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Early noncardiac complications of coronary artery bypass graft surgery

Authors
Sary Aranki, MD
Julian M Aroesty, MD
Rakesh M Suri, MD, DPhil
Section Editors
Gabriel S Aldea, MD
Donald Cutlip, MD
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 major complications associated with CABG are death, myocardial infarction, stroke, wound infection, prolonged requirement for mechanical ventilation, acute kidney injury, and bleeding requiring transfusion or reoperation [1-4]. The short-term, particularly perioperative, noncardiac complications that can occur following conventional CABG (using cardiopulmonary bypass) will be reviewed here. Cardiac complications and perioperative mortality after CABG are discussed separately. (See "Early cardiac complications of coronary artery bypass graft surgery" and "Operative mortality after coronary artery bypass graft surgery".)

Off-pump and minimally invasive CABG are discussed separately. (See "Minimally invasive coronary artery bypass graft surgery: Definitions and technical issues" and "Off-pump and minimally invasive direct coronary artery bypass graft surgery: Outcomes".)

PREVENTION OF COMPLICATIONS

Mechanisms — Many complications related to traditional techniques of cardiac surgery are primarily the result of cardiopulmonary bypass (CPB). An important factor is aortic instrumentation and manipulation, including cannulation, decannulation, and partial or complete clamping and unclamping, which can result in embolization of atherosclerotic debris. Technical errors in bypass graft construction that can lead to graft occlusion, primarily in saphenous vein grafts, also may be important [5,6]. (See "Embolism from aortic plaque: Thromboembolism".)

Other factors that contribute to complications include:

                                     

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 12 00:00:00 GMT 2015.
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