal| author=Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M et al.| title=Strategies for Multivessel Revascularization in Patients with Diabetes. | journal=N Engl J Med | year= 2012 | volume= | issue= | pages= | pmid=23121323 | doi=10.1056/NEJMoa1211585 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23121323 }} </ref> | ||
==2017 ESC/EACTS Guidelines for the management of valvular heart disease <ref name="pmid28886619">{{cite journal |vauthors=Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL |title=2017 ESC/EACTS Guidelines for the management of valvular heart disease |journal=Eur. Heart J. |volume=38 |issue=36 |pages=2739–2791 |year=2017 |pmid=28886619 |doi=10.1093/eurheartj/ehx391 |url=}}</ref> == | |||
===Management of Coronary Artery Disease (CAD) in patients with Valvular Heart Disease (VHD)=== | |||
{| class="wikitable" style="width: 80%; text-align: justify;" | |||
! style="width:80%" | '''Recommendations''' | |||
! style="width:10%" | ''' Class''' | |||
! style="width:10%" | '''Level''' | |||
|- | |||
| colspan="3" |'''Diagnosis of Coronary Artery Disease''' | |||
|- | |||
| Coronary angiography is recommended before valve surgery in patients with severe VHD and any of the following: | |||
• history of cardiovascular disease | |||
• suspected myocardial ischaemiad | |||
• LV systolic dysfunction • in men >40 years of age and postmenopausal women | |||
• one or more cardiovascular risk factors. | |||
| bgcolor="LightGreen" | I || bgcolor="LightBlue" | C | |||
|- | |||
| Coronary angiography is recommended in the evaluation of moderate to severe secondary mitral regurgitation. || bgcolor="LightGreen" | I || bgcolor="LightBlue" | C | |||
|- | |||
| CT angiography should be considered as an alternative to coronary angiography before valve surgery in patients with severe VHD and low probability of CAD or in whom conven- tional coronary angiography is technically not feasible or associated with a high risk. || bgcolor="LightGreen" | II || bgcolor="LightBlue" | A | |||
|- | |||
| CT angiography should be considered as an alternative to coronary angiography before valve surgery in patients with severe VHD and low probability of CAD or in whom conven- tional coronary angiography is technically not feasible or associated with a high risk. || bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C | |||
|- | |||
| colspan="3" | '''Indications for Myocardial Revascularization''' | |||
|- | |||
| CABG is recommended in patients with a primary indication for aortic/mitral valve surgery and coronary artery diameter stenosis ≥70% || bgcolor="LightGreen" | I || bgcolor="LightBlue" | C | |||
|- | |||
| CABG should be considered in patients with a primary indication for aortic/mitral valve surgery and coronary artery diameter stenosis ≥50–70%.|| bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C | |||
|- | |||
| PCI should be considered in patients with a primary indication to undergo TAVI and coronary artery diameter stenosis >70% in proximal segments.|| bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C | |||
|- | |||
| PCI should be considered in patients with a primary indication to undergo transcatheter mitral valve interventions and coronary artery diameter stenosis >70% in proximal segments.|| bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C | |||
|- | |||
| colspan="3" |CABG = coronary artery bypass grafting; CAD = coronary artery disease; CT = computed tomography; LV = left ventricular; MSCT = multislice computed tomography; PCI = percutaneous coronary intervention; TAVI = transcatheter aortic valve implantation; VHD = valvular heart disease. | |||
|} | |||
==References== | ==References== | ||
Revision as of 20:54, 25 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Surgery
- Procedures and surgeries used to treat CHD include:
- Angioplasty and stent placement, called percutaneous coronary interventions (PCIs)
- Coronary artery bypass surgery
- Minimally invasive heart surgery
Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction, and requires urgent medical attention. It is treated with morphine, oxygen, intravenous nitroglycerin, and aspirin. Interventional procedures such as angioplasty may be done.
Indications for Revascularization in Chronic Coronary Artery Disease
- Improve symptoms
- Improve long term survival.
Revascularization has not been shown to decrease incidence of myocardial infarction, congestive heart failure and arrhythmias.
Revascularization in Patients with Diabetes
Patients with diabetes and advanced three-vessel coronary artery disease have shown lower mortality and myocardial infarction rates and higher risk of strokes when undergoing CABG compared to PCI with drug eluting stents.[1]
2017 ESC/EACTS Guidelines for the management of valvular heart disease [2]
Management of Coronary Artery Disease (CAD) in patients with Valvular Heart Disease (VHD)
| Recommendations | Class | Level |
|---|---|---|
| Diagnosis of Coronary Artery Disease | ||
| Coronary angiography is recommended before valve surgery in patients with severe VHD and any of the following:
• history of cardiovascular disease • suspected myocardial ischaemiad • LV systolic dysfunction • in men >40 years of age and postmenopausal women • one or more cardiovascular risk factors. |
I | C |
| Coronary angiography is recommended in the evaluation of moderate to severe secondary mitral regurgitation. | I | C |
| CT angiography should be considered as an alternative to coronary angiography before valve surgery in patients with severe VHD and low probability of CAD or in whom conven- tional coronary angiography is technically not feasible or associated with a high risk. | II | A |
| CT angiography should be considered as an alternative to coronary angiography before valve surgery in patients with severe VHD and low probability of CAD or in whom conven- tional coronary angiography is technically not feasible or associated with a high risk. | IIa | C |
| Indications for Myocardial Revascularization | ||
| CABG is recommended in patients with a primary indication for aortic/mitral valve surgery and coronary artery diameter stenosis ≥70% | I | C |
| CABG should be considered in patients with a primary indication for aortic/mitral valve surgery and coronary artery diameter stenosis ≥50–70%. | IIa | C |
| PCI should be considered in patients with a primary indication to undergo TAVI and coronary artery diameter stenosis >70% in proximal segments. | IIa | C |
| PCI should be considered in patients with a primary indication to undergo transcatheter mitral valve interventions and coronary artery diameter stenosis >70% in proximal segments. | IIa | C |
| CABG = coronary artery bypass grafting; CAD = coronary artery disease; CT = computed tomography; LV = left ventricular; MSCT = multislice computed tomography; PCI = percutaneous coronary intervention; TAVI = transcatheter aortic valve implantation; VHD = valvular heart disease. | ||
References
- ↑ Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M; et al. (2012). "Strategies for Multivessel Revascularization in Patients with Diabetes". N Engl J Med. doi:10.1056/NEJMoa1211585. PMID 23121323.
- ↑ Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL (2017). "2017 ESC/EACTS Guidelines for the management of valvular heart disease". Eur. Heart J. 38 (36): 2739–2791. doi:10.1093/eurheartj/ehx391. PMID 28886619.