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Coronary artery bypass grafting

Last updated: October 9, 2020


Coronary artery bypass grafting (or CABG) is a cardiac revascularization technique used to treat patients with significant, symptomatic stenosis of the coronary artery (or its branches). The stenosed segment is bypassed using an arterial (e.g., internal thoracic artery) or venous (e.g., great saphenous vein) autograft, re-establishing blood flow to the ischemic areas of the myocardium. This may be performed either with the help of a heart-lung bypass machine (traditional CABG, performed via a thoracotomy), or on a beating heart (off-pump CABG, and minimally invasive direct CABG). In addition to general surgical risks, the main complications associated with bypass grafting are bypass occlusion and postpericardiotomy syndrome. The procedure provides more effective symptom relief than medical management and is superior to PCI in multivessel coronary disease.


Indication for CABG is established after careful consideration of the clinical features, coronary catheterization findings, cardiac function, and the patient's general condition.



There are no absolute contraindications for CABG. Relative contraindications include:


We list the most important contraindications. The selection is not exhaustive.


  • Types of CABG
    • Traditional CABG
    • Off-pump coronary artery bypass (OPCAB) surgery
    • Minimally invasive direct, or totally endoscopic CABG
  • Alternate procedure: percutaneous coronary intervention (PCI)
    • Advantages: decreased periprocedural morbidity, decreased cost, decreased hospital stay
    • Disadvantages: higher rate of patients requiring reintervention
    • CABG is proven to be a superior long-term form of revascularization in high-risk multivessel disease (diabetics or low LV function), certain cases of severe two-vessel CAD, and in all patients with three-vessel CAD.
    • PCI is preferred in cases with symptomatic low-risk obstruction (single vessel, mild double vessel obstruction).

Postoperative long-term treatment with antiplatelet drugs (e.g., 100 mg aspirin 1-0-0) is required to reduce the risk of subsequent myocardial ischemia!



Cardiac complications

Mediastinal complications



We list the most important complications. The selection is not exhaustive.

Outcome and prognosis

  • Prognosis following CABG depends on a variety of factors, such as anatomical location and severity of the stenoses, presence of comorbidities, patient age, and preoperative levels of activity.
  • Successful grafts typically last 8–15 years and provide an improved chance of survival (decreased 5-year mortality, especially in patients with triple vessel disease).
  • Further progression of arteriosclerosis may still occur after CABG.


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