Complications of Coronary Artery Bypass Grafting

Abstract

Introduction Coronary artery bypass grafting (CABG) is one of the most commonly performed operations with approximately 200 000 procedures performed annually in the United States of America and an incidence of 62 per 200 000 inhabitants in Western Europe. 1 It has evolved over the past century from a high-risk procedure to a relatively safe one with a current mortality rate of 1%-2% in elective patients. 2 Nonetheless, it is still a highly complex surgery and has been associated with a number of complications. The complications from this major surgery can be classified in various ways; some are catastrophic, such as death and stroke, while others can be self-limiting without any long-term residual effects, such as atelectasis, lower respiratory infection, or transient acute kidney injury. 2,3 CABG can be considered as a large operation incorporating many smaller operations. There may be variations in these smaller operations that can have both advantages and disadvantages. However, the end goal is to bypass a blocked or narrow coronary artery by anastomosis of a vessel conduit. 3 This may be done with or without cardio-pulmonary bypass, with arterial or venous grafts, and with open or endoscopic harvesting of conduits. The overall risk of this operation is determined by the Euroscore, which is a statistical determination of risk using logistic regression. 4,5 It is determined by patient-related factors (age, gender, renal impairment, peripheral vascular disease, mobility, previous cardiac surgery, chronic lung disease, active endocarditis, critical pre-operative state, insulin dependent diabetes), cardiac-related factors (NYHA dyspnea classification, CCS angina classification, left ventricular function, recent myocardial infarction, and pulmonary hypertension) and operation factors (urgency, weight of intervention, and involvement of thoracic aorta). 5 For the purposes of valid patient consent, it is considered mandatory to discuss the risk of death, peri-operative myocardial infarction, stroke, and sternal wound infection. 6 The general complications of CABG surgery are briefly discussed below followed by a discussion of the specific complications associated with cardiopulmonary bypass and graft patency. Extent of Complications Complications can be broadly divided into catastrophic events, such as death and stroke, or less serious complications, such as pulmonary, renal, or sternal wound complications. Death Mortality following CABG is reported to be between 1%-2% for elective procedures; however, it can be confounded by many factors including the urgency of the case, previous acute myocardial events, the presence of multiple comorbidities such as diabetes or chronic renal failure, or poor coronary vessels that are not amenable for grafting. 4-6 Stroke Post-operative stroke has an incidence of 1.4% to 3.8%. 2 The risk factors for this complication include increased age,

Concomitant severe carotid and coronary artery diseases: a separate management or concomitant approach

“…8,9 Patients referred for CABG who have concomitant carotid artery disease represent a high-risk population, potentially adding to the range of potential complications of CABG. 10 The optimal management of such patients remains controversial due to the absence of randomized control trials. Therefore, it is crucial to optimize the patient to prevent such catastrophic complications through either staged or concomitant treatment of carotid artery stenosis when it is significant.…”

“…Patients referred for CABG who have concomitant carotid artery disease represent a high‐risk population, potentially adding to the range of potential complications of CABG . The optimal management of such patients remains controversial due to the absence of randomized control trials.…”

Learning Needs and Educational Strategies for Adult Patients in the Preoperative Period of Myocardial Revascularization: Scoping Review

“…The third category comprises the procedure and care during surgery. It was related to the instruction about the proper name of the surgery, which can be RVM or saphenous or breast bridge; in addition, how it is performed and some characteristics, such as extracorporeal circulation, complications, results, risks, prognosis, and survival rate (67,68). It is noteworthy that the previous items should be part of the scope of preoperative orientations since the patient needs to be aware of the interventions that will be performed during the surgery (36).…”

Association of hematological and biochemical tests and complications after cardiovascular surgery

“…A cirurgia é uma modalidade terapêutica, e alguns dos procedimentos desenvolvidos com maior frequência são a revascularização do miocárdio (CRM) e a correção de doenças valvares, utilizando-se a técnica convencional não pulsátil de circulação extracorpórea (CEA) 3 . Porém as mesmas causam condições fisiopatológicas complexas 4 , com importantes repercussões orgânicas, instabilidade clínica, com subsequente manifestação de complicações no período pós-operatório de gravidade e de causas diversas 5 . DOI: 10.15343/0104-7809.202246209220…”