Implementation of the Heart Team decision-making process may furthermore strengthen the position of a centre. This approach highlights the centre's collaborative environment between specialties, which is appreciated by patients.
Outcomes after surgical revascularization have the potential to improve beyond the level achieved during recent decades Figure 5. However, to facilitate these improvements, surgeons need to be willing to adopt new techniques that increase procedural safety, patient satisfaction, and long-term survival. To achieve these goals, guidelines should be conclusive about recommending certain techniques and provide guidance for their use.
Future trials will need to provide sufficient evidence for such recommendations by focussing on specific areas where optimal therapy has yet to be substantiated. Summary of developments to optimize short- and long-term results after coronary artery bypass grafting. Google Scholar. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Operative techniques. Intra-operative assessments. Secondary prevention. Future studies. Coronary artery bypass grafting: Part 2—optimizing outcomes and future prospects.
Head , Stuart J. Oxford Academic. Ruben L. Teresa M. Volkmar Falk. David P. John D. Jan F. Revision received:. Cite Cite Stuart J. Select Format Select format. Permissions Icon Permissions. Abstract Since first introduced in the mids, coronary artery bypass grafting CABG has become the standard of care for patients with coronary artery disease. Coronary artery bypass grafting , Off-pump , Anaortic , Minimally invasive , Hybrid revascularization , Arterial grafting , Endoscopic vein harvesting , Epiaortic scanning , Graft flow measurement , Secondary prevention , Guidelines , Heart team.
Author year. Use of devices. Unadjusted day outcomes. Perioperative MI. Open in new tab. Table 2 Reasoning supporting hybrid revascularization.
Figure 1. Open in new tab Download slide. Table 3 Systematic review of studies evaluating hybrid revascularization. Type of lesions. Long-term outcomes. Mean follow-up. Table 4 Trends in the use of secondary preventive medication and the difference between coronary artery bypass grafting and percutaneous coronary intervention.
Figure 2. Table 5 Pros and cons of different surgical revascularization techniques. Conventional CABG. Off-pump CABG. Hybrid revascularization. Figure 3. Figure 4.
Table 6 American and European guideline recommendations. Several recommendations are provided with regard to lifestyle and risk factor management e. Figure 5. Coronary artery bypass grafting: part 1—the evolution over the first 50 years. Google Scholar Crossref. Search ADS. Long-term clinical outcomes of biodegradable polymer biolimus-eluting stents vs. Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. Three-year results of clinical follow-up after a bioresorbable everolimus-eluting scaffold in patients with de novo coronary artery disease: the ABSORB trial.
From metallic cages to transient bioresorbable scaffolds: change in paradigm of coronary revascularization in the upcoming decade? Coronary artery bypass graft surgery vs. Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial. Off-pump vs. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial.
Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy. Off-pump versus on-pump coronary artery bypass grafting: a systematic review and meta-analysis of propensity score analyses.
Risk-adjusted short- and long-term outcomes for on-pump vs. Comparing long-term survival between patients undergoing off-pump and on-pump coronary artery bypass graft operations. One-year coronary bypass graft patency: a randomized comparison between off-pump and on-pump surgery angiographic results of the PRAGUE-4 trial.
Early graft patency after off-pump and on-pump coronary bypass surgery: a prospective randomized study. Lower graft patency after off-pump than on-pump coronary artery bypass grafting: an updated meta-analysis of randomized trials.
Incomplete revascularization reduces survival benefit of coronary artery bypass grafting: role of off-pump surgery. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year.
Off-pump coronary artery bypass disproportionately benefits high-risk patients. Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: a case control study.
Google Scholar PubMed. Patient selection and current practice strategy for off-pump coronary artery bypass surgery. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients.
Off-pump techniques benefit men and women and narrow the disparity in mortality after coronary bypass grafting. Gaseous and solid cerebral microembolization during proximal aortic anastomoses in off-pump coronary surgery: the effect of an aortic side-biting clamp and two clampless devices. Clampless off-pump versus conventional coronary artery revascularization: a propensity score analysis of patients.
Aortic no-touch technique makes the difference in off-pump coronary artery bypass grafting. Neurologic complications after off-pump coronary artery bypass grafting with and without aortic manipulation: meta-analysis of 11, cases from 8 studies. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials.
Drug-eluting stents vs. Port-access coronary artery bypass grafting: technique and comparative results. Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study. Review of a year single-center experience with minimally invasive direct coronary artery bypass as the primary surgical treatment of coronary artery disease.
Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Outcomes associated with bilateral internal thoracic artery grafting: the importance of age. Preliminary experience with minimally invasive coronary-artery bypass surgery combined with coronary angioplasty. Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass.
Hybrid coronary revascularization versus off-pump coronary artery bypass for the treatment of left main coronary stenosis. Hybrid coronary revascularization versus off-pump coronary artery bypass grafting for the treatment of multivessel coronary artery disease.
