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Complications of Coronary Artery Bypass Grafting Surgery

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Abstract

More than 800,000 patients undergo coronary artery bypass grafting (CABG) each year worldwide (Nalysnyk et al. Heart 89:767–772, 2003). In the recent years, there have been major advances in techniques used in CABG surgery in order to assure better success rates and reduce complication rates. Thus, there has been a move toward arterial graft revascularization as compared to venous grafts in order to allow longer patency rates. In addition, newer methods such as minimal access and off-cardiopulmonary bypass (CPB) surgery are now in routine practice in many centers around the world with an aim to reduce the rates of postoperative morbidity and length of hospital stay. Despite achieving such technical advances are referred, patients that a significant proportion of CABG surgery nowadays are relatively older and frailer with multiple cardiopulmonary and other comorbidities as compared to patients operated on in the last century. This is perhaps due to increased life expectancy in the western world thanks to improved medical care and advances reached in percutaneous coronary intervention successfully managing less advanced coronary disease in the younger, fitter patient groups whom in the past would have otherwise undergone surgery. Hence, the risk of significant postoperative morbidity and mortality still exists and is even expected to increase in the coming years due to severity of coronary disease and increasing general complexity of cases that will be encountered (Nalysnyk et al. Heart 89:767–772, 2003). In this chapter we will be discussing the complications of CABG surgery.

Her Majesty the Queen in Right of United Kingdom

Daniela Graf (2013)

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Abbreviations

Cardioplegia:

A cold (4 ° C), high potassium content solution administered at the time of CABG bypass surgery to arrest the heart in diastole. Diastolic cardiac arrest significantly reduces leads to significant reduction in myocardial cellular metabolism and thereby reducing myocardial ischemia during the operation. This solution also contains nutrition necessary for the myocardial cell survival during diastolic cardiac arrest (Bojar 2011; Chikwe et al. 2006).

Cardiopulmonary bypass (CPB):

This machine is used to perfuse organs during cardioplegic cardiac arrest during cardiac surgery. It includes heparinized circuit of a venous pipe and an arterial pipe, a mechanical pump, a blood reservoir, and an oxygenator. The venous pipe takes deoxygenated blood from the venous system. The blood is oxygenated and pumped back into the arterial system via the arterial pipe (Bojar 2011).

Deep hypothermic circulatory arrest:

In cardiac surgery patients who undergo major aortic procedures, e.g., aortic arch surgery, and run the risk of cerebral hypoperfusion/injury undergo so as to preserve cellular function circulatory arrest. The body is cooled to as low as 18 ° deep hypothermic based on the Q10 temperature coefficient principal every 10 ° C of temperature reduction reduces cellular metabolism by 50 %, thereby reducing the risk of ischemic injury to the brain (Bojar 2011).

Intra-aortic balloon pump (IABP):

This is a balloon device that is inserted percutaneously, most commonly through the femoral artery into the the descending aorta. It inflates in diastole thereby impedance/reducing the work of the heart by reducing afterload and improving the coronary circulation (Bojar 2011; Chikwe et al. 2006).

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Authors and Affiliations

  1. Department of Cardio-Thoracic surgery, Royal Infirmary of Edinburgh, Edinburgh, UK

    Maziar Khorsandi

  2. Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon St, G81 4DY, Clydebank, Greater Glasgow, Dunbarto, UK

    Dr. Kasra Shaikhrezai

  3. Little France Crescent, Royal Infirmary of Edinburgh, EH16 4SU, Edinburgh, UK

    Dr. Vipin Zamvar (Consultant Cardiothoracic Surgeon)

Authors
  1. Maziar Khorsandi
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  2. Dr. Kasra Shaikhrezai
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  3. Dr. Vipin Zamvar
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Correspondence to Maziar Khorsandi .

Editor information

Editors and Affiliations

  1. Akademisches Lehrkrankenhaus MLU, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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© 2014 Her Majesty the Queen in Right of United Kingdom

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Khorsandi, M., Shaikhrezai, K., Zamvar, V. (2014). Complications of Coronary Artery Bypass Grafting Surgery. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_233-2

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  • DOI: https://doi.org/10.1007/978-3-642-37393-0_233-2

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Chapter history

  1. Latest

    Complications of Coronary Artery Bypass Grafting Surgery
    Published:
    08 July 2014

    DOI: https://doi.org/10.1007/978-3-642-37393-0_233-2

  2. Original

    Complications of Coronary Artery Bypass Grafting Surgery
    Published:
    08 April 2014

    DOI: https://doi.org/10.1007/978-3-642-37393-0_233-1

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