Coronary Artery Bypass Graft：.ppt

Coronary Artery Bypass Graft Joshua Paul Aronson March 20, 2003 5.22J Biotechnology Engineering Professors J. Essigmann and R. Langer TA: Jyoti Agarwal Prior to 1930’s, heart surgery seen as impossible, with high morbidity and mortality “Surgery of the heart has probably reached the limits set by nature to all surgery” ? –Stephen Paget, 1896, Surgery of the Chest 1937: Dr. John Gibbon designs heart-lung machine, which enables cardiopulmonary bypass (CPB) 1955: Vineburg and Buller implant internal mammary artery into myocardium to treat cardiac ischemia and angina 1958: Longmire, Cannon and Kattus at UCLA perform first open coronary artery endarterectomy without CPB During 1960’s and 1970’s, CPB and cardioplegic arrest are adopted, allowing Coronary Artery Bypass Graft (CABG) to emerge as a viable surgical treatment Chronic angina Unstable angina Acute myocardial infarction Acute failure of percutaneous transluminal coronary angioplasty (PTCA) Severe coronary artery disease Most common arteries bypassed: Right coronary artery Left anterior descending coronary artery Circumflex coronary artery Saphenous vein used for bypassing right coronary artery and circumflex coronary artery Internal mammary artery (IMA) used for bypassing left anterior descending coronary artery Patency rate over 90% after 10 years If more veins are needed, alternative sites such as upper extremity veins can be used Patency rate as low as 47% after 4.6 years Conduit removed Median sternotomy Sternum divided using electric saw Cold potassium cardioplegia Cardiopulmonary bypass Cannulation of: Ascending aorta Femoral artery Right atrium Heparin administered to minimize clotting Bypass of arteries: Incision in target artery: Anastamosis of graft with artery: Positive: Relief of angina in 90% of patients 80% angina free after 5 years Survival about 95% after 1 year Low chance of restenosis Negative: 2-3 days in ICU, 7-10 day total hospital stay 3-6 month full recovery time 5-