Coronary Artery Bypass Graft

Excerpt

Coronary artery bypass grafting (CABG) is a major surgical operation where atheromatous blockages in a patient’s coronary arteries are bypassed with harvested venous or arterial conduits. The bypass restores blood flow to the ischemic myocardium which, in turn, restores function, viability, and relieves anginal symptoms. Almost 400,000 CABG surgeries are performed each year making it the most commonly performed major surgical procedure, but surgical trends have decreased as the use of alternative options such as medical treatment and percutaneous coronary intervention (PCI) have increased.

In general, on-pump and off-pump are the 2 types of CABG surgical procedures with the difference being the use of a cardiopulmonary bypass circuit and an arrested heart to operate during an on-pump CABG. The conduits used as bypass grafts are routinely the left internal mammary artery (LIMA) and the saphenous vein grafts (SVG) out of the lower extremities. Other conduits that may be grafted include the right internal mammary artery (RIMA), the radial artery, and the gastroepiploic artery. The type and location of the grafts depend on the patient’s anatomy and the location of the arteries that are occluded. Typically, the LIMA is grafted to the left anterior descending (LAD) artery, and the other conduits are used for the other occluded arteries.