Five hundred cases of robotic totally endoscopic coronary artery bypass grafting: predictors of success and safety. Minimally invasive coronary artery bypass grafting: dual-center experience in consecutive patients. Hybrid coronary revascularization using robotic totally endoscopic surgery: perioperative outcomes and 5-year results. Randomized comparison of minimally invasive direct coronary artery bypass surgery versus sirolimus-eluting stenting in isolated proximal left anterior descending coronary artery stenosis.
Is hybrid coronary revascularization favored by cardiologists or cardiac surgeons? Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study.
Contemporary coronary graft patency: 5-year observational data from a randomized trial of conduits. Ten-year experience with off-pump coronary artery bypass grafting: lessons learned from early postoperative angiography. Coronary bypass graft fate: angiographic grading of consecutive grafts early after operation and of after one year.
Read the disclaimer. Coronary artery bypass grafting. Summary Coronary artery bypass grafting or CABG is a cardiac revascularization technique used to treat patients with significant, symptomatic stenosis of the coronary artery or its branches. Indications Indication for CABG is established after careful consideration of the clinical features, coronary catheterization findings, cardiac function, and the patient's general condition.
Relative contraindications include: Asymptomatic patients with a low risk of myocardial infarction or death Comorbidities e. PCI is preferred in cases with symptomatic low-risk obstructio n single vessel, mild double vessel obstruction. Postoperative renal failure Neurologic deficits and coma References: [2] We list the most important complications. Outcome and prognosis Prognosis following CABG depends on a variety of factors, such as anatomical location and severity of the stenoses, presence of comorbidities, patient age, and preoperative levels of activity.
Successful grafts typically last 8—15 years and provide an improved chance of survival decreased 5-year mortality , especially in patients with triple vessel disease. Further progression of arteriosclerosis may still occur after CABG.
As your condition stabilizes, he or she will gradually decrease and then stop these medicines. Once your doctor removes the breathing and stomach tubes and you are stable, you may start to drink liquids. You can gradually include more solid foods as you can handle them. When your doctor determines that you are ready, you will be moved from the ICU to a post-surgical nursing unit. Your recovery will continue there. You can gradually increase your activity as you get out of bed and walk around for longer periods.
You can eat solid foods as soon as you can tolerate them. A member of your care team will arrange for you to go home and schedule a follow-up visit with your doctor.
Once you are home, it will be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. Your doctor will remove the sutures or surgical staples during a follow-up office visit, if they were not removed before leaving the hospital.
One to two times per month, Virtual Advisors receive a link to short, interactive surveys. All responses are confidential. If you have a new or existing heart problem, it's vital to see a doctor. Our heart health checklist can help you determine when to seek care. Health Home Treatments, Tests and Therapies. Why might I need coronary artery bypass surgery? There may be other reasons for your doctor to recommend CABG surgery.
What are the risks of coronary artery bypass surgery? Possible risks of coronary artery bypass graft surgery CABG include: Bleeding during or after the surgery Blood clots that can cause heart attack, stroke, or lung problems Infection at the incision site Pneumonia Breathing problems Pancreatitis Kidney failure Abnormal heart rhythms Failure of the graft Death There may be other risks depending on your specific medical condition.
How do I get ready for coronary artery bypass surgery? Your doctor will explain the procedure and you can ask questions. Tell your doctor if you are pregnant or think you could be. Tell your doctor if you have a pacemaker or any other implanted cardiac device. Based on your medical condition, your doctor may ask you to do other things to get ready.
What happens during coronary artery bypass? Generally, CABG follows this process: You will be asked to remove any jewelry or other objects that may interfere with the procedure.
You will change into a hospital gown and empty your bladder. You will lie on your back on an operating table. A catheter will be put into your bladder to drain urine.
The skin over the surgical site will be cleaned with an antiseptic solution. The doctor will make an incision cut below the Adam's apple to just above the navel. Coronary artery bypass graft surgery--on-pump procedure To sew the grafts onto the very small coronary arteries, your doctor will need to stop your heart temporarily. Coronary artery bypass surgery--off-pump procedure Once your doctor has opened the chest, he or she will stabilize the area around the artery to be bypassed with a special instrument.
The rest of the heart will continue to function and pump blood through the body. Procedure completion, both methods Your doctor will sew the sternum together with small wires like those sometimes used to repair a broken bone. Your doctor will sew the skin over the sternum back together.
He or she will then apply a sterile bandage or dressing. What happens after coronary artery bypass surgery? In the hospital After the surgery, you will be taken to the intensive care unit ICU to be closely monitored.
At home Once you are home, it will be important to keep the surgical area clean and dry. Do not drive until your doctor tells you it's OK.
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