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Cardiothoracic Surgery Service
LAC+USC Medical Center Student Handout

Coronary Artery Disease

  • Coronary Artery Disease (CAD) is one of the leading causes of death in the US.
  • Approximately 250-300,000 coronary surgeries are performed in the US / year.
  • Approximately 250-300,000 Percutaneous Transluminal Coronary Angioplasties (PTCAs) are performed in the US / year.
  • Risk factors for developing coronary artery disease:
    • family history
    • diabetes mellitus
    • hypertension
    • hypercholesterolemia
    • smoking
  • Differentiate between coronary atherosclerosis and ischemic coronary artery disease. Ischemic disease involves areas of myocardium at risk for a myocardial infarct because of a hemodynamically significant stenosis proximally. This gives classic signs of angina pectoris.
  • Indications for Coronary Artery Bypass Grafting (CABG):
    • unstable angina
    • Left Main coronary disease
    • multiple vessel disease with crescendo angina refractory to medication
    • high grade proximal LAD diseasepost-infarction angina
    • complication of myocardial infarction (ventricular wall rupture, ventricular septal defect, papillary muscle dysfunction--acute mitral regurgitation).
    • complication of failed PTCA.
  • Common statistics for CABG:
    • operative mortality 1-3%
    • peri-operative myocardial infarction 3%
    • post-operative wound infection 3%
    • post-operative bleeding 3-5%
    • post-operative arrhythmias 30%


Possible conduits for bypass include: 1 year patency
internal mammary artery (right or left)
reverse saphenous vein graft
cephalic vein
radial artery
gastroepiploic artery
inferior epigastric artery
cadaver cryopreserved vein
synthetic conduits (Gore-Tex)


  • Recurrent Coronary Artery Disease
    • reoperation for recurrent angina is 3%/year
    • operative mortality for re-do CABG 5-7%
    • morbidity for re-do CABG 2x
    • reoperation is usually needed because:
      • Incomplete initial revascularization
      • Poor control of hypertension, cholesterol, diabetes
      • Continued smoking
      • Non-use of the IMA
      • Progressive atherosclerosis
  • 30% of the patients that undergo CABG will need "something" else done in their lifetime--re-do CABG, PTCA, etc. The hope is that by the time a further intervention is necessary, technology will have advanced and the outcome will be better.



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