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Contemporary coronary artery bypass graft surgery and subsequent percutaneous revascularization. [Review]

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Citation: Nature Reviews Cardiology. 19(3):195-208, 2022 03.PMID: 34611327Institution: MedStar Washington Hospital CenterDepartment: Ophthalmology ResidencyForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Coronary Artery Disease | *Percutaneous Coronary Intervention | Coronary Artery Bypass/ae [Adverse Effects] | Coronary Artery Bypass/mt [Methods] | Coronary Artery Disease/su [Surgery] | Humans | Percutaneous Coronary Intervention/ae [Adverse Effects] | Saphenous Vein/tr [Transplantation] | Treatment OutcomeYear: 2022 ISSN:

1759-5002

Name of journal: Nature reviews. CardiologyAbstract: Patients who have undergone coronary artery bypass graft (CABG) surgery are susceptible to bypass graft failure and progression of native coronary artery disease. Although the saphenous vein graft (SVG) was traditionally the most-used conduit, arterial grafts (including the left and right internal thoracic arteries and the radial artery) have improved patency rates. However, the need for secondary revascularization remains common, and percutaneous coronary intervention (PCI) has become the most common modality of secondary revascularization after CABG surgery. Procedural characteristics and clinical outcomes differ considerably from those associated with PCI in patients without previous CABG surgery, owing to altered coronary anatomy and differences in conduit pathophysiology. In particular, SVG PCI carries an increased risk of complications, and operators are shifting their focus towards embolic protection strategies and complex native-vessel interventions, increasingly using SVGs as conduits to facilitate native-vessel PCI rather than pursuing SVG PCI. In this Review, we discuss the differences in conduit pathophysiology, changes in CABG surgery techniques, and the latest evidence in terms of PCI in patients with previous CABG surgery, with a particular emphasis on safety and long-term efficacy. We explore the subject of contemporary CABG surgery and subsequent percutaneous revascularization in this complex patient population. Copyright (c) 2021. Springer Nature Limited.All authors: Beerkens FJ, Claessen BE, Dangas GD, Gaudino MFL, Henriques JPS, Mahan M, Mehran R, Tam DYOriginally published: Nature Reviews Cardiology. 2021 Oct 05Fiscal year: FY2022Digital Object Identifier:

https://dx.doi.org/10.1038/s41569-021-00612-6

Date added to catalog: 2021-11-01

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	34611327	Available		34611327

Patients who have undergone coronary artery bypass graft (CABG) surgery are susceptible to bypass graft failure and progression of native coronary artery disease. Although the saphenous vein graft (SVG) was traditionally the most-used conduit, arterial grafts (including the left and right internal thoracic arteries and the radial artery) have improved patency rates. However, the need for secondary revascularization remains common, and percutaneous coronary intervention (PCI) has become the most common modality of secondary revascularization after CABG surgery. Procedural characteristics and clinical outcomes differ considerably from those associated with PCI in patients without previous CABG surgery, owing to altered coronary anatomy and differences in conduit pathophysiology. In particular, SVG PCI carries an increased risk of complications, and operators are shifting their focus towards embolic protection strategies and complex native-vessel interventions, increasingly using SVGs as conduits to facilitate native-vessel PCI rather than pursuing SVG PCI. In this Review, we discuss the differences in conduit pathophysiology, changes in CABG surgery techniques, and the latest evidence in terms of PCI in patients with previous CABG surgery, with a particular emphasis on safety and long-term efficacy. We explore the subject of contemporary CABG surgery and subsequent percutaneous revascularization in this complex patient population. Copyright (c) 2021. Springer Nature Limited.

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