The AHA Guidelines and Scientific Statements Handbook

Coronary Artery Bypass Graft Surgery

Cullen D. Morris, Kim Eagle, Robert A. O’Rourke,

and Robert A. Guyton

7

Background

Management recommendations in the reduction of

perioperative mortality and morbidity

Preventing adverse cerebral outcomes

Ascending aortic atherosclerosis

Atrial fi brillation and postoperative stroke

Recent anterior MI, LV mural thrombus, and stroke

risk

Recent antecedent cerebrovascular accident (CVA)

CPB time and neurologic risk

Carotid disease and neurological risk reduction

Other techniques to reduce neurologic risk

Reducing risk of perioperative myocardial

dysfunction

Myocardial protection for patients with satisfactory

preoperative cardiac function

Myocardial protection for patients with acutely

depressed cardiac function

Myocardial protection for chronically dysfunctional

myocardium

Cardiac biomarker elevation and outcome

Adjuncts to myocardial protection

Reoperative patients

Inferior infarct with right ventricular (RV)

involvement

Attenuation of the systemic sequelae of CPB

Reducing the risk of perioperative infection

Prevention of postoperative arrhythmias

Strategies to reduce perioperative bleeding and

transfusion

General management considerations

Maximizing postoperative benefi t

Antiplatelet therapy for SVG patency

Pharmacologic management of hyperlipidemia

Hormonal manipulation

Smoking cessation

Cardiac rehabilitation

Special patient subsets

CABG in the elderly: age 70 and older

CABG in women

CABG in patients with diabetes

CABG in patients with pulmonary disease, COPD, or

respiratory insuffi ciency

CABG in patients with end-stage renal disease (ESRD)

Valve disease

Reoperation

Concomitant PVD

Poor left ventricular function

Transplant patients

CABG in acute coronary syndromes

Impact of evolving technology

Less-invasive CABG

Robotics

Arterial and alternate conduits

Transmyocardial laser revascularization

Institutional and operator competence

Volume considerations

Report cards and quality improvement

Hospital environment

Economic issues

Cost-effectiveness of CABG

Cost comparison with angioplasty

Indications

Asymptomatic or mild angina

Stable angina

Unstable angina/non-ST segment elevation MI

(NSTEMI)

ST-segmental elevation MI (STEMI)

Poor LV function

Life-threatening ventricular arrhythmias

CABG after failed PTCA

Patients with previous CABG

Future guidelines

The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978-1-405-18463-2