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Article name

Hi, guys. It might be a small point but I changed the intro to 'coronary artery bypass graft surgery', as this is more precise. I'd suggest a move. - Richardcavell 14:43, 25 March 2006 (UTC)[reply]

PubMed likes the shorter version more:
Google prefers the shorter version too:
MedlinePlus calls it Heart Bypass Surgery.[1]
The American Heart Association calls it coronary artery bypass surgery.[2]
Coronary artery bypass graft surgery is, perhaps, more formal. That said, the shorter version seems to be just as well understood-- and yields more hits. I think it is worth mentioning both in the title... will re-work. I oppose the move--as per above. BTW-- the article, IMHO, needs a good overhaul... if you're up to the task jump right in. I look forward to further comments and/or edits from you. Nephron  T|C 02:58, 26 March 2006 (UTC)[reply]

Graft patency

Anyone have a good reference for graft patency rates? The numbers I have are only for SVG grafts and I don't have a proper reference for where I got the numbers from. :-( Ksheka 14:23, 29 August 2006 (UTC)[reply]

Here are some reference articles for graft patency. I don't time (at the moment to sift through them, but 50% patency in 10-15 years sounds about right: 1 2 3 4. Ksheka 15:20, 29 August 2006 (UTC)[reply]
50% is what I remember off the top of my head. The important thing is really the comparison to arterial grafts, particularily the ITA--which has patency rate of something like 90% at 10 years. Surprising is-- there doesn't seem to be a meta-analysis on this (I spent a bit of time searching PubMed). Nephron  T|C 03:42, 30 August 2006 (UTC)[reply]
From what I recall in the PCI talks, there is some debate about how good ITA grafts really are. Patency of the graft itself is excellent. However, there are issues with stenosis at the anastamosis site. Definitely need some hard facts on this. Ksheka 15:33, 3 September 2006 (UTC)[reply]
That grafts fail at the distal anastomosis is fairly well known:
  • Ojha M, Leask RL, Johnston KW, David TE, Butany J. Histology and morphology of 59 internal thoracic artery grafts and their distal anastomoses. Ann Thorac Surg. 2000 Oct;70(4):1338-44. PMID 11081895
  • Leask RL, Butany J, Johnston KW, Ethier CR, Ojha M. Human saphenous vein coronary artery bypass graft morphology, geometry and hemodynamics. Ann Biomed Eng. 2005 Mar;33(3):301-9. PMID 15868720
Nephron  T|C 18:49, 3 September 2006 (UTC)[reply]

The patency rates are as follow (in decending order):

  • LIMA
  • RIMA
  • Free LIMA
  • Free RIMA
  • Radial - should quote the RAPS study by Desai, Fremes et. al. in NEJM (2005 I think). Radial grafts historically got a bad rap due to improper handling - the patency is excellent when handled with the same regard as the IMA's.
  • SVG

If I find time to track down references for this, I will insert in in the article.

So, what happens after 15 years, when the the grafts fail? Are they replaced? --89.56.190.194 (talk) 16:36, 2 April 2008 (UTC)[reply]
Sometimes. There is re-do CABG.

Patency also depends on the quality of the outflow tract (downstream from the distal anastomosis). For this reason, a LIMA to LAD graft has the highest patency of any configurations. BakerStMD T|C 18:16, 9 January 2015 (UTC)[reply]

First of all... surprised that the talk page had more info than the article itself.

Second: I am working on my thesis on graft patency and I have my references on this handy. May as well put them here so someone else can work them into the article.

Third: Its not that after 15 years the graft all fail. But when they do, its the question of whether the patient is symptomatic or not. If the patient is coping well and not showing any symptoms, then we leave them alone. If they cannot stand up without feeling angina pain, then we operate on them again. Chances are, with people operated on being about 70-80 years old anyway, 15 years post-surgery most of them would have died by other cause (cancer most likely).

