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Early cardiac complications of coronary artery bypass graft surgery

Authors
Sary Aranki, MD
Donald Cutlip, MD
Julian M Aroesty, MD
Section Editors
Gabriel S Aldea, MD
Edward Verrier, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

The treatment of coronary heart disease has evolved significantly over the past several years due in part to improvement in both surgical and percutaneous revascularization techniques. The majority of patients with chronic stable angina are still treated with medical therapy; however, revascularization with either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention should be considered in several subgroups. (See "Stable ischemic heart disease: Indications for revascularization".)

The early cardiac complications after CABG will be reviewed here. Noncardiac complications and perioperative mortality after CABG are discussed separately. (See "Early noncardiac complications of coronary artery bypass graft surgery" and "Operative mortality after coronary artery bypass graft surgery".)

CARDIAC COMPLICATIONS

Perioperative MI — The diagnosis of perioperative myocardial infarction (MI) may be difficult to make after coronary artery bypass graft surgery (CABG), since cardiac enzyme elevations occur as a result of the surgical procedure and since electrocardiographic (ECG) changes may reflect postoperative pericardial inflammation.

We suggest using the Joint European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Health Federation Task Force definition for MI (type 5) after CABG, which requires increases of biomarkers greater than five times the 99th percentile of the upper reference limit plus either new pathologic Q waves or new left bundle branch block, angiographically documented new graft, native coronary artery occlusion, or imaging evidence of new loss of viable myocardium [1]. (See "Criteria for the diagnosis of acute myocardial infarction".)

We recommend obtaining pre- and post-procedural ECGs as well as measurements of troponin at baseline and 8 to 16 hours after the procedure.

              

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Literature review current through: Nov 2016. | This topic last updated: Mon Nov 14 00:00:00 GMT 2016.
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