20042005 Guidelines for the Clinical Application of Bypass Grafts and the Surgical Techniques (JCS 2006) 2006 11 1 2 2.1 2.1.1 CCAB 2.1.2 2.1.3 2.1.4 2.1.5 2.1.6 2.1.7 2.2 2.2.1 MIDCAB 2.2.2 2.3 CCAB OPCAB 3 3.1 LITA 3.2 RITA 3.3 GEA 3.4 IEA 3.5 RA 3.6 SVG Circulation Journal Vol. 70, Suppl. IV, 2006 1555
20042005 4 4.1 In-situ graft 4.2 Free graft 4.2.1 4.2.2 Composite graft 5 5.1 LAD 5.2 LAD 5.2.1 Cx 5.2.2 RCA 6 6.1 6.2 Ca 6.3 PCI 6.3.1 6.3.2 6.4 6.5 6.6 6.7 6.8 7 CABG 7.1 80 7.2 7.3 7.4 7.5 7.6 7.6.1 1 7.6.2 7.6.3 2 7.7 Porcelain aorta 7.8 7.9 7.9.1 AS 7.9.2 MR 7.10 7.11 7.11.1 7.11.2 7.12 7.13 7.14 7.15 7.16 Acute Coronary Syndromes 7.17 8 8.1 8.2 8.3 8.4 8.5 9 CABG 9.1 CABG 9.2 CABG DPC 9.2.1 CCABOPCAB 9.2.2 9.2.3 10 10.1 10.1.1 10.1.2 10.2 10.2.1 10.2.2 10.3 Awake OPCAB 10.3.1 10.4 10.4.1 10.4.2 TMLR 10.4.3 TMLR CABG ACCAHA 1999 2004 OPCAB CABG 60 % PCI CABG 8 ACCAHA CABG ACCAHA 1556 Circulation Journal Vol. 70, Suppl. IV, 2006
ACCAHA Class Class Class a b Class Class evidence level 3 evidence level A B1 C 2.1 CCAB OPCAB CCAB ACCAHA OPCAB 2.1.1 OPCAB Class evidence level B Classaevidence level B Classb evidence level C Classevidence level B 1 2 3 4 2.1.2 CCAB CABG CCAB OPCAB CABG Class 2.1.3 Class OPCAB CCABG Classa 2.1.4 Classbevidence level B skeletonization Classa 2.1.5 OPCAB Classbevidence level C 2.1.6 CABG Class Circulation Journal Vol. 70, Suppl. IV, 2006 1557
20042005 Classaevidence Classa 2.1.7 OPCAB CCAB 30 1-2 Class evidence level A OPCAB CCAB Classevidence level B OPCAB CCAB Classevidence level A OPCAB CCAB ICU Classevidence level A Classbevidence level C Classbevidence level C 2.3 OPCAB CCAB Classevidence level A stabilizer heart postioner OPCAB CCAB Classaevidence level A OPCAB CCAB Classaevidence level B 2.2 2.2.1 MIDCAB Minimally Invasive Direct Coronary Artery Bypass in-situ LAD Class evidence level A Classa LAD LAD Classb Classevidence level C Classevidence level C MIDCAB MIDCAB Class 2.2.2 OPCAB Classaevidence level C In-situ graft, Free graft, Composite graft 3.1 LAD LITA Class LITACx LITALAD Classa LITA skeletonization Classa 3.2 BITA mortality morbidity Classa In situ RITA 1558 Circulation Journal Vol. 70, Suppl. IV, 2006
Classa 3.3 GEA Classa GEA Class a Classb SVG Classevidence level A 3.4 4.1 IEA composite graft free graft evidence 3.5 RA LAD ITA Classa RA in-situ ITA A-C Classa A-C RA SVG Classa RA Classa 3.6 SVG CABG emergency rescue CABG 1 SVG 10 60 % LITA-LAD RA SVG Classb RCA SVG GEA In situ LITA LAD Class In situ RITA LAD LITA quality Class BITA single ITA mortality, morbidity Classaevidence In situ ITA SVG flow demand Class skeletonization In situ ITA skeletonization BITA Classaevidence level B In situ GEA Classa 4.2 4.2.1 SVG 10 50 % SVG LAD Classa A-C RA SVG Classa Circulation Journal Vol. 70, Suppl. IV, 2006 1559
20042005 A-C radial artery Classa atheromatous emboli Classaevidence level C OPCAB Class evidence level C 4.2.2 LITA-RITA LITA-RA Y-composite graft LITA Classevidence level B LITA-RITA LITA-RA composite graft Class Composite graft Classa in-situ ITA Y-composite graft Classaevidence level C LAD 2 FAD LITARITARASVG Dx LITARITARASVG Composite RAFITA Cx LITARITARASVG Composite RAFITA RCA1-3 RITAGEARASVG Composite RAFITA RCA4 GEARASVG Composite RAFITA LADleft anterior descending arterydxdiagonal arteryco circumflex arteryrcaright coronary arterylitaleft internal thoracic arteryritaright internal thoracic arteryraradial arterysvgsaphenous vein graftgeagastro epiproic artery FITAfree internal thoracic artery 5.1 LAD Classa LAD ITA SVG Class LAD RITA LITA Class 5.2 LAD ITA LAD CxRCA LAD ITA RASVG LAD ITA ITA RCA Cx Classaevidence LAD ITA RA Classa LAD ITA SVG 10 Classa LAD RA SVG Classbevidence level C 5.2.1 LAD ITA ITA RCA Cx Classaevidence 1560 Circulation Journal Vol. 70, Suppl. IV, 2006
5.2.2 RCA#1-3 RCA #1-3#4 Classa RCA GEA SVG Classbevidence 6.1 Classevidence level A 6.2 CABG RA Carpentier Ca RA 6.3 6.3.1 Classaevidence 6.3.2 6.4 CABG Classevidence level A 6.5 Ca 1 CABG 2 CABG CABG 6.6 CABG Class 6.7 CABG Class Class 6.8 CABG Classevidence level B Circulation Journal Vol. 70, Suppl. IV, 2006 1561
