6. Left main coronary artery stenosis >50%
Stenosis of proximal LAD and proximal circumflex >70%
3-vessel disease in asymptomatic patients or those with
mild or stable angina
3-vessel disease with proximal LAD stenosis in patients with
poor left ventricular (LV) function
1- or 2-vessel disease and a large area of viable
myocardium in high-risk area in patients with stable angina
>70% proximal LAD stenosis with either ejection fraction
<50% or demonstrable ischemia on non-invasive testing
Indications for CABG
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for
Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011 Nov 7
7.
8. Saphenous v
Left internal
mammary a
Right internