2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary

Hillis, L. David; Smith, Peter K.; Anderson, Jeffrey L.; Bittl, John A.; Bridges, Charles R.; Byrne, John G.; Cigarroa, Joaquin E.; DiSesa, Verdi J.; Hiratzka, Loren F.; Hutter, Adolph M.; Jessen, Michael E.; Keeley, Ellen C.; Lahey, Stephen J.; Lange, Richard A.; London, Martin J.; Mack, Michael J.; Patel, Manesh R.; Puskas, John D.; Sabik, Joseph F.; Selnes, Ola A.; Shahian, David M.; Trost, Jeffrey C.; Winniford, Michael D.

doi:10.1161/cir.0b013e31823b5fee

Cited by 443 publications

(122 citation statements)

References 482 publications

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“…29,[30][31][32] Though we are unable to report prevalence of these CVD indications worldwide, several millions of patients, such as the 111.7 million with angina worldwide, 10 are candidates for CR. These alarming figures demonstrate the scope of the need for CR services.…”

Section: Population Indicated For Crmentioning

confidence: 99%

Global availability of cardiac rehabilitation

2014

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The most prevalent non-communicable disease globally, namely cardiovascular disease (CVD), is also the leading cause of mortality, with over 80% of the deaths occurring in low-and middleincome countries. To lessen the impact of CVDs on individuals and societies, a comprehensive approach is needed. Cardiac rehabilitation (CR) involves delivery of structured exercise, education and risk reduction, in a cost-effective manner. Robust evidence demonstrates it reduces mortality up to 25%, improves functional capacity, as well as decreases re-hospitalization. Despite its benefits, and clinical practice guideline recommendations to refer cardiac patients, CR programs are grossly under-used. Worldwide, there is low availability of CR; only 38.8% of countries globally have CR programs. Specifically, 68.0% of high-income and 23% of LMICs (28.2% for middle-and 8.3% for low-income countries) have CR. CR density estimates ranged from 1 program per 0.1-6.4 million inhabitants. CR availability is much lower than that of other evidencebased secondary prevention therapies, such as revascularization and pharmacological therapies. Multi-level strategies to augment CR capacity and availability at national and international levels such as supportive public health policies, systematic referral strategies, and alternative models of delivery are needed.

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Section: Population Indicated For Crmentioning

confidence: 99%

Global availability of cardiac rehabilitation

2014

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“…A metaanalysis of six retrospective studies found that HCR was associated with no difference in freedom from MACCE at 1 year when compared with CABG but a greater incidence of repeat revascularization. The 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery suggests that HCR is reasonable in patients with (relative) contraindications to traditional CABG, such as heavily calcified proximal aorta or poor target vessels for CABG; lack of conduits; or unfavorable LAD artery for PCI (class IIa, level of evidence B) (39). Furthermore, HCR may be reasonable as an alternative to multivessel PCI or CABG in an attempt to improve the overall risk-benefit ratio (class IIb, level of evidence C).…”

Section: A B Cmentioning

confidence: 99%

The future of off-pump coronary artery bypass grafting: a North American perspective

2016

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Off-pump coronary artery bypass graft (OPCAB) is currently performed routinely in a minority of specialized centers and in many more centers, utilized only when a porcelain aorta mandates a no-touch aortic technique. The OPCAB literature can be summarized as follows: (I) large-scale randomized trials in relatively low risk patients that include surgeons with a range of experience demonstrating no consistent beneficial differences in major cardiovascular and cerebrovascular outcomes but lower transfusion rates and shorter length of stay, tempered by some reports of higher rates of incomplete revascularization and lower rates of long term graft patency; (II) smaller randomized controlled trials (RCTs) from highly specialized programs demonstrating equivalent or superior outcomes with OPCAB and similar completeness of revascularization and graft patency; and (III) observational data from large databases demonstrating a consistent benefit of OPCAB, especially in higher-risk patient subsets. Our rationale for OPCAB remains that if complete and precise revascularization can be safely and routinely accomplished, then the patient should benefit by avoiding the morbidities that can be attributed to aortic cannulation/clamping, cardiopulmonary bypass (CPB), hemodilution, hypothermia and global myocardial ischemia/cardioplegia.We further believe that OPCAB procedures should emphasize the use of arterial grafts to optimize long term patency and minimize aortic manipulation to limit the risk of stroke. Moving forward, the off-pump surgical community and specialty societies must address the challenge of training surgeons and their teams to master this technically demanding procedure. Furthermore, OPCAB opens the door to minimally-invasive surgical revascularization via hybrid coronary revascularization (HCR). A large NIH-funded RCT is currently underway to determine whether hybrid revascularization can offer a superior alternative to multi-vessel percutaneous coronary intervention for patients with low SYNTAX score and proximal LAD disease.

