2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary

Hillis, L. David; Smith, Peter K.; Anderson, Jeffrey L.; Bittl, John A.; Bridges, Charles R.; Byrne, John G.; Cigarroa, Joaquin E.; DiSesa, Verdi J.; Hiratzka, Loren F.; Hutter, Adolph M.; Jessen, Michael E.; Keeley, Ellen C.; Lahey, Stephen J.; Lange, Richard A.; London, Martin J.; Mack, Michael J.; Patel, Manesh R.; Puskas, John D.; Sabik, Joseph F.; Selnes, Ola A.; Shahian, David M.; Trost, Jeffrey C.; Winniford, Michael D.; Jacobs, Alice K.; Albert, Nancy; Creager, Mark A.; Ettinger, Steven M.; Guyton, Robert A.; Halperin, Jonathan L.; Hochman, Judith S.; Kushner, Frederick G.; Ohman, E. Magnus; Stevenson, William G.; Yancy, Clyde W.; Holmes, David R.; Lewin, John C.; Wright, Janet; May, Charlene; Barrett, Erin A.; Bradfield, Lisa; Mukherjee, Debjani; Keller, Sue; Koinis, Maria; Sacco, Ralph L.; Brown, Nancy; Robertson, Rose Marie; Whitman, Gayle R.; Perkins, Cheryl L.

doi:10.1016/j.jtcvs.2011.10.015

Cited by 226 publications

(54 citation statements)

References 468 publications

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“…4 In 2011, ACCF/AHA also published a Guideline for Coronary Artery Bypass Surgery that did not discuss the performance of PCI without on-site surgery. 26 …”

Section: Accf/aha/scai Guideline For Percutaneous Coronary Interventionmentioning

confidence: 99%

SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup

et al. 2014

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“…4 In 2011, ACCF/AHA also published a Guideline for Coronary Artery Bypass Surgery that did not discuss the performance of PCI without on-site surgery. 26 …”

Section: Accf/aha/scai Guideline For Percutaneous Coronary Interventionmentioning

confidence: 99%

SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup

et al. 2014

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“…Post‐CABG, moreover, there appears to be more of a need than ever for coordinating interdisciplinary, clinical team‐based, collaborative management of patients postdischarge. The establishment and/or utilization of a “heart team” represents one such multidisciplinary approach to improve the quality of postdischarge cardiovascular patient care a Class I–C recommendation in the ACCF/AHA Guidelines for Coronary Artery Bypass Graft Surgery 21, 22. Though the use of a heart team is typically constructed to include the cardiac surgeon and cardiologist, based on these findings it appears that other specialists, most notably nephrologists, may be important additions to consider in building future “heart teams.”…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Post‐CABG Survival: Performance of Clinical Risk Models Versus Actuarial Predictions

et al. 2015

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Background/aimClinical risk models are commonly used to predict short‐term coronary artery bypass grafting (CABG) mortality but are less commonly used to predict long‐term mortality. The added value of long‐term mortality clinical risk models over traditional actuarial models has not been evaluated. To address this, the predictive performance of a long‐term clinical risk model was compared with that of an actuarial model to identify the clinical variable(s) most responsible for any differences observed.MethodsLong‐term mortality for 1028 CABG patients was estimated using the Hannan New York State clinical risk model and an actuarial model (based on age, gender, and race/ethnicity). Vital status was assessed using the Social Security Death Index. Observed/expected (O/E) ratios were calculated, and the models' predictive performances were compared using a nested c‐index approach. Linear regression analyses identified the subgroup of risk factors driving the differences observed.ResultsMortality rates were 3%, 9%, and 17% at one‐, three‐, and five years, respectively (median follow‐up: five years). The clinical risk model provided more accurate predictions. Greater divergence between model estimates occurred with increasing long‐term mortality risk, with baseline renal dysfunction identified as a particularly important driver of these differences.ConclusionsLong‐term mortality clinical risk models provide enhanced predictive power compared to actuarial models. Using the Hannan risk model, a patient's long‐term mortality risk can be accurately assessed and subgroups of higher‐risk patients can be identified for enhanced follow‐up care. More research appears warranted to refine long‐term CABG clinical risk models. doi: 10.1111/jocs.12665 (J Card Surg 2016;31:23–30)

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“…Current guidelines suggest carotid revascularization for patients requiring CABG with one of the following conditions: (1) a recently symptomatic severe carotid stenosis, (2) bilateral asymptomatic severe carotid stenoses, and (3) a unilateral asymptomatic severe stenosis and contralateral carotid occlusion [35,36]. Meanwhile, the benefit of carotid revascularization in patients undergoing CABG has not been systematically addressed.…”

Section: Prophylactic Carotid Interventionmentioning

confidence: 99%

Stroke associated with coronary artery bypass grafting

Arai

2015

Gen Thorac Cardiovasc Surg

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While coronary artery bypass grafting (CABG) has been playing a significant role in the revascularization for ischemic heart disease, neurological complications associated with CABG have been a primary concern. Stroke, although the incidence is low, is one of the most devastating complication of CABG. Many studies have identified the risk factors for stroke with CABG, such as prior stroke, carotid artery stenosis, aortic atherosclerosis, atrial fibrillation and cardiopulmonary bypass. Various rational approaches focusing on individual risk factor have been proposed for the stroke. Prophylactic carotid revascularization is an important strategy, and the diagnosis of carotid stenosis has to be established correctly. Prevention of emboli from aortic plaque is also an essential issue. Intraoperative monitoring with transesophageal or epiaortic ultrasound is useful to identify mobile atheromatous plaques and to select appropriate aortic manipulations. Maintenance of cerebral blood flow and blood pressure during cardiopulmonary bypass might be critical issues. Besides, there are conflicting two opinions regarding off-pump CABG; one supports an efficiency for the prevention of stroke while the other advocates no effect. This discrepancy might be explained by the difference of the risk of stroke in the population of the individual study and by the variation of the percentage of aortic clamping or aortic anastomosis in each study. Pharmaceutical therapies such as statin, preventive medication for atrial fibrillation, or antiplatelet are promising methods. Although it is hard to decrease the incidence of the stroke with any single countermeasure, sustained effort should be continued to overcome the stroke associated with CABG.

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2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary

Cited by 226 publications

References 468 publications

SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup

SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup

Long‐Term Post‐CABG Survival: Performance of Clinical Risk Models Versus Actuarial Predictions

Stroke associated with coronary artery bypass grafting

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