Coronary Artery Bypass Graft

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Presentation Description

Postgraduate Lecture

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Presentation Transcript

History : 

2 History

Introduction : 

3 Introduction

Technical considerations : 

4 Technical considerations

cabg : 

5 cabg

Port-access cabg : 

6 Port-access cabg

Minimally invasive direct cabg : 

7 Minimally invasive direct cabg MIDCAB Limited left thorocotomy Beating heart (off pump) Most commonly LIMA to LAD 98% angiographic patency Full sternotomy needed-5% Less access to LCA and RCA Need for repeat RVN - 6% Risk of MI – 3% Mortality – 2.5% Combined with PCI

OFF pump cabg : 

8 OFF pump cabg Standard median sternotomy Small skin incisions Stabilization devices to reduces the motion of target vessels while anastomoses are being performed No cardioplegia Beating heart surgery Reduction in blood loss Reduction in transfusions

Cardioplegia : 

9 Cardioplegia

procedure : 

procedure 10

Venous conduits : 

11 Venous conduits

Occlusion of venous graft : 

12 Occlusion of venous graft Careful harvesting – avoidance of over distension – use of modified storage solutions – inclusion of surrounding tissues – minimizing manipulation of graft

Internal mammary artery graft : 

13 Internal mammary artery graft

OTHER CONDUITS : 

OTHER CONDUITS 14 14 Radial Gastroepiploic Inferior epigastric Subscapular Intercostal Splenic Left gastric Gastroduodenal Indicated in Young Diabetic Hyperlipidemic Saphenous unsuitable Saphenous un available Radial grafts Initial enthusiasm Blunted later Preferable to RIMA

Peri-operative complications : 

15 Peri-operative complications

Peri-operative complications : 

Peri-operative complications 16

Peri-operative complications : 

Peri-operative complications 17

Peri-operative complications : 

Peri-operative complications 18

Complications : 

19 Complications

Operative mortality : 

20 Operative mortality

VENOUS GRAFT PATENCY : 

21 VENOUS GRAFT PATENCY Occlusion rate 8-12% at I year Occlusion rate 8-12% at I year Occlusion rate 2% after I year Occlusion rate 4% after 6 years At 10 years 50% of grafts will be occluded Predictors of graft occlusion Small target vessel diameter High LDL and low HLD

Symptomatic results : 

22 Symptomatic results

ARTERIAL GRAFT PATENCY : 

23 ARTERIAL GRAFT PATENCY

PROGRESSION OF DISEASE IN NON-GRAFTED : 

24 PROGRESSION OF DISEASE IN NON-GRAFTED

CONTINUING THERAPY WITH DRUGS : 

25 CONTINUING THERAPY WITH DRUGS

CONTINUING THERAPY WITH DRUGS : 

26 CONTINUING THERAPY WITH DRUGS

SUMMARY OF INDICATIONS FOR CABG : 

27 SUMMARY OF INDICATIONS FOR CABG

OTHER INDICATIONS : 

28 OTHER INDICATIONS

Long term survival after cabg : 

29 Long term survival after cabg

Slide 30: 

30 Thank You for the patient listening