Coronary Artery Bypass Surgery
When patients have severe coronary artery disease not amenable to percutaenous coronary revascularization, Coronary Artery Bypass Surgery (CABG) is considered, particularely if left ventricular dysfunction is present. CABG involves a mid-line strenotomy followed by cardiopulmonary bypass using a heart lung machine. Then, the left internal mammary artery is taken down and attached to the left anterior descending artery and saphenous vein graft are taken from the legs and used to bypass the other arteries. Occasionally, other arterial conduits are used including the right internal mammary artery and the radial arteries. CABG results usually in complete revascularization, however, it is a major procedure. In addition, saphenous vein grafts are prone to atherosclerosis in 5-10 years (sometimes sooner). This implies that CABG should be avoided in young patients if possible. Newer techniques include MidCAB and OpCAB with minimally invasive procedures. Robotic surgery is emerging as an experimental technique to perform CABG