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Management of Heart Failure After CABG

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Coronary Graft Failure

Abstract

Heart failure (HF) after coronary artery bypass graft (CABG) could be attributed to preoperative HF or postoperative HF. Preoperative HF accounted for about 45 % of patients referred for a condition of HF symptoms with systolic left ventricular (LV) ejection fraction (EF) less than 50 % before the surgery. The goal of treatment in patients with established HF is to relieve symptoms, prevent hospital admission, and improve survival before the surgery. Even though standard medications for HF including beta-blockers, angiotensin-converting enzyme (ACE) inhibitor, and mineralocorticoid have been shown beneficial, the early post surgery introduction of beta-blockers and ACE inhibitors should be cautious in patients with severe low LVEF, low blood pressure, and with pulmonary diseases.

On the other hand, occurrence of HF after CABG surgery is not uncommon. Perioperative myocardial injury, pre-existing left ventricular systolic dysfunction, and stunning due to reperfusion injury all can contribute to heart failure post CABG. The clinical suspicion of graft failure should be raised in the patient with signs of low cardiac output syndrome, ventricular arrhythmia, or hemodynamic instability with additional alterations of electrocardiogram (EKG) and increase of creatine kinase MB (CKMB) or troponin. Early intervention after detecting the graft failure by angiography should be done to limit the development of large myocardial injury and prevent the development of severe myocardial pump failure. In the non-graft-related HF post surgery, there are several other factors that need to be addressed, including reperfusion injury, perioperative complication, kidney injury, cardiac arrhythmia, infection, and post cardiotomy syndrome.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Faculty of Medicine, University of Padjadjaran and Binawaluya Cardiac Center, Jakarta, Indonesia

    Beny Hartono MD

  2. Department of Cardiovascular Medicine, Faculty of Medicine, University of Indonesia and Binawaluya Cardiac Center, Indonesia University, Jakarta, Indonesia

    Dian Andina Munawar MD

  3. Department of Cardiovascular Medicine, Faculty of Medicine, University of Gadjahmada/University of Indonesia/University of Padjadjaran/University of Samratulagi and Binawaluya Cardiac Center, Jakarta, Indonesia

    Muhammad Munawar MD, PhD

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  1. Beny Hartono MD
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  2. Dian Andina Munawar MD
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  3. Muhammad Munawar MD, PhD
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Correspondence to Muhammad Munawar MD, PhD .

Editor information

Editors and Affiliations

  1. Cardiology, Army's Center for Cardiovascular Di, Bucharest, Romania

    Ion C. Ţintoiu

  2. Department of Surgery, Chinese University of Hong Kong, Sha Tin, Hong Kong

    Malcolm John Underwood

  3. University Fribourg, Hospital HFR Fribourg, Fribourg, Fribourg, Switzerland

    Stephane Pierre Cook

  4. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan

    Hironori Kitabata

  5. University Medical Center, Texas Tech Univ. Health Science Center, EL PASO, Texas, USA

    Aamer Abbas

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Hartono, B., Munawar, D.A., Munawar, M. (2016). Management of Heart Failure After CABG. In: Ţintoiu, I., Underwood, M., Cook, S., Kitabata, H., Abbas, A. (eds) Coronary Graft Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-26515-5_53

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  • DOI: https://doi.org/10.1007/978-3-319-26515-5_53

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