Coronary artery bypass surgery in association with other cardiac procedures: Difference between revisions
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{{Coronary artery bypass surgery}} | {{Coronary artery bypass surgery}} | ||
{{CMG}}; {{AOEIC}} {{VK}} | {{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]]. | ||
===CABG in | ==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>=== | |||
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| 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> | |||
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class 2b Recommendation, Level of Evidence:C-LD]] | |||
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|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> | |||
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===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" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | 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> | | 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> | ||
|} | |} | ||
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|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> | |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== | ==References== | ||
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[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
Latest revision as of 07:05, 9 September 2022
Coronary Artery Bypass Surgery Microchapters | |
Pathophysiology | |
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Diagnosis | |
Treatment | |
Perioperative Monitoring | |
Surgical Procedure | |
Special Scenarios | |
Coronary artery bypass surgery in association with other cardiac procedures On the Web | |
FDA on Coronary artery bypass surgery in association with other cardiac procedures | |
CDC on Coronary artery bypass surgery in association with other cardiac procedures | |
Coronary artery bypass surgery in association with other cardiac procedures in the news | |
Blogs on Coronary artery bypass surgery in association with other cardiac procedures|- |
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Risk calculators for Coronary artery bypass surgery in association with other cardiac procedures | |
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]
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 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:[1]
- Comorbidities
- Technical feasibility of CABG
- Extent of the affected myocardium
- Conduit availability
- Left ventricular ejection fraction
- The additional time required to construct the coronary bypass while the patient is on cardiopulmonary bypass
- Studies that were done on patients between the ages of 75 and 84 years show that age is not a prohibitive risk factor for adding CABG to other cardiac surgeries.[2][3][4] Although risk increases in patients older than 85 years of age.[5]
- Numerous observational studies and meta-analyses demonstrated similar long-term survival and health-related quality of life in patients who underwent aortic valve replacement with concomitant CABG compared to those without coronary heart disease.[6][7][8][9][5] However, concomitant CABG is associated to a higher rate of perioperative morbidity and mortality in comparison to isolated aortic valve replacement.[3][10][4]
2021 ACA Revascularization Guideline[1]
Class 1 Recommendation, Level of Evidence:C-LD |
In a patient with significant coronary heart disease who is undergoing another cardiac surgery, such as valve surgery and aortic surgery, CABG is recommended with a goal of reducing ischemic events.[2][3][10][4][11][6][7][8][9][12][13] |
Class 2b Recommendation, Level of Evidence:C-LD |
In a patient with intermediate coronary heart disease who is undergoing another cardiac surgery, such as valve surgery and aortic surgery, CABG may be reasonable with a goal of reducing ischemic events.[11][7][12][5] |
2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[14]
Class I |
"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. (Level of Evidence: C)" |
Class IIa |
"1. The use of the LIMA is reasonable to bypass a significantly narrowed LAD artery in patients undergoing noncoronary cardiac surgery. (Level of Evidence: C)" |
"2. CABG of moderately diseased coronary arteries (>50% luminal diameter narrowing) is reasonable in patients undergoing noncoronary cardiac surgery. (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 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). - ↑ 2.0 2.1 Abel NJ, Rogal GJ, Burns P, Saunders CR, Chamberlain RS (2013). "Aortic valve replacement with and without coronary artery bypass graft surgery in octogenarians: is it safe and feasible?". Cardiology. 124 (3): 163–73. doi:10.1159/000346153. PMID 23467192.
- ↑ 3.0 3.1 3.2 Agarwal S, Garg A, Parashar A, Svensson LG, Tuzcu EM, Navia JL; et al. (2015). "In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective". J Thorac Cardiovasc Surg. 150 (3): 571–8.e8. doi:10.1016/j.jtcvs.2015.05.068. PMID 26183193.
- ↑ 4.0 4.1 4.2 Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández J (2010). "Short- and mid-term results for aortic valve replacement in octogenarians". Interact Cardiovasc Thorac Surg. 10 (4): 549–54. doi:10.1510/icvts.2009.218040. PMID 20100705.
- ↑ 5.0 5.1 5.2 Li Z, Anderson I, Amsterdam EA, Young JN, Parker J, Armstrong EJ (2013). "Effect of coronary artery disease extent on contemporary outcomes of combined aortic valve replacement and coronary artery bypass graft surgery". Ann Thorac Surg. 96 (6): 2075–82. doi:10.1016/j.athoracsur.2013.07.035. PMID 24070699.
- ↑ 6.0 6.1 Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL; et al. (2012). "Effect of coronary bypass and valve structure on outcome in isolated valve replacement for aortic stenosis". Am J Cardiol. 109 (9): 1334–40. doi:10.1016/j.amjcard.2011.12.028. PMID 22386959.
- ↑ 7.0 7.1 7.2 Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B; et al. (2013). "Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis". J Am Coll Cardiol. 61 (8): 837–48. doi:10.1016/j.jacc.2012.10.049. PMC 4262244. PMID 23428216.
- ↑ 8.0 8.1 Shan L, Saxena A, McMahon R, Wilson A, Newcomb A (2013). "A systematic review on the quality of life benefits after aortic valve replacement in the elderly". J Thorac Cardiovasc Surg. 145 (5): 1173–89. doi:10.1016/j.jtcvs.2013.01.004. PMID 23415689.
- ↑ 9.0 9.1 Vasques F, Lucenteforte E, Paone R, Mugelli A, Biancari F (2012). "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". Am Heart J. 164 (3): 410–418.e1. doi:10.1016/j.ahj.2012.06.019. PMID 22980309.
- ↑ 10.0 10.1 Biancari F, Martin M, Bordin G, Vettore E, Vinco G, Anttila V; et al. (2014). "Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery". J Cardiothorac Vasc Anesth. 28 (5): 1251–6. doi:10.1053/j.jvca.2013.07.020. PMID 24290746.
- ↑ 11.0 11.1 Di Gioia G, Pellicano M, Toth GG, Casselman F, Adjedj J, Van Praet F; et al. (2016). "Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations". J Cardiovasc Transl Res. 9 (2): 145–52. doi:10.1007/s12265-016-9680-6. PMID 26883368.
- ↑ 12.0 12.1 Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM; et al. (2015). "The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era". J Thorac Cardiovasc Surg. 149 (2): 451–60. doi:10.1016/j.jtcvs.2014.08.073. PMID 25308117.
- ↑ Yamanaka K, Komiya T, Tsuneyoshi H, Shimamoto T (2016). "Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting". Ann Thorac Cardiovasc Surg. 22 (4): 251–7. doi:10.5761/atcs.oa.16-00056. PMC 5045853. PMID 27237968.
- ↑ 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.