Ok, so here are the current recommendations:

For Left Coronary System: (i.e. the Left Anterior Descending Artery and the Circumflex Artery)

          • Bilateral in-situ Internal Thoracic Arteries (i.e. both LITA and RITA used together)

Ref1: Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 2001;358(September(9285)):870-5. Ref2: Lytle B, Blackstone E, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM. The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Trial awaiting Result: Taggart DP, Lees B, Gray A, Altman DG, Marcus F, Channon K, ART investigators. Arterial Revascularisation Trial (ART). A randomised trial to compare survival following bilateral versus single internal mammary grafting in coronary revascularisation [ISRCTN46552265]. Trials. 2006; 7: 7. doi: 10.1186/1745-6215-7-7. PMC 1450314

This is the accepted norm (at least in the US and European Countries) for the moment

For the Right Coronary System: (i.e. the Right Coronary Artery, the Left Ventricular Branches of the RCA and in most cases the Posterior Descending Artery)

          • Use the Radial Artery or the Saphenous Vein, not the Gastro-eplipoic Artery

Ref1: Glineur D, D'hoore W, El Khoury G, Sondji S, Kalscheuer G, Funken JC, Rubay J, Poncelet A, Astarci P, Verhelst R, Noirhomme P, Hanet C. Angiographic predictors of 6-month patency of bypass grafts implanted to the right coronary artery a prospective randomized comparison of gastroepiploic artery and saphenous vein grafts. J Am Coll Cardiol. 2008 Jan 15;51(2):120-5. Ref2: Hayward PA, Hadinata IE, Hare D, Moten S, Rosalion A, Seevanayagam S, Buxton B, Matalanis G. Choice Of Conduit For The Right Coronary System: An 8-year Analysis From The Radial Artery Patency And Clinical Outcomes Trial. Proceedings of the 2009 Society For Cardiothoracic Surgery In Great Britain and Ireland Annual Meeting BIC; 2009 Mar 22-24; Bournemouth, United Kingdom. (Abstract available online - Manuscript publication pending) 

                ***EDIT: The paper is now published. The correct reference is: Hadinata IE, Hayward PAR, Hare DL, Matalanis GS, Seevanayagam S, Rosalion A, Buxton BF. Choice of Conduit for the Right Coronary System: 8-Year Analysis of Radial Artery Patency and Clinical Outcomes Trial. Ann Thorac Surg 2009;88:1404–9*** Ignatius Eric Hadinata (talk) 15:38, 8 January 2010 (UTC)[reply]

Yes, I am one of the authors of that last reference. I admit that not everyone will agree with what I have written above, especially if you research publications older than 2008. Older surgeons also tend not to agree with newer research. Not every country has adopted the bilateral ITA approach. This method is new and still debated. The randomised controlled trial to prove it is not finished yet, but there is enough evidence to convince the majority of surgeons to adopt it.

P.S: The study by Dr. Fremes (mentioned in the comment above) was started before the theory of the bilateral ITA was put forward. It studies the difference between Saphenous vein (SV) and Radial Artery (RA) in the same patient. Basically he randomises each patient to either receive an SV or RA to the circumflex artery. If the patient receives SV to the circumflex, then he puts the RA to the right coronary artery and vice versa. He then follows up those patients over 10 years (I believe) and compares the patencies of the RA and SV.

Ignatius Eric Hadinata (talk) 05:27, 21 April 2009 (UTC)[reply]

Double/Triple/Quad etc. terms

I came looking for information on what the difference was between a double/triple etc. bypass. I can't find any information here, not any reference to double/triple anything anywhere in the article. Seems a little odd, seeing as every time I hear someone has this surgery there is always some kind of number prefix. —Preceding unsigned comment added by 82.23.199.1 (talk • contribs) 14:26, 30 November 2006 (UTC)[reply]

