Coronary Artery Bypass Graft (CABG) Surgery: Eligibility Criteria and Preoperative Steps

Coronary artery bypass grafting (CABG) is recommended for patients with significant coronary artery disease (CAD) not optimally managed with medical therapy or percutaneous coronary intervention (PCI). Eligibility is determined through a comprehensive, multidisciplinary evaluation.

General Requirements for CABG

1. Medical Necessity: Documented significant left main disease, multi-vessel CAD with reduced left ventricular function, diabetes with multi-vessel disease, or refractory angina despite optimal medical therapy.
2. Diagnostic Confirmation: Coronary angiography (cardiac catheterization) defining anatomy; often supplemented by stress testing, echocardiography, CT angiography, or fractional flow reserve (FFR).
3. Comorbidity Assessment: Evaluation of diabetes, chronic kidney disease, COPD, peripheral arterial disease, frailty, and prior stroke — impacting surgical risk (STS/EuroSCORE).
4. Age Considerations: No absolute upper age limit; decision based on physiological age, life expectancy, frailty, and goals of care.
5. Insurance Authorization: Prior authorization required; documentation of medical necessity, failed conservative management, and Heart Team discussion (for complex cases).
6. Lifestyle Optimization: Smoking cessation (mandatory ≥4 weeks pre-op), weight management, glycemic control, cardiac rehabilitation referral.
7. Psychosocial Evaluation: Assess cognitive capacity, social support, mental health, and ability to adhere to complex postoperative regimen.
8. Preoperative Optimization: Labs (CBC, coagulation, renal, liver), chest X-ray, carotid ultrasound (if indicated), dental clearance, medication reconciliation (hold antiplatelets/anticoagulants per protocol).
9. Informed Consent: Detailed discussion of risks (stroke, MI, bleeding, infection, arrhythmia, cognitive decline, mortality), benefits, alternatives (PCI, medical management), and expected recovery.

Shared decision-making between the patient, cardiologist, and cardiac surgeon is fundamental to determining if CABG is the optimal treatment strategy.