Coronary Revascularization: PCI, CABG

Question 1

CABG: def

Answer 1

Coronary Artery Bipass Graft: open surgical technique used to graft a artery in purpose to bypass the sclerotic one

Question 2

CABG: indications

Answer 2

• window marker: blockage of the proximal LAD lesion -> which blocks the whole front wall of the heart
• LAD + LCA + RCA (tri vessel)
• when PCI is not an option
• in high risk patients: ventricular dysfunction or DM

Question 3

CABG: procedure

Answer 3

• Open heart surgery, perform a median sternotomy
• bypass graft from: internal thoracic, radial, internal mammilary, or saphenous vein
• use heparin to prevent clot formation
• graft is sutured to aorta and the coronary after -> restart heart -> restart the heart -> give protamine to reverse heparin effect -> sternum is wired -> incision sutured and closed -> sent to ICU

Question 4

CABG: complications

Answer 4

• post-perfusion syndrome (transient neurocognitive impairment)
• non-union of sternum because harvesting internal thoracic artery de-vascularizes the sternum
• stroke secondary to aortic manipulation or hypo perfusion
• post op bleeding due to heparin
• CBP-machine can evoke systemic inflammatory response -> which can lead to organ dysfunction
• aortic cannulation can cause embolism
• neuropsychiatric effects
• rhytm disturbances
• MI due to hypoperfusion
• early graft occlusion or failure of graft