CABG (coronary artery bypass surgery, pronouncd "cabbage") is surgery involving that involves bypassing an obstructed coronary artery.

• The obstruction being bypassed is due to arteriosclerosis, atherosclerosis, or both:
  • Arteriosclerosis is characterized by thickening, loss of elasticity, and calcification of the arterial wall, most often resulting in a generalized narrowing in the affected coronary artery
  • Atheroscolerosis is characterized by yellowish plaques of cholesterol, lipids, and cellular debris deposited into the inner layer of the wall of a large or medium-sized coronary artery, most often resulting in a focal partial obstruction in the affected artery
• Each can limit blood flow if it causes a cross sectional narrowing of >50%

• Disease of the LMCA (L main coronarya rtery)
• Disease of all 3 coronary vessels (LAD, LCX, RCA)
• Diffuse disease not amnenable to Tx w/ a PCI
• Other high-risk Pt's, e.g. those w/ severe ventricular dysfunction (i.e. low ejection fraction), or diabetes mellitus

• Involves either:
  • Diverting the L internal thoracic artery to the L anterior descending (LAD) of the L main coronary artery
  • Harvested great saphenous vein of the leg, attaching the proximal end to the aorta (or 1 of its major branches), and the distal end to immediately beyond a partially obstructed coronary artery (the target vessel), usually a 50-99% blockage
• The purpose is to restore normal blood flow to that partially obstructed coronary artery
• Usually performed w/ the heart stopped, necessitating the usage of cardiopulmonary bypass. However, alternative techniques allow CABG to be performed on a beating heart:
  • Off-pump surgery, without using cardiopulmonary bypass
  • On-pump beating surgery, performing beating surgery using partial assistance of the cardiopulmonary bypass. This gathers the advantages of the on-pump stopped and off-pump while minimizing their respective side effects

• Relieve angina unsatisfactorily controlled by maximum tolerated anti-ischemic drug
• Prevent or relieve LV dysfunction
• Reduce the risk of death
• Does NOT prevent heart attacks

• Angioplasty