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“…Aspirin is classified as class IA treatment (consistent Level I Studies or a systematic review SR or meta-analysis MA) recommendation post CABG based on the American College of Cardiology/American Heart Association guidelines [27]. It is now known that long term aspirin therapy in patients with coronary artery disease (CAD) reduces the risk of death, myocardial infarction and stroke [28] and prevents ischaemic complications [29].…”

Section: Aspirin Monotherapymentioning

confidence: 99%

http://oatext.com/Dual-antiplatelet-therapy-after-coronary-artery-bypass-grafting-Do-we-have-a-consensus.php

Jaaly¹,

Zakkar²,

Pufulete³

et al. 2015

J Integr Cardiol

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Coronary artery bypass grafting (CABG) remains the gold standard treatment in patients with complex multivessel coronary artery disease (CAD). Reversed long saphenous vein is the most commonly used conduit despite the known early thrombotic failure and low long-term patency rate. Post-operative antiplatelet therapy is an established treatment to improve graft patency and also a secondary treatment of the underlying native CAD.Aspirin has traditionally been the first line therapy; however, aspirin resistance especially in the early period after CABG, has been reported over the years and as a result, the use of dual antiplatelet therapy (DAPT) has become more common. However, there is limited evidence about the effect of DAPT and duration of use after CABG on graft patency, clinical outcomes (such as bleeding and myocardial infarction), and survival. The optimal dose of aspirin when given in DAPT is unclear and the duration of DAPT in association with quality of life is unknown.Furthermore, a better understanding of the pathology of vein graft disease and how available drugs influence it, could lead to the development of customised therapy for cohorts of patients undergoing CABG with potential benefits to early and long term outcomes. Here we review the available evidence on the routine use of DAPT after CABG. Coronary artery bypass grafting (CABG)Ischaemic heart disease (IHD) is the main leading cause of death in the world, with 7.4 million deaths in 2012 [1,2]. Coronary artery bypass grafting (CABG) is the gold standard intervention in patients with complex multivessel disease [3]. In the UK, there are about 25,000 CABG operations performed annually [4] and the majority of these operations is carried out on patients over 70 years of age [5]. Demand for CABG is likely to increase considerably in the future as a result of rapidly ageing populations [6] and increased expectations of patients and surgeons to expand their indications for surgery.During the early years of coronary surgery, saphenous vein grafts (SVGs) were the only conduits used [7]. Over the years different arterial conduits were introduced with variable degree of success [8][9][10]. Contemporary data on international use of grafts are available from the SYNTAX trial that included 1541 patients who underwent CABG at 85 sites in 18 countries between 2005 and 2007 [11]. The SYNTAX trial confirmed that the long saphenous vein (LSV) graft, is the most used conduit for multivessel revascularisation, despite its known low early and late patency rates.The underlying mechanism behind vein graft disease is multifactorial and can include conduit trauma/graft thrombosis (within 1 month, early failure), activation of intimal hyperplasia associated with harvest and implantation into the arterial high-pressure system (1 to 12 months, intermediate failure), superimposed atherosclerosis (beyond 12 months, late failure) [12][13][14][15]. A prospective cohort study of 1,388 patients carried out between 1969 to 1994, in which patency was assessed using coronary...

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2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary

Cited by 443 publications

References 482 publications

Global availability of cardiac rehabilitation

Global availability of cardiac rehabilitation

The future of off-pump coronary artery bypass grafting: a North American perspective

http://oatext.com/Dual-antiplatelet-therapy-after-coronary-artery-bypass-grafting-Do-we-have-a-consensus.php

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