Coronary artery by pass graft

Grossing of heart with by pass
Types of graft
Complications
Hemodynamics

1. CORONARY ARTERY BYPASS GRAFTS : TECHNIQUE AND PATHOLOGY Moderator: Prof Kim Vaiphei

2. 1894: Assassination of the French president Sadi Carnot Alexis Carrel

3. Triangulation suture 1912

4. John H. Gibbon Gibbon-IBM heart lung machine, 6 May 1953

5. May 2, 1960 by Dr Robert Goetz

6. Indications for CABG Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011 Nov 7

7. Types of graft

8. Harvesting – Saphenous v

9. Harvesting – Internal mammary a

10. CABG – procedure

11. CABG – procedure

12. CABG – procedure

13. Suture

14. Clips

15. Anastomoses

16. Dissection of Heart : Post CABG Dissection to be kept to minimum

17. Dissection of Heart : Post CABG Lee AH, Gallagher PJ. Post‐mortem examination after cardiac surgery. Histopathology. 1998 Nov 1;33(5):399-405.

18. Dissection of Heart : Post CABG Lee AH, Gallagher PJ. Post‐mortem examination after cardiac surgery. Histopathology. 1998 Nov 1;33(5):399-405.

19. Dissection of Heart : Post CABG Lee AH, Gallagher PJ. Post‐mortem examination after cardiac surgery. Histopathology. 1998 Nov 1;33(5):399-405. Transverse sections at site of anastomoses and from graft vessel and occluded coronary

20. Complications

21. Kainuma S, Masai T, Yamauchi T, Takeda K, Iwakura K, Ito H, Abe K, Sawa Y. Chronic expanding intrapericardial hematoma after coronary artery bypass surgery presenting with congestive heart failure. Annals of thoracic and cardiovascular surgery. 2008 Feb 1;14(1):52.

22. Hirsch WS, Ledley GS, Kotler MN. Acute ischemic syndromes following coronary artery bypass graft surgery. Clinical cardiology. 1998 Sep 1;21(9):625-32.

23. Steal – phenomenon Takach TJ, Reul GJ, Cooley DA, Duncan JM, Livesay JJ, Ott DA, Gregoric ID. Myocardial thievery: the coronary-subclavian steal syndrome. The Annals of thoracic surgery. 2006 Jan 31;81(1):386-92.

24. Post graft atherosclerosis Bernad SI, Totorean AF, Vekas L. Particles deposition induced by the magnetic field in the coronary bypass graft model. Journal of Magnetism and Magnetic Materials. 2016 Mar 1;401:269-86.

25. Hyperplasia at sites of turbulence

26. Otsuka F, Yahagi K, Sakakura K, Virmani R. Why is the mammary artery so special and what protects it from atherosclerosis?. Annals of cardiothoracic surgery. 2013 Jul;2(4):519. Fibro-intimal hyperplasia at 1 week post CABG

27. Internal mammary a. is better than saphenous v. Otsuka F, Yahagi K, Sakakura K, Virmani R. Why is the mammary artery so special and what protects it from atherosclerosis?. Annals of cardiothoracic surgery. 2013 Jul;2(4):519.

28. Internal mammary a. is better than saphenous v. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulation 1998;97:916-31. IMA Saphenous vein Anatomic properties    Endothelial fenestrations Few Many    Intercellular (IC) processes Many Few    IC junction permeability Low High    Internal elastic lamina (IEL) Well defined Poorly defined    Heparan sulfate in IEL/media High Low    Dependence on vasa vasorum Minimal High    Valves Absent Present    Size match with grafted native vessel Good Poor    Resistance to trauma of harvesting High Low

29. Internal mammary a. is better than saphenous v. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulation 1998;97:916-31. IMA Saphenous vein Physiological properties    Flow reserve High Low    Shear stress High Low    Nitric oxide/prostacyclin production High Low    Vasomotor response to thrombin Relaxation Constriction    Vasoconstrictor sensitivity Low High    Vasodilator sensitivity High Low    Basic fibroblast growth factor receptors Few Many (8× IMA)    Lipolysis Rapid Slow    Lipid synthesis Less active More active    Lipid uptake Slow Rapid