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Coronary Artery Bypass Grafting (CABG): Procedure, Grafts & Recovery

What Is CABG?

Coronary artery bypass grafting creates new conduits for blood to reach heart muscle beyond atherosclerotic blockages in the native coronary arteries.

Conduit Selection

  • Left Internal Mammary Artery (LIMA) → LAD: Gold standard; 10-year patency >90%.
  • Radial Artery: Second arterial conduit; excellent patency for non-LAD targets.
  • Saphenous Vein Grafts (SVG): Readily available; 10-year patency ~50–60%.
  • Right Internal Mammary / Gastroepiploic / Ulnar Artery: Less common, specific indications.

Operative Steps (On-Pump vs. Off-Pump)

  1. Median sternotomy (or minimally invasive thoracotomy for single-vessel).
  2. Harvest conduit(s) endoscopically or open.
  3. On-pump: Cardiopulmonary bypass, cardioplegic arrest.
  4. Off-pump (OPCAB): Stabilizers on beating heart.
  5. Proximal & distal anastomoses (microsurgical technique).
  6. Hemostasis, sternal closure (wires ± plates), chest tubes.

Postoperative Course

  • ICU 24–48 hrs: extubation, hemodynamic optimization, pacing wires.
  • Step-down → telemetry floor (total stay 4–7 days).
  • Early mobilization, incentive spirometry, cardiac rehab referral.
  • Dual antiplatelet (aspirin + P2Y12 inhibitor) per protocol; statin, beta-blocker, ACEi/ARB, SGLT2i as indicated.

Outcomes

  • Operative mortality: 1–2% (elective), higher in emergency/salvage.
  • Symptom relief (angina): >90%.
  • Survival benefit vs. medical therapy in left main / multi-vessel disease with reduced LV function.
  • 10-year freedom from reintervention: ~80% (LIMA-LAD).

CABG remains the revascularization cornerstone for complex coronary disease. Heart Team discussion (cardiologist + surgeon) guides PCI vs. CABG choice.

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