Cardiac dysfunction in the CABG patient

Abstract

Coronary revascularization with conventional CABG has the best evidence for improving outcome in patients with ischemic heart disease. Three main complications after CABG are myocardial infarction, heart failure and atrial fibrillation. Although preoperative statin and aspirin therapy are established treatment for post CABG myocardial infarction when to stop and restart aspirin is still debatable. Evidence on the use of clopidogrel and prasugrel may be unfavourable but ticagrelor may be beneficial. In post CABG heart failure mixture of GIK, changing the cardioplegic solution and careful intra-operative management to reduce myocardial stunning may prove beneficial. Intra aortic balloon pump and ischemic preconditioning have shown benefit in the postoperative heart failure. Instead of post hoc treatment for atrial fibrillation new upstream therapies are available.