Single, double, triple, quadruple -- refers to the number of coronary arteries that are bypassed in the procedure. In other words, a double bypass means two vessels are bypassed (e.g. the left anterior descending coronary artery (LAD) and right coronary artery (RCA)); a triple bypass means three vessels are bypassed (e.g. LAD, RCA, left circumflex artery (LCX)); a quadruple bypass means four vessels are bypassed (e.g. LAD, RCA, LCX, first diagnonal artery of the LAD).
There are some pictures:
Generally speaking, the higher the number the bypasses-- the longer the procedure & the sicker the patient. Nephron  T|C 04:54, 1 December 2006 (UTC)[reply]
The above sentence is directly contradicted by the article. Erb2000 00:35, 19 October 2007 (UTC)[reply]
The article is correct. The above statement was once in the article. I added the example of left main disease (with the highest risk of death) requiring only two bypasses. The above sentence is correct that more bypasses requires more time. Dlodge 02:45, 19 October 2007 (UTC)[reply]
I think Erb2000 is referring to the sicker patient bit, which I know David (Dlodge) removed at some point when I had added it to the article earlier.
More disease, that is amendable to bypass, gets a larger number of bypasses, i.e. a patient with diffuse 2 vessel disease (not amendable to PCI) ideally gets two (or more) bypasses (if technically feasible); a patient with diffuse 3 vessel disease (not amendable to PCI) ideally gets three (or more) bypasses (if technically feasible).
Dissecting the statement a bit further, cardiac surgeons often forgo grafting less dominant vessels with diffuse disease -- not considered salvageable by bypass. If you really want to pick appart the statement you have to define sicker patient, which I suppose could be done with something like the NYHA classification or the CCS classification. Examined in this respect, the article is correct; sicker patients (as defined by the CCS classification) typically don't get more bypasses.[3] Nephron  T|C 08:34, 19 October 2007 (UTC)[reply]

In the illustration, I cannot see the difference between the triple and quadruple. Maybe a description would help. 108.203.48.183 (talk) 16:01, 21 April 2014 (UTC)[reply]

Clarifications

I made many changes to this article to help improve its accuracy. If there are any issues, let me know and I will explain further. You cannot talk about on pump bypass surgery without mentioning the aortic cross clamp and the perfusionist. Partial clamp grafts are done while still on bypass, so they don't reduce bypass time. Respiratory therapists do not intubate patients before surgery. Nearly all bypass surgeries use the LIMA and the saphenous vein. The other arteries are rarely used. Boyd888 23:28, 8 November 2007 (UTC)[reply]

I undid the edits. I recognize the edits were well-intentioned.
  • CRNA's are unique to the U.S - RTs do intubate patients in some OR's.
  • Proximal SVG's can can be done after the heart is restarted and bypass is stopped (all off-pump SVG proximals, T-grafts from the IMA's aside, are done with the C-clamp) - but this is not done because it is safer to remain on bypass. Many surgeons refuse to use the C-clamp in on-pump cases (and do the proximal SVG's with the cross-clamp in place) because the extra aortic manipulation increases the risk of stroke. The multiple applications of the partial occlusion clamp are probably more risky than a few extra minutes on CPB.
  • Radial arteries are commonly used - there is a lot of literature on their use (the best would be the RAPS study published by Desai et al in the NEJM). Many institutions practice total arterial grafting (TAG) - using SVG's only when the IMA's and radials have been used (some surgeons will use bilateral IMA's and radials, but bilateral radials is rare). Look up PMID:17956634 by Legare et al - 4696 CABG patients with 1019 patients undergoing TAG (22%); the raw outcomes show a mortality benefit with TAG, but this was not proven when adjusted for clinical factors. The LIMA to LAD graft has been shown to improve survival, and is the standard of care for CABG. Evidence shows radials (RAPS was the landmark study) and RIMA'a are superior to SVGs, but there is no proven mortality benefit, so it has not become the standard of care. SVG harvesting is less resource intensive (much faster and therefore cheaper than radials and bilateral IMA's) and hospitals / surgeons receive the same amount of money for CABGs done with multiple arterials vs. SVG's. Dlodge 05:28, 12 November 2007 (UTC)[reply]
There was no need to remove ALL of my edits. I see you added CRNA back in. In addition, the perfusionist is mentioned in the caption in the main article picture; that position surely deserves mention in the procedure/article itself. The way it was written made it sound like the surgeon ran the bypass machine. Heparin and Protamine are two very widely used drugs and deserve mention as well. It would also make a great addition to the article to mention some of the issues that arise from the usage of these drugs (coagulation issues, HIT, protamine reactions, etc) since they are some of the most common complications seen. Boyd888 02:02, 15 November 2007 (UTC)[reply]
Sorry about removing all of the edits. Protamine, heparin, HIT, aortic cross-clamps and procedures to institute CPB would be more appropriate on the Cardiopulmonary bypass page rather than on the CABG page. I think stating only "starting CPB and arresting the heart" is appropriate in the simplified CABG procedure. If someone is interested, they can read the specifics on the CPB page. Also the information could be easily accessible from all cardiac surgery pages rather than on only the CABG page. Dlodge 02:45, 15 November 2007 (UTC)[reply]

Prognosis

It says in the article that: " The older patient can usually be expected to suffer further blockage of the coronary arteries". There is no indication what is meant by "older". Could this be added? Aixroot (talk) 09:44, 28 January 2008 (UTC)[reply]

At present, it cannot be added, as no such research exists. Indeed, due to patient education on diet, blood pressure, cholesterol control and exercise, the repeat of further myocardial vascular incidents has gone far on from mere months to a few years to multiple decades and beyond.Wzrd1 (talk) 04:24, 16 February 2012 (UTC)[reply]

External links?

