TY  - CHAP
M1  - Book, Section
TI  - Primary Coronary Artery Bypass Surgery
A1  - Rushing, G.D.
A1  - Yuh, David D.
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
PY  - 2014
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - EpidemiologyAffecting  more  than  1.5  million  Americans  annually,  coronary  artery  disease  is  the  most  common  form  of  heart  disease,  and  its  complications  are  the  leading  cause  of  death  in  both  men  and  women.PathophysiologyCoronary  artery  disease  is  generally  caused  by  atherosclerotic  luminal  narrowing,  resulting  in  insufficient  coronary  blood  flow  to  the  myocardium.  The  process  consists  of  subintimal  atheroma  deposition,  leading  to  arterial  luminal  stenosis  or  occlusion  and  wall  thickening.Clinical  featuresTypically,  significant  coronary  atherosclerosis  becomes  manifest  as  angina,  but  it  can  also  present  with  anginal-equivalent  symptoms,  including  dyspnea,  dizziness,  syncope,  and  pulmonary  edema.  Malignant  coronary  disease  leading  to  ischemic  cardiomyopathy  is  associated  with  congestive  symptoms.  Identified  factors  that  contribute  to  severe  atherosclerotic  coronary  artery  disease  include  obesity,  hypercholesterolemia,  obesity,  diabetes,  tobacco  use,  and  sedentary  lifestyle.DiagnosticsTwelve-lead  electrocardiography  is  initially  used  to  diagnose  myocardial  ischemia.  Further  investigation  consists  of  exercise  stress  testing,  evaluation  of  myocardial  enzymes  (i.e.,  CPK-MB,  troponin),  echocardiography,  and  coronary  angiography.TreatmentInitial  medical  management  of  acute  myocardial  ischemia  consists  of  beta  blockade,  nitrates,  anti-platelet  therapy,  and  supplemental  oxygen.  After  precise  delineation  of  coronary  arteriopathy,  definitive  treatment  consists  of  coronary  artery  bypass  grafting  (CABG)  or  percutaneous  angioplasty  and  stenting.Outcomes/prognosisCABG  carries  an  overall  mortality  of  about  3  percent;  elective  primary  coronary  bypass  carries  a  mortality  rate  of  approximately  1.7  percent.  Complications  associated  with  CABG  include  renal  failure,  neurologic  injury,  heart  failure,  hemorrhage,  respiratory  failure,  and  renal  dysfunction.  Overall,  CABG  achieves  excellent  outcomes  with  respect  to  anginal  relief  and  resumption  of  normal  activities.  In  general,  completeness  and  durability  of  revascularization  is  superior  with  surgical  revascularization  versus  percutaneous  interventions.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104588826
ER  -