TY - CHAP M1 - Book, Section TI - Quantitative Systematic Review A1 - Filardo, Giovanni A1 - da Graca, Briget A1 - Ballard, David J. A2 - Greenberg, Raymond S. PY - 2014 T2 - Medical Epidemiology: Population Health and Effective Health Care, 5e AB - Mr. P. is a 67-year-old, retired engineer who has had Canadian Cardiovascular Society class III angina for the past 3 months and symptomatic intermittent claudication for the past 12 months. His medical history shows no previous cardiovascular interventions, but he does have a number of vascular risk factors, including smoking, hypertension, and diabetes. Coronary angiography showed blockages in three vessels, with involvement of the left anterior descending coronary artery; his ejection fraction is 45%, and chest radiography showed a possible calcified ascending aorta. Mr. P. was referred to Dr. S. for consideration of coronary artery bypass graft surgery (CABG). After discussion of Mr. P.’s health goals and priorities and of the risks and benefits associated with CABG, Dr. S. and Mr. P. agree that surgery is the best treatment option for Mr. P. Mr. P., however, has an additional question: He has looked up some information on CABG procedures, as well as questioning friends and family members who have undergone revascularization procedures themselves or who work in medicine and has learned that CABG can be performed in more than one way, specifically, on pump (which uses cardiopulmonary bypass to enable surgeons to work on a still heart that has been arrested temporarily) versus off pump (which is performed on a beating heart). He wants to know if he is a candidate for both types of surgery, and, if so, what the risks and benefits of each type are and which is likely to offer him the best outcome. Dr. S. only performs on-pump CABG, and although he knows some of his colleagues strongly believe in the superiority of the off-pump procedure, he is not familiar enough with it to provide Mr. P. with the answers he is looking for. Because Mr. P.’s surgery is not immediately urgent, Dr. S. suggests that they schedule another appointment in a few days, giving him the opportunity to review the relevant literature regarding the two techniques. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessmedicine.mhmedical.com/content.aspx?aid=1108590843 ER -