Coronary artery bypass surgery TEE

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Coronary Artery Bypass Surgery Microchapters

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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

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Trans-Esophageal Echocardiography

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Goals of Treatment

Perioperative Management

Perioperative Monitoring

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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
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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]

Coronary Artery Bypass Surgery TEE

2021 ACA Revascularization Guideline [1][2][3][4][5][6][7][8]

CABG + Valve Procedures To perform a real-time assessment of heart valves, intraoperative TEE is recommended by using intraoperative TEE.
Isolated CABG The role of intraoperative TEE is less established in isolated CABG, nevertheless, it could be helpful as a tool for real-time assessment of hemodynamic status, regional wall motion, ventricular function, valve anatomy, and diastolic function.

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[9]

Class I
"1. Intraoperative transesophageal echocardiography should be performed for evaluation of acute, persistent, and life-threatening hemodynamic disturbances that have not responded to treatment.[3][2] (Level of Evidence: B)"
"2. Intraoperative transesophageal echocardiography should be performed in patients undergoing concomitant valvular surgery.[3][10] (Level of Evidence: B)"
Class IIa
"1. Intraoperative transesophageal echocardiography is reasonable for monitoring of hemodynamic status, ventricular function, regional wall motion, and valvular function in patients undergoing CABG.[2][11][12][4][5][13][14] (Level of Evidence: B)"

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.[9]

References

  1. Kihara C, Murata K, Wada Y, Hadano Y, Ohyama R, Okuda S; et al. (2009). "Impact of intraoperative transesophageal echocardiography in cardiac and thoracic aortic surgery: experience in 1011 cases". J Cardiol. 54 (2): 282–8. doi:10.1016/j.jjcc.2009.06.001. PMID 19782266.
  2. 2.0 2.1 2.2 Savage RM, Lytle BW, Aronson S, Navia JL, Licina M, Stewart WJ; et al. (1997). "Intraoperative echocardiography is indicated in high-risk coronary artery bypass grafting". Ann Thorac Surg. 64 (2): 368–73, discussion 373-4. doi:10.1016/S0003-4975(97)00612-7. PMID 9262577.
  3. 3.0 3.1 3.2 Eltzschig HK, Rosenberger P, Löffler M, Fox JA, Aranki SF, Shernan SK (2008). "Impact of intraoperative transesophageal echocardiography on surgical decisions in 12,566 patients undergoing cardiac surgery". Ann Thorac Surg. 85 (3): 845–52. doi:10.1016/j.athoracsur.2007.11.015. PMID 18291154.
  4. 4.0 4.1 Qaddoura FE, Abel MD, Mecklenburg KL, Chandrasekaran K, Schaff HV, Zehr KJ; et al. (2004). "Role of intraoperative transesophageal echocardiography in patients having coronary artery bypass graft surgery". Ann Thorac Surg. 78 (5): 1586–90. doi:10.1016/j.athoracsur.2004.05.001. PMID 15511437.
  5. 5.0 5.1 Swaminathan M, Morris RW, De Meyts DD, Podgoreanu MV, Jollis JG, Grocott HP; et al. (2007). "Deterioration of regional wall motion immediately after coronary artery bypass graft surgery is associated with long-term major adverse cardiac events". Anesthesiology. 107 (5): 739–45. doi:10.1097/01.anes.0000287008.70453.81. PMID 18073549.
  6. Swaminathan M, Nicoara A, Phillips-Bute BG, Aeschlimann N, Milano CA, Mackensen GB; et al. (2011). "Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery". Ann Thorac Surg. 91 (6): 1844–50. doi:10.1016/j.athoracsur.2011.02.008. PMID 21492828.
  7. Suehiro K, Tanaka K, Yamada T, Matsuura T, Funao T, Mori T; et al. (2015). "The utility of intra-operative three-dimensional transoesophageal echocardiography for dynamic measurement of stroke volume". Anaesthesia. 70 (2): 150–9. doi:10.1111/anae.12857. PMID 25265890.
  8. Aggarwal N, Unnikrishnan KP, Biswas I, Karunakaran J, Suneel PR (2017). "Intraoperative assessment of transient and persistent regional left ventricular wall motion abnormalities in patients undergoing coronary revascularization surgery using real time three-dimensional transesophageal echocardiography: A prospective observational study". Echocardiography. 34 (11): 1649–1659. doi:10.1111/echo.13661. PMID 28833528.
  9. 9.0 9.1 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.
  10. American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography (2010). "Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography". Anesthesiology. 112 (5): 1084–96. doi:10.1097/ALN.0b013e3181c51e90. PMID 20418689.
  11. Bergquist BD, Bellows WH, Leung JM (1996). "Transesophageal echocardiography in myocardial revascularization: II. Influence on intraoperative decision making". Anesth Analg. 82 (6): 1139–45. PMID 8638781.
  12. Moisés VA, Mesquita CB, Campos O, Andrade JL, Bocanegra J, Andrade JC; et al. (1998). "Importance of intraoperative transesophageal echocardiography during coronary artery surgery without cardiopulmonary bypass". J Am Soc Echocardiogr. 11 (12): 1139–44. PMID 9923994.
  13. Wang J, Filipovic M, Rudzitis A, Michaux I, Skarvan K, Buser P; et al. (2004). "Transesophageal echocardiography for monitoring segmental wall motion during off-pump coronary artery bypass surgery". Anesth Analg. 99 (4): 965–73, table of contents. doi:10.1213/01.ANE.0000130614.45647.81. PMID 15385335.
  14. Zimarino M, Gallina S, Di Fulvio M, Di Mauro M, Di Giammarco G, De Caterina R; et al. (2004). "Intraoperative ischemia and long-term events after minimally invasive coronary surgery". Ann Thorac Surg. 78 (1): 135–41. doi:10.1016/j.athoracsur.2003.12.030. PMID 15223418.

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