20042005 7.5 Class b evidence level C 7.1 7.6 LAD 80 Classa OPCAB 80 Classaevidence level C 7.2 Class OPCAB Class a 7.3 PCI CABG Class skeletonization Classa OPCAB Classb 7.4 Classa MIDCAB Classbevidence level C 1 2 Classa 7.6.1 1 TEE OPCAB Classevidence level C CABG 24 4 Classbevidence level C CABG 36 Classaevidence level C Classbevidence level C 7.6.2 80 % CABG Classa evidence level C 65 1562 Circulation Journal Vol. 70, Suppl. IV, 2006
Classaevidence level C 7.6.3 2 CABG ICU 7.7 OPCAB Classa Classaevidence level C Classbevidence level C Class 7.8 2 high risk OPCAB Child-Pugh B C Classbevidence level C CABG MR Classb evidence level C 7.10 CABG Classevidence Classa Classb 7.11 7.11.1 1630 % 1530 % 7.11.2 34 % 25 % CABG PTCA 7.9 7.12 7.9.1 CABG AS AVRClassevidence CABG AS AVR AVR Classaevidence level C CABG AS AVR AVR Classbevidence level C 7.9.2 CABG MR Classa CABG PCI Class CABG 3 Class CABG Classa LAD Circulation Journal Vol. 70, Suppl. IV, 2006 1563
20042005 50 % Classa 7.13 37 % 78 % CABG Classa 7.14 CABGClassevidence level B CABG Classa CABG Classbevidence level C 7.15 CABG 7.16 PCI CABG CABG PCI Classaevidence level A 7.17 CABGClass CABGClassaevidence Classbevidence level C 8.1 3 8.2 STS database Euro SCORE 8.3 STS risk algorithm Euro SCORE 8.4 CABG CABG 1564 Circulation Journal Vol. 70, Suppl. IV, 2006
Parsonnet score Higgins score French score OPR score Pons score Euro SCORE STS risk algorithm 1989 1992 1995 1995 1996 1999 1994 single center single center Multi center 42 Multi center 9 Multi center 7 Multi center 128 Multi center USA USA France Canada Spein 8 USA 3500 5051 7181 13098 1309 19030 728 20 13 11 6 11 23 14 Heart Surgery for CABG Heart Surgery Heart Surgery Heart Surgery Heart Surgery Heart Surgery Mortality Mortality Mortality Mortality Mortality Mortality Mortality Morbidity Morbidity Morbidity Morbidity Morbidity Univariated and Univariated and Univariated and Univariated and Univariated and Univariated and Univariated and logistic regression logistic regression logistic regression logistic regression logistic regression logistic regression logistic regression analysis analysis analysis analysis analysis analysis analysis Score Score Score Score Score Inter net Inter net data data data data data mortality mortality morbidity morbidity 8.5 9.1, STS Euro SCORE morbidity CABG CABG 1 CABG evidence level A CABG PCI doctor's feesurgeon s fee 2 17 82 DPC DPC 3 2 1 18 PCI CABG PCI 16 OPCAB 60 % Circulation Journal Vol. 70, Suppl. IV, 2006 1565
20042005 CCAB OPCAB 4 PCI CABG Drug eluting stent 16 9 9.2 15 35.219.9 29 0.56 11.211.2 7 23.214.7 19 3,494,9001,592,000 3,310,000 0.46 9.2.1 34.220.1 vs 36.719.6 p0.01 11.1 11.3 vs 10.911.1 NS 22.014.8 vs 25.014.5 p0.001 OPCAB 3,100,0001,140,000 vs 4,100,0001,960,000 p0.001 OPCAB 100 OPCAB OPCAB 30 % on pump CABG 20 9.2.2 On pump CABG 1 487,000 2 813,000 OPCAB 30 % 1 146,100 2 243,900 OPCAB on pump CABG 255,000 200 % 9.2.3 OPCAB DPC incentive OPCAB CCAB OPCAB single use 10.1 Classb evidence level C SVG 2 10.1.1 10.1.2 MVP systemst Jude Medical ATG coronary connector system St Jude Medical Inc, St Paul, Minn 2 1566 Circulation Journal Vol. 70, Suppl. IV, 2006
10.2 Classevidence level C 2 AESOPIntuitive Surgical, Inc. Sunnyvale, CA da Vinci Surgical System 10.2.1 OPCAB TEA Awake CABG 10.4 Classaevidence level A CO2 Transmyocardial surgical laser revascularizationtmlr 10.2.2 10.4.1 1 10.3 Classevidence level C High Thoracic epidural anesthesia: TEA awake off-pump CABGAwake OPCAB 1999 Awake OPCAB TEA 10.3.1 Awake OPCAB LAD 1 RCA 2 Awake OPCAB TMLR PCI CABG 10.4.2 TMLR CO2 Heart Laser TM PLC Medical Systems, Milford, MAHolmiumYAG Eclipse TM Cardio Genesis Corp, Sunnyvale, CA 2 CO2 HolmiumYAG 1 1 HolmiumYAG CO2 photoacoustic 10.4.3 TMLR 1 23 TMLR OPCAB Circulation Journal Vol. 70, Suppl. IV, 2006 1567