Coronary artery bypass surgery perioperative management of myocardial ischemia



==ACCF/AHA Guidelines for Preconditioning/Management of Myocardial Ischemia == {{cquote|

Class I
1. Management targeted at optimizing the determinants of coronary arterial perfusion (eg, heart rate, diastolic or mean arterial pressure, and right ventricular or LV end-diastolic pressure) is recommended to reduce the risk of perioperative myocardial ischemia and infarction. (Level of Evidence: B)

Class IIa
1. Volatile-based anesthesia can be useful in reducing the risk of perioperative myocardial ischemia and infarction. (Level of Evidence: A)

Class IIb
1. The effectiveness of prophylactic pharmacological therapies or controlled reperfusion strategies aimed at inducing preconditioning or attenuating the adverse consequences of myocardial reperfusion injury or surgically induced systemic inflammation is uncertain. (Level of Evidence: A)

2. Mechanical preconditioning might be considered to reduce the risk of perioperative myocardial ischemia and infarction in patients undergoing off-pump CABG. (Level of Evidence: B)

3. Remote ischemic preconditioning strategies using peripheral-extremity occlusion/reperfusion might be considered to attenuate the adverse consequences of myocardial reperfusion injury. (Level of Evidence: B)

4. The effectiveness of postconditioning strategies to attenuate the adverse consequences of myocardial reperfusion injury is uncertain. (Level of Evidence: C)}}

==ACCF/AHA Guidelines for Management of Perioperative Myocardial Dysfunction == {{cquote|

Class IIa
1. In the absence of severe, symptomatic aorto-iliac occlusive disease or PAD, the insertion of an intraaortic balloon is reasonable to reduce mortality rate in CABG patients who are considered to be at high risk (eg, those who are undergoing reoperation or have LVEF <30% or left main CAD). (Level of Evidence: B)

2. Measurement of biomarkers of myonecrosis (eg, creatine kinase-MB, troponin) is reasonable in the first 24 hours after CABG. (Level of Evidence: A)}}

Guidelines Resources

 * 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines