The coronary artery bypass graft (CABG) operation is one of the few remaining operations/interventions on diseased arteries that are not routinely verified during or immediately after the procedure. This review answers the ‘how’, ‘when’ and ‘why’ of intraoperative CABG assessment.
More recent than new literature on this topic, is the increased interest in quality assurance of CABG. This is most likely due to reports in the last 5 years suggesting CABG superiority to percutaneous coronary intervention (PCI) for improved mid-term and long-term outcomes; for example, for patients with diabetes mellitus (Freedom Trial by Farkouh in 2012), and for patients with SYNTAX score ≥ 33 (SYNTAX Trial by Mohr in 2013). Possibly CABG is re-emerging from the era-of-better-and-better-stents and is now deemed worthy of improvement.
In order to fully compliment PCI, the operative major adverse cardiac event rate of CABG must rival that of PCI. In order to reduce technical errors, it is best practice to perform intra-operative assessment of bypasses, especially since we have the tools.
Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
Correspondence to Teresa M. Kieser, MD, PhD, FRCS, FACS, Cardiac Surgeon, Libin Cardiovascular Institute of Alberta, Associate Professor, University of Calgary, Room C814, Foothills Medical Centre, 1403, 29th St NW, Calgary, AB, Canada T2N 2T9. Tel: +1 403 944 8449; fax: +1 403 944 8495. e-mail: email@example.com