Coronary Artery Bypass Grafting

Abstract

An estimated 92 million adults in the United States have cardiovascular disease, costing about $316 billion dollars in annual health care expenditures. Furthermore, it is estimated that about 16 million Americans greater than 20 years old have coronary artery disease (CAD), which results in a disruption of the oxygen supply-demand relationship in the myocardium and can have adverse effects on the function of the heart. Management of CAD involves both nonsurgical and surgical interventions, of which coronary artery bypass grafting (CABG) is the main surgical option. The majority of CABG surgery is done with the assistance of the cardiopulmonary bypass circuit (CPB), although in the last 30 years there has been a trend toward performing CABG without CPB, also known as off-pump CABG. Many cardiac surgical patients have other medical comorbidities that make significant contributions to their ability to recover. Management of the patient requiring CABG, both with and without CPB, poses several challenges for the cardiac anesthesiologist. These include planning for appropriate monitoring of hemodynamics and oxygenation, obtaining adequate intravascular access, and anticipating and reacting to changes in pathophysiology related to CPB.