Coronary artery bypass grafting

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Introduction

Commonly referred to as CABG and pronounced 'cabbage'

A surgical procedure carried out by Cardiac surgeons for patients with ischaemic heart disease (IHD) in which narrowed coronary blood vessels are bypassed using either a reversed saphenous vein graft (SVG), a left (LIMA) or right internal mammary artery (RIMA) or a radial artery graft. On-pump CABG is superior to no-pump CABG[1]

Indications

Surgery is indicated for certain patients with IHD. The aim of surgery is twofold:

  1. improve symptoms, e.g. to relieve angina or symptomatic left ventricular dysfunction
  2. improve prognosis, e.g. to prevent further MI or IHD-related death

As the name of the operation suggests, a stenosis of a coronary artery is surgically bypassed using a graft. The grafts used include the long saphenous vein, radial arteries and the internal thoracic arteries. In terms of long-term patency of the grafts, the internal thoracic arteries grafts appear to be the best, so much so that internal-thoracic-artery graft to the left anterior descending coronary artery is now routine but other grafts must use other vessels. For further grafts radial arteries are superior to veins. The advantage for prognostic reasons, of using the internal thoracic artery in a graft to the left anterior descending artery of the heart, is as this artery supplies much of the left ventricle.

The majority of CABG surgery requires cardio-pulmonary bypass, although new techniques have allowed an increasing proportion of patients to have off-pump CABG.

History

The first series of successful CABG was reported in 1968[2].

References