Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- 47 Routine management after cardiac surgery
- 48 Management after coronary artery bypass grafting surgery
- 49 Management after valve surgery
- 50 Management after aortic surgery
- 51 Management after thoracic surgery
- 52 Lung volume reduction surgery
- 53 Chronic thromboembolic pulmonary hypertension and pulmonary endarterectomy
- 54 Oesophagectomy
- 55 Management after heart transplant
- 56 Management after lung transplant
- 57 Prolonged critical care stay after cardiac surgery
- 58 Palliative care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
48 - Management after coronary artery bypass grafting surgery
from SECTION 4 - Procedure-Specific Care in Cardiothoracic Critical Care
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- 47 Routine management after cardiac surgery
- 48 Management after coronary artery bypass grafting surgery
- 49 Management after valve surgery
- 50 Management after aortic surgery
- 51 Management after thoracic surgery
- 52 Lung volume reduction surgery
- 53 Chronic thromboembolic pulmonary hypertension and pulmonary endarterectomy
- 54 Oesophagectomy
- 55 Management after heart transplant
- 56 Management after lung transplant
- 57 Prolonged critical care stay after cardiac surgery
- 58 Palliative care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
Summary
Introduction
Coronary artery bypass grafting (CABG) is the commonest cardiac operation performed. Its purpose is to relieve angina and help prevent myocardial infarction by bypassing narrowed or occluded coronary arteries. This is done by suturing a pedicled arterial graft (such as a left internal mammary artery [LIMA]) or a free graft (such as a segment of saphenous vein or a radial artery) to the affected coronary artery downstream from the lesion. A pedicled LIMA brings its blood supply with it from the subclavian artery. A free graft needs to be joined to a nearby source of oxygenated arterial blood, usually the ascending aorta.
Most CABG is done on cardiopulmonary bypass with cardioplegic cardiac arrest, but it is possible to achieve good results without cardiopulmonary bypass on the beating heart. This chapter deals with specific problems that may be encountered after CABG.
Myocardial ischaemia
The heart should not be is chaemic after CABG. If the electrocardiograph shows is chaemic changes, this may indicate:
• myocardial damage owing to
◦ poor protection during surgery or
◦ compromise of a coronary artery;
• incomplete revascularization, leaving a segment of myocardium still ischaemic;
• a technical graft problem (such as thrombosis, occlusion or kink); or
• spasm of a coronary artery.
- Type
- Chapter
- Information
- Core Topics in Cardiothoracic Critical Care , pp. 373 - 375Publisher: Cambridge University PressPrint publication year: 2008