Surgical complications after coronary artery bypass graft (CABG) revascularization are common, especially when emergent surgery is performed after an acute myocardial infarction. They include multiorgan failure manifested by ischemic colitis (inadequate blood flow to the intestine) and kidney failure. These complications can occur in the setting of systemic emboli causing necrotic hands and toes. Systemic emboli are often attributed to cross-clamping of the aorta and may be unavoidable if a patient has a severely diseased ascending aortas. Intra-aortic balloon pumps (IABP) rarely cause this problem and would not cause emboli to the right hand because the balloon is placed in the descending aorta, downstream from the artery feeding the right hand.
Thromboembolic and ischemic complications are much more likely to occur when CABG is performed emergently. In the emergent situation, the patient’s hemodynamic status is more tenuous, frequently requiring pressor support that increases ischemic complications. This is one of the most important reasons why PCI is the standard of care for acute myocardial infarction.
Thrombotic occlusion of a stented vessel is a reason to consider CABG, but it is not the treatment of choice emergently, when rapid catheter-based therapy is an option, or balloon angioplasty with or without stenting results in a quick, reliable re-establishment of flow to a vessel.
Coronary artery bypass grafting medical expert witness specialties include cardiovascular surgery, cardiac anesthesiology, general surgery, anesthesiology, surgical critical care, critical care medicine, nad vascular surgery.