coronary artery bypass grafting pdf

Dic 26, 2020

This article focuses on the preoperative and postoperative nursing care of patients undergoing coronary artery bypass graft surgery. 0000006693 00000 n Surgical coronary artery bypass grafting (CABG) is the standard of care for revascularization of left main or three-vessel coronary artery disease. Conversely, the number of patients with high complexity studied in RCTs is low due to exclusion criteria and the risk estimates and CIs remain imprecise. Redo coronary artery bypass grafting (CABG) is more challenging than primary CABG in many aspects. Theoretically, OPCAB may improve long-term outcome … The SYNTAX score remains the best tool to guide decisions on the revascularization strategy among patients with multivessel CAD complemented by considerations in the presence of left main CAD and diabetes. Despite its proven validity, the SYNTAX score cannot prevail as the sole criterion for decision making on the revascularization strategy. %PDF-1.3 %���� Here, we will review the rationale and new evidence in support of this stratification scheme (Take home figure). 0000009275 00000 n Ample evidence from observational and controlled studies indicate that extent and severity of coronary artery stenoses impact prognosis. The choice between PCI and CABG is informed by carefully weighing the benefits and risks inherent to the respective revascularization technique as well as local expertise. 0000008024 00000 n Moreover, complete anatomical and physiological revascularization among patients with multivessel CAD is associated with improved outcomes irrespective of the revascularization strategy but has been less complete in case of PCI particularly among patients with chronic total occlusions (CTO).10,11,13,55 In addition, pre-interventional physiologic lesion mapping56 and intracoronary imaging (intravascular ultrasound (IVUS) and optical coherence tomography (OCT))57–60 as well as post-procedural assessment translate into improved outcomes particularly among patients with left main and multivessel disease. 21) He GW, Taggart DP. Assuming that the number of diseased vessels was not the only marker for CAD severity, the SYNTAX score systematically addressed other lesion-based factors including the location of lesions, the degree of coronary stenosis, calcification, the specific complexity of left main, bifurcations, total occlusions, thrombus, and small vessels.27 The SYNTAX score was first validated in the ARTS II study showing that the lowest SYNTAX tertile was associated with significantly higher freedom from major adverse cardiac events than the intermediate and high SYNTAX tertiles.28 In multivariable analyses, the SYNTAX score emerged as independent predictor of MACE at 5 years suggesting a potential role of baseline assessment of the SYNTAX score in the risk stratification of patients undergoing PCI. Revascularization aims to improve myocardial blood flow thereby reducing ischaemia.51 An important pre-requisite to achieve this goal is the comprehensive assessment and treatment planning of lesions requiring revascularization including treatment optimization. At 3 years of follow-up, the primary endpoint of death, stroke, or MI occurred with similar frequency in the CABG and PCI group [14.7% vs. 15.4%, HR 1.00, 95% confidence interval (CI) 0.79–1.26; P = 0.98] without significant differences in the individual components. Ann performed such a test for linear trend of log HRs across ordered SYNTAX tertiles using the same approach as for the primary analysis, a random-effects Cox model with shared frailty reflected by a random intercept to account for variation in baseline risk between trials. Description Total Length 45º Blades 7007-442 Micro Fine Blades 10 mm 6 1/2” (16.5 cm) 90º Blades 7007-446 6 1/4” (16 cm) 125º Blades 7007-449 6 1/4” (16 cm) SCANLAN® Premier 1991; 5 (9):447–457. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Stahle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW; Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW. Email; Twitter; Facebook; Linked In; Sina Weibo; more. Corresponding author. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions, ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons, Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration, Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery, Northern New England Cardiovascular Disease Study Group, Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England, Long-term outcomes of coronary-artery bypass grafting versus stent implantation, Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease, Comparative effectiveness of revascularization strategies, Everolimus-eluting stents or bypass surgery for multivessel coronary disease, Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease, The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease, Cyphering the complexity of coronary artery disease using the SYNTAX score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention, Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data, Interpretation of results of pooled analysis of individual patient data, Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II, Validity of SYNTAX score II for risk stratification of percutaneous coronary interventions: a patient-level pooled analysis of 5,433 patients enrolled in contemporary coronary stent trials, Individual long-term mortality prediction following either coronary stenting or bypass surgery in patients with multivessel and/or unprotected left main disease: an external validation of the SYNTAX Score II Model in the 1,480 patients of the BEST and PRECOMBAT randomized controlled trials, Landmark article (JAMA 1912). 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