 |
Cardiothoracic Surgery Service
LAC+USC Medical Center Student Handout
Coronary Artery Disease
- Coronary Artery Disease (CAD) is one of the leading causes of death in the US.
- Approximately 250-300,000 coronary surgeries are performed in the US / year.
- Approximately 250-300,000 Percutaneous Transluminal Coronary Angioplasties (PTCAs) are performed in the US / year.
- Risk factors for developing coronary artery disease:
- family history
- diabetes mellitus
- hypertension
- hypercholesterolemia
- smoking
- Differentiate between coronary atherosclerosis and ischemic coronary artery disease. Ischemic disease involves areas of myocardium at risk for a myocardial infarct because of a hemodynamically significant stenosis proximally. This gives classic signs of angina pectoris.
- Indications for Coronary Artery Bypass Grafting (CABG):
- unstable angina
- Left Main coronary disease
- multiple vessel disease with crescendo angina refractory to medication
- high grade proximal LAD disease
- post-infarction angina
- complication of myocardial infarction (ventricular wall rupture, ventricular septal defect, papillary muscle dysfunction--acute mitral regurgitation).
- complication of failed PTCA.
- Common statistics for CABG:
- operative mortality 1-3%
- peri-operative myocardial infarction 3%
- post-operative wound infection 3%
- post-operative bleeding 3-5%
- post-operative arrhythmias 30%
| Possible conduits for bypass include: | 1 year patency |
| internal mammary artery (right or left) | 96% |
| reverse saphenous vein graft | 86% |
| cephalic vein | 80% |
| radial artery | 90% |
| gastroepiploic artery | 90% |
| inferior epigastric artery | 90% | | cadaver cryopreserved vein | 40% | | synthetic conduits (Gore-Tex) | 00% |
- Recurrent Coronary Artery Disease
- reoperation for recurrent angina is 3%/year
- operative mortality for re-do CABG 5-7%
- morbidity for re-do CABG 2x
- reoperation is usually needed because:
- Incomplete initial revascularization
- Poor control of hypertension, cholesterol, diabetes
- Continued smoking
- Non-use of the IMA
- Progressive atherosclerosis
- 30% of the patients that undergo CABG will need "something" else done in their lifetime--re-do CABG, PTCA, etc. The hope is that by the time a further intervention is necessary, technology will have advanced and the outcome will be better.
|
|
|