Why is there an external link section and no external links? 24.22.24.208 (talk) 03:55, 4 March 2008 (UTC)[reply]

Because the links that were there were deleted for being linkspam. I have now added one good external link. Dlodge (talk) 06:13, 4 March 2008 (UTC)[reply]

Diagram?

Would a diagram be useful, to make the article easier to understand? Ultra two (talk) 17:29, 1 November 2008 (UTC)[reply]

A diagram would be very helpful. Finding an image without copyright issues may be challenging. Dlodge (talk) 19:01, 2 November 2008 (UTC)[reply]

Risks & unbalanced statements

The risks located on this page should be cleaned up. The broad general surgical risks should be moved to the "Surgery" page. General cardiac surgery risks should be moved to the higher level "cardiac surgery" page.

The statements regarding lack of comparison to placebo is very unbalanced and should be removed. The reality is there are many good trials demonstrating superiority of CABG to medical management and / or PCI. It is unethical to conduct any form of "sham surgery". If these statements are to be included as the second side of a debate, the citations for the original research studies must be provided. Dlodge (talk) 22:58, 3 March 2010 (UTC)[reply]

The controversy section is rather POV and dated to when insurance companies were considering cardiac bypass surgery "experimental"

Can we get a subject matter expert to restore NPOV? I know as FACT WITNESSED (pity it's OR), that patients who had cardiac bypass surgery survived for a generation, whereas those who were denied, due to insurance issues, did not. I lack the time necessary to dig into the NIH archives and WHO archives to give balance to that section.Wzrd1 (talk) 04:28, 16 February 2012 (UTC)[reply]

Image

Advice — Preceding unsigned comment added by Advicexxx (talk • contribs) 01:08, 30 January 2014 (UTC)[reply]

Thanks for the link to the image. If you have created it and would like help uploading it, see the picture tutorial. Graham87 01:52, 30 January 2014 (UTC)[reply]

on-pump, off-pump

"Two alternative techniques are also available allowing CABG to be performed on a beating heart either without using the cardiopulmonary bypass deemed as "off-pump" surgery or performing beating surgery using partial assistance of the cardiopulmonary bypass called as "on-pump beating" surgery. The latter gathers the advantages of the on-pump stopped and off-pump while minimizing their respective side-effects."

Hello, as a non-expert, I am having difficulty parsing these two sentences. Let me give it a try. The following is what I think this text may be saying:

Two alternative techniques are also available allowing CABG to be performed on a beating heart, 1) without using cardiopulmonary bypass at all, this is called "off-pump surgery", and 2) using partial assistance from the cardiopulmonary bypass, this is called "on-pump beating surgery". The latter combines the advantages of cardiopulmonary bypass (on-pump) and off-pump surgery while minimizing their respective side-effects.

My problem with the original is that I'm not sure if the 'deemed as' refers to cardiopulmonary bypass itself, or 'without using cardiopulmonary bypass', because the word pump does not appear in connection with cardiopulmonary bypass in the preceding text. In the second sentence, 'on-pump stopped' also leaves me bewildered.

As an aside, is aortic no-touch technique something that deserves mention in wikipedia? Papafrancis (talk) 18:01, 17 September 2015 (UTC)[reply]

NEJM review

doi:10.1056/NEJMra1406944 JFW | T@lk 05:01, 19 May 2016 (UTC)[reply]

Donor vessel

Shouldn't there be a section on the donor vessel in the article? Which vessels are being used as donor vessel? Why that vessel or those vessels? This with some good pictures would improve the article. I am insufficiently knowledgable on the subject to do it myself so I simply address it. 145.132.75.218 (talk) 16:19, 22 October 2019 (UTC)[reply]

Section "Complications"

