|Ischaemic heart disease
|Assessing Chest Pain
|ACS - General
|ACS - STEMI
|ACS - NSTEMI
|ACS - GRACE Score
|ACS - ECG Changes
|ACS -Cardiac Troponins
|ACS - Post MI arrhythmias
|ACS: Right Ventricular Infarction
As compared with the use of saphenous vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up
- Coronary Artery bypass grafting has been in use since the early 1960s to manage IHD
- Approximately 90% of patients have no angina postoperatively, with almost all patients experiencing a significant improvement.
- Originally using saphenous vein grafts but developments have included the use of the Internal Mammary artery which gives improved long term patency.
- The use of radial-artery grafts for coronary artery bypass grafting (CABG) may result in better postoperative outcomes than the use of saphenous vein grafts
- More recently minimally invasive techniques have been developed which include CABG without using cardiopulmonary bypass.
- The Internal mammary artery is also known as the internal thoracic artery and is usually remarkably free of atheroma, especially in patients younger than 65 years
- Usually Left Internal mammary bypasses the LAD and the Right internal mammary the RCA
- Reverse saphenous vein grafts are attached from the aorta to beyond distal obstruction
- CABG Relieves angina in 90% of those treated and With TVD or LMS stenosis evidence shows improved life expectancy
Indications for CABG
- Those with left main stem disease (LMS)
- Those with triple vessel disease (TVD)
- Two vessel disease with proximal LAD disease
- Improved outcome in those with moderately poor Left ventricular function
- Late complications include graft occlusion especially with veins
- Grafts can be treated with angioplasty and stented
- Sternal wound infections
- Thromboembolic phenomena
- Graft failure
- Atrial fibrillation
- Pulmonary hypertension
- Pericardial effusion
- Renal injury
- Gastrointestinal insults
- Haemodynamic instability
- Aspirin is usually continued for the procedure, but other antiplatelet drugs such as Clopidogrel are stopped up to 5 days in advance.
- During the procedure patients are Heparinised to prevent thrombosis on CPB.
- Antibiotic cover is provided using a broad-spectrum antibiotic to prevent bacteraemia.
- Operative mortality depends on many factors including age and concomitant disease, it usually varies from 1 to 5%.
- There is a similar, age-related risk of stroke.