Makindo Medical Notes

Related Subjects: |Cardiopulmonary bypass |Atherosclerosis |Ischaemic heart disease |Assessing Chest Pain |ACS - General |ACS - STEMI |ACS - NSTEMI |ACS - GRACE Score |ACS - ECG Changes |ACS -Cardiac Troponins |ACS - Post MI arrhythmias |ACS: Right Ventricular Infarction

As compared with saphenous vein grafts, radial-artery grafts for CABG show better 5-year patency and fewer adverse cardiac events.

🫀 About CABG

• In use since the early 1960s for managing ischaemic heart disease (IHD).
• 90% of patients are angina-free post-surgery; almost all experience symptomatic improvement.
• Grafts used:
  • Saphenous vein (traditional; higher late occlusion rate).
  • Internal Mammary Artery (IMA/ITA) – gold standard, esp. LIMA → LAD, with excellent long-term patency.
  • Radial artery – superior to vein grafts in long-term outcomes (see NEJM trial).
• Minimally invasive CABG techniques increasingly used (e.g. off-pump CABG).
• The internal mammary artery is usually free of atheroma (esp. <65 years).
• Reverse saphenous vein grafts: aorta → distal to coronary obstruction.
• CABG improves survival in:
  • Triple vessel disease (TVD)
  • Left main stem stenosis (LMS)

📌 Indications for CABG

• LMS disease
• Triple vessel disease (TVD)
• Two-vessel disease with proximal LAD involvement
• Symptomatic patients despite maximal medical therapy
• Improved outcome with moderately impaired LV function

⚠️ Complications

• Sternal wound infection / mediastinitis
• Pneumonia, pulmonary complications
• Graft failure / occlusion (vein >> arterial)
• Atrial fibrillation (common early arrhythmia)
• Thromboembolic events → stroke, MI
• Pericardial effusion, tamponade
• Renal impairment (esp. post-CPB)
• GI complications (e.g. mesenteric ischaemia)
• Haemodynamic instability

💊 Peri-Operative Issues

• Aspirin usually continued; Clopidogrel and other antiplatelets stopped 5 days before surgery.
• Heparinisation during CPB to prevent clotting.
• Broad-spectrum antibiotic prophylaxis to prevent bacteraemia & wound infection.
• Operative mortality: 1–5% (higher in older/comorbid patients).
• Age-related stroke risk: 1–2%.

📈 Long-Term Outcomes

• Arterial grafts (LIMA, radial) offer superior long-term patency vs. vein grafts.
• Repeat interventions possible via PCI (angioplasty/stenting) if graft occludes.
• Quality of life improves dramatically; survival benefit proven in LMS/TVD.

📚 References

• Radial-Artery vs. Saphenous-Vein Grafts in CABG (NEJM)
• CABG complications: Review for emergency clinicians (PubMed)