Complications section (see current version) shouldnt be an indiscriminate list of various complications that might appear. Rather we should be describing the most common and dangerous (ie graft failure, heart failure, infection, sepsis, renal failure, Stroke and maybe some more), so reader should put things into the right perspective. Cinadon36 09:16, 19 September 2022 (UTC)[reply]

Section Procedure

Section procedure should have just two subsections, on and off Pump (criticism for current version. Cinadon36 09:19, 19 September 2022 (UTC)[reply]

GA Review

GA toolbox
Reviewing
This review is transcluded from Talk:Coronary artery bypass surgery/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Tom (LT) (talk · contribs) 04:26, 23 October 2022 (UTC)[reply]


Hi, nice to meet you, I will be taking up this review. I'll be reviewing this article against the six good article criteria (WP:GA?). As way of introduction, I mostly edit anatomy and medical articles and have reviewed around 75 - 100 articles for GA status. I will spend a few days examining this article before posting my assessment and as always look forward to a dialogue after if there are no significant issues identified. Cheers, Tom (LT) (talk) 04:26, 23 October 2022 (UTC)[reply]

Hi Tom, nice meeting you! That is an impressive number of GA reviews! I will be awaiting your review and comments. Note that I have listed the article for Copy-editing ( I am not a native English speaker). Maybe we can postpone the review, maybe not- I am not sure. Cinadon36 05:07, 23 October 2022 (UTC)[reply]

Hi Cinadon36, thanks for your edits and this nomination. I have had a look and do have some issues:

  • I agree with you that this article needs some copy-editing.
  • I think also that this article needs to be simplified a bit - it's full of acronyms, medical jargon and written I think from a surgical / medical perspective. Concepts should be wikilinked where possible. I wrote an essay about this topic if it helps: WP:ANATSIMPLIFY. See also: Wikipedia:Manual_of_Style/Medicine-related_articles#Common_pitfalls.
  • I can't help but feel this article is not as comprehensive as it could be (see Wikipedia:Manual_of_Style/Medicine-related_articles#Surgeries_and_procedures for common headings) - I think in particular the non surgical course before and after the operation could be more fully explained, and, in fact, lots of things are just listed but not much attempt is made to explain in simple terms why they occur.

Thanks greatly for your edits to this article - it's clear a lot of effort has been put in, and the referencing is solid and the pictures are pretty relevant. However, Rome wasn't built in a day and, with the active copyediting tag and these issues, I'm going to fail this review for the moment. Happy to take up the review again if you want to renominate once you've addressed these issues. Thanks again for your contributions, Tom (LT) (talk) 09:38, 25 October 2022 (UTC)[reply]

Thanks @Tom (LT): for review. I was not aware of those guidelines, I will have a look. I will try to improve the article further and I will call for yet another review. Cinadon36 11:34, 25 October 2022 (UTC)[reply]
You're welcome. By the way, asking here (WP:GOCE) and here (WT:MED) might help you find editors willing to copyedit. Tom (LT) (talk) 09:24, 26 October 2022 (UTC)[reply]

Copy editing comments

@Cinadon36: I'll try to do a good copy edit. From a glance, there are a lot of exotic medical terms used here that will really need context and glossing, especially for such an important article like this one, which should be broadly accessible. I will note those as applicable and gloss the few I'm familiar enough with. I would pretend like you are writing for a 16 year old, with a basic understanding of the body as might be learned in high school. It's much better to be slightly imprecise or informal ("heart attack" instead of "myocardial infarction") than to make an article impenetrable to anyone not already immersed in the subject. Ovinus (talk) 01:29, 17 December 2022 (UTC)[reply]

Hi @Ovinus and thank you for taking up this difficult task. I will try to be as helpful as possible. Cinadon36 09:31, 17 December 2022 (UTC)[reply]
Thanks for the help. Ovinus (talk) 15:39, 22 December 2022 (UTC)[reply]

Terms that need to be defined

A list of terms that (in my opinion) must be defined or simply not used. (in progress)

