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Coronary Artery Bypass Graft (CABG) Surgery

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    Overview and Recommendations

    • Background

    • Evaluation

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      Indications

      • In patients with stable coronary artery disease

      • In patients with acute coronary syndromes (other than STEMI)

      • In patients with ST-elevation myocardial infarction (STEMI)

    • Management

  • Related Summaries

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    Overview

    • General Description

    • Indications for CABG

    • Preoperative preparation

    • Perioperative medical management

    • Surgical technique

    • Postrevascularization management

    • Prognosis

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    Indications and Efficacy

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      CABG in acute coronary syndrome (ACS)

      • Indications for CABG in ACS

      • Indications for CABG in other acute situations

      • Efficacy of CABG for ACS

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      CABG in ST-elevation myocardial infarction (STEMI)

      • Indications for CABG in STEMI

      • Efficacy of CABG in STEMI

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      CABG in stable coronary artery disease (CAD)

      • Indications for CABG in stable coronary artery disease

      • Efficacy of CABG in stable coronary artery disease

    • CABG in other patient populations

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    Preoperative Preparation

    • Preoperative evaluation

    • Preoperative inspiratory muscle training

    • Preconditioning

    • Preoperative intra-aortic balloon pump (IABP)

    • Preprocedure waiting period

    • Additional preoperative considerations

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    Perioperative Management

    • Intraoperative epiaortic ultrasound

    • Antibiotic and antiseptic prophylaxis

    • Venous thromboembolism prophylaxis

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      Aspirin and other antiplatelet agents

      • Recommendations from professional organizations

      • Aspirin

      • Preoperative clopidogrel

      • Cangrelor

    • Beta blockers

    • Other antiarrhythmic agents

    • Atrial natriuretic peptides

    • Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers

    • Fluid support

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      Glucose management

    • Hypertension management

    • Management of patients with prior myocardial infarction or left ventricular dysfunction

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      Perioperative blood transfusions

      • Recommendations

      • Transfusion threshold

      • Adverse effects

      • Additional considerations

    • Antifibrinolytic drugs

    • Statins

    • Medications for renal protection

    • Additional perioperative medications

    • Other perioperative treatments

    • Perioperative monitoring

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    Intraoperative Management

    • Bypass graft conduit

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      Additional cardiac reconstruction

      • Ventricular reconstruction

      • Valvular reconstruction

      • Carotid endarterectomy

      • Left atrial appendage closure

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      Off-pump CABG

      • Indications

      • Operative mortality

      • Long-term mortality

      • Cardiovascular morbidity

      • Renal morbidity

      • Specific populations

      • Operative approach

      • Additional considerations

    • Miniaturized extracorporeal circulation

    • Anesthesia and early extubation

    • Analgesia

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      Intraoperative monitoring

      • Transesophageal echocardiography

      • Central nervous system monitoring

    • Additional information

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    Postrevascularization Management

    • Postoperative complications

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      Postoperative medications

      • General information

      • Aspirin and other antiplatelet agents

      • Statins

      • Antihypertensive medications

      • Vitamin supplements

    • Smoking cessation

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      Resumption of normal activities

      • Driving and travel restrictions

      • Sexual activity

    • Psychosocial considerations

    • Additional postoperative considerations

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    Prognosis

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      Mortality after CABG

      • Risk factors for operative mortality after CABG

      • Risk factors for long-term mortality after CABG

      • Risk prediction models for mortality after CABG

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      Morbidity after CABG

      • Stroke

      • Other neurologic outcomes

      • Adverse renal outcomes

      • Postoperative atrial fibrillation

      • Other adverse outcomes

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    Quality Improvement

    • Physician Quality Reporting System Quality Measures

    • Choosing Wisely Australia

    • Choosing Wisely Italy

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    Guidelines and Resources

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      Guidelines

      • International guidelines

      • United States guidelines

      • United Kingdom guidelines

      • Canadian guidelines

      • European guidelines

    • Review articles

  • Patient Information

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    ICD Codes

    • ICD-10 codes

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    References

    • General references used

    • Recommendation grading systems used

    • Synthesized Recommendation Grading System for DynaMed

    • DynaMed Editorial Process

    • Special acknowledgements

    • How to cite

Topic Editor
Dale K. Mueller MD
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Affiliations

Section Chief, Department of Surgery, University of Illinois; Illinois, United States; Cardiovascular and Thoracic Surgeon, HeartCare Midwest SC; Illinois, United States

Conflicts of Interest

Dr. Mueller declares no relevant financial conflicts of interest.

Recommendations Editor
Zbys Fedorowicz MSc, DPH, BDS, LDSRCS
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Affiliations

Director of Bahrain Branch of the United Kingdom Cochrane Center, The Cochrane Collaboration; Awali, Bahrain

Conflicts of Interest

Dr. Fedorowicz declares no relevant financial conflicts of interest.

Deputy Editor
Peter Oettgen MD
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Affiliations

Editor in Chief, DynaMed; Cardiologist, Beth Israel Deaconess Medical Center; Massachusetts, United States; Associate Professor of Medicine, Harvard Medical School; Massachusetts, United States

Conflicts of Interest

Dr. Oettgen declares no relevant financial conflicts of interest.

Produced in collaboration with American College of Physicians
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