coronary artery bypass graft (CABG) Flashcards
definition fo CABG
a cardiac revascularization technique used to treat patients with significant, symptomatic stenosis of the coronary artery (or its branches)
The stenosed segment is bypassed using an arterial (e.g., internal thoracic artery) or venous (e.g., great saphenous vein) autograft, re-establishing blood flow to the ischemic areas of the myocardium
indications of CABG
improve survival
- L main stem disease
- triple vessel disease involving prox part of LAD
relieve symptoms
- angina unresponsive to drugs
- unstable angina sometimes
- if angioplasty is unsuccessful
when PCI and CABG are both valid options NICE recommends PCI
In practice, patients with single-vessel coronary artery disease and normal LV function usually undergo PCI, and those with triple-vessel disease and abnormal LV function more often undergo CABG.
Px comparison of PCI and CABG
early procedural mortality rates and 5-year survival rates are similar after PCI and CABG.
Compared with PCI, CABG = more complete long-term relief of angina in patients, and less repeated revascularization.
complications of CABG
open surgery = slow recovery, 2 large wounds - sternal and vein harvesting
myocardial dysfunction
postpericardiotomy syndrome: autoimmune febrile pericarditis or pleuritis that may occur 1–6 weeks following cardiac surgery
- fever, malaise
- chest pain with or w/o associated dysphagia
- tachycardia
- pericardial friction rub
post-op cardiac tamponade with cardiogenic shock
bypass occlusion
arrhythmias
postop acute mediastinitis: fever, chest pain, raised WBC, CXR shows mediastinal widening
mediastinal haemorrhage - excessive blood (> 100–200 mL per hour) in chest tube drainage; decreased cardiac output, hemoglobin, blood pressure, or urine output; chest x-ray shows mediastinal widening
complications from sternotomy - wound infection, sternal dehiscence, sternal osteomyelitis
post op renal failure
neuro deficits and coma