Ones I tried to do myself
  • ischemic, anastomosis, stenotic, lesion, angina, myocardial infarction, graft
    • Ischemic: (USA english) or ischaemic (UK english) roughly means that a territory gets less blood than needed to survive.
    • Anastomosis: Anastomosis is a connection of two vessels. It is made by surgeons. Usually they open a hole in the side of one vessel and, using sutures, they attach the other vessel to it, so blood can flow from one vessel to another.
    • stenotic: Partially obstructed.
    • Lesion: an abnormality
    • Stenotic lesion in a vessel. A point where the normal wall of a vessel has been modified, most commonly because of accumulated fat. This fat causes the diameter of the vessel to become smaller and smaller. It is called a stenotic lession. The tissue that depends on the vessel becomes ischaemic.
    • Angina (or more formally angina pectoris) is the chest pain that is caused by heart that receives less blood than it needs to survive. Ischaemic heart disease causes angina.
    • Myocardial infraction: Roughly, no blood is supplied to a territory of the heart. A stenotic lesion has become totally occluded for some reason, or thrombus has been created (because of the stenotic lesion) that wont let blood flow towards the rest of the heart tissue.
    • Graft: Graft in the context of cardiac surgery, is a tube that is used to overpass a stenotic lesion and thus protect the heart from an infraction. Grafts used in CABG are other body vessels, either veins or arteries.
Ones I have no clue about
  • left internal mammary artery (maybe elaboration isn't necessary for this one, but the link doesn't make sense to me)
    • Each important artery in our body has a name. Now, in most cases, there are two pairs of each artery, one in each side of our body. Left kidney artery, right kidney artery. Left testicular artery, right testicular artery. So Left IMA is the IMA on the left side of our body. In many cases, there are two arteries suppling a tissue or an organ. There are various ways to qualify them, one of them is being exterior or interior to another structure. In this case, since the location of the specific artery is within the rib cage, it is called interior. (There is another artery that is called external mammary artery). Mammary signifies that it mostly supplies mammaries, mammaries are the breasts we have. So the artery that runs parallel and somewhat left to our sternum, inside of the ribs, is called left internal mammary artery or LIMA. There is another one in the right side, it is called Righ internal mammary artery (RIMA). To make things more confusing, some decades ago, it was known as Left internal Thoracic Artery (LITA) and RITA. But now the word mammary is more commonly used. Are you still perplexed? Any questions? Dont hesitate, please ask! Cinadon36 09:41, 17 December 2022 (UTC)[reply]
  • dobutamine stress echocardiography
    • Echocardiography, or echo, is a scan of the heart. Basically, you can check how heart contracts, and also how valves are working. It is widely used to examine all kinds of patients, either they are having symptoms or not (ie young athletes). It examines the heart when patient is resting. Sometimes, a CAD does not have any echographic manifestations when patient is at rest. So what cardiologists do to overcome this issue? Instead of walking in a treadmill (as it happens with cardiac stress test), they inject dobutamine to the patient. dobutamine is a drug that makes heart work as if patient is exercising. Then cardiologists can see how heart is functioning and valves work, under stress. This examination is called dobutamine stress echocardiography. It is considered more advanced than echocardiography.
      • Could we find a suitable place to wikilink this? And could we introduce it in the "Coronary artery disease" section instead of "stable patients"? I've removed the parenthetical in "Stable patients" containing a list of noninvasive procedures, since that should be redundant with the section above. Ovinus (alt) (talk) 21:04, 19 January 2023 (UTC)[reply]
  • LV function
    • Function of Left Ventricle
  • LM disease
    • CAD disease spotted in the Left Main Artery (LM). It is considered more significant that stenosis in some other branch of cardiac arteries. LM has two branches LAD and Cx
  • LAD.
    • Left Ascending Artery. The most significant vessel of the heart, after Left Main Artery. It supplies large part of Left Ventricle.
  • Cx
    • Circumflex artery. A branch of the LM.
  • RCA
    • Right Coronary Artery. Supplies the right ventricle (roughly speaking)

Continuing

Thanks for your ongoing effort to improve the article. Cinadon36 08:48, 20 January 2023 (UTC)[reply]

  • If you could think of a better way to define or explain "pseudo-lumen", that would be appreciated. Ovinus (talk) 22:25, 23 January 2023 (UTC)[reply]
    • In dissection, the internal layer of the aorta is teared (Aorta has 3 layers). After the tear, the two layers (internal and the "middle one") separate because of the blood pressure's force. A space is created that resembles a lumen. This illustration from Radiopedia [5] may help you visualize what a false is .
      Blood penetrates the intima and enters the media layer. (From WP article on Aortic dissection
  • "runoff of LM is not protected by a patent graft since previous CABG operation" what is a runoff? I don't understand Ovinus (talk) 22:25, 23 January 2023 (UTC)[reply]
    • Runoff is the vascular bed after a given point. For example the runoff of Left Main is the left anterior descending (LAD) and Circumflex artery (Cx). So lets say a patients has a lesion at LM, then in case of occlusion, the branches (LAD and Cx) will have no blood flowing through them. Now, had a patient had a CABG (with an anastomosis to LAD), and subsequently developed an LM lesion, there will be less risk for him since blood will still be delivered. Thus, in the former case, it is said that the patient has an "unprotected LM", while in the latter case, he has "protected LM"
  • "branch of the conduit insufficiently sealed or from the sternum" What does this mean? (The vessel is attached to the sternum during the procedure?) Ovinus (talk) 22:25, 23 January 2023 (UTC)[reply]
    • Maybe it needs an oxford comma. Common sites of surgical bleeding in cases of CABG include a) the sternum and b)a branch of a graft-conduit that has not been sealed properly.
      • Gotcha
  • "optimization of pre- and afterload" What are these? Ovinus (talk) 04:41, 25 January 2023 (UTC)[reply]
    • Think as if load means "work has to be done". Pre-load, means the work has to be done for issues that are "before" heart. The more blood there is in the venous systems, the more the work heart has to do in order to circulate it. Afterload, is the work that has to be done for issues that lies "ahead" of the heart. Lets say the arteries constrict for a reason and thus blood pressure rises. So, heart will spend more energy to move 100 ml of blood from its champers to the circulation. In such cases, we say "there is increased afterload". Going back to the article, when writing "optimization of pre- and afterload" I mean we make sure there is adequate but not excessive fluid within the veins and the blood pressure is not too high. Look, I know pre-load and afterload are not easy meanings to grasp. If there are any questions, pls ask. Cinadon36 08:22, 25 January 2023 (UTC)[reply]
  • "either technical or patient factors" What is a technical factor? Ovinus (talk) 04:41, 25 January 2023 (UTC)[reply]
    An infraction may occur because of technical factor (bad anastomosis technique, kinking of the graft, too much tension of the graft, rotation of the graft) or a patient factor (commonly: too much coronary artery disease) Cinadon36 08:25, 25 January 2023 (UTC)[reply]
  • "New ECG features as Q waves and/or US documented alternation of cardiac wall motions are indicative." Indicative of what? Ovinus (talk) 04:41, 25 January 2023 (UTC)[reply]
    Indicative of the Myocardial Infraction.Cinadon36 08:26, 25 January 2023 (UTC)[reply]
  • "Inflammation caused by CPB, hypoperfusion or cerebral embolism." What are we saying about the inflammation? Ovinus (talk) 04:41, 25 January 2023 (UTC)[reply]
    Oh, ok, makes no sense. Fixed that. [6] Cinadon36 08:28, 25 January 2023 (UTC)[reply]
  • "hypoperfusion" What does this mean in context? Ovinus (talk) 04:41, 25 January 2023 (UTC)[reply]
    It means that brain does not adequate blood (and oxygen). Most common it is because of technical factors (aortic cannula that delivers blood to the body during CPB has been misplaced)Cinadon36 08:30, 25 January 2023 (UTC)[reply]

Pre-GAN note

@Cinadon36: This page has two [citation needed] tags that really should be resolved immediately. Sammi Brie (she/her • t • c) 19:49, 24 August 2023 (UTC)[reply]

Not any more![7] Thanks Cinadon36 20:40, 24 August 2023 (UTC)[reply]

Recent edits

Recent edits by Wpntm have tried to increase the prominence of René Favaloro; while that might be a worthy goal, I'm not really sure that was the best way of going about it so I [[Special:Diff/1180576328|reverted them. The sources they used are not as comprehensive as the Head (2013) reference that's already in the article; I don't know much about the topic but I doubt there's a much better source than Head (2013), which also gives a little more prominence to Favaloro than we do ... although not in a very encyclopedic way. Pinging Cinadon36, the main writer of this page. Graham87 (talk) 15:49, 17 October 2023 (UTC)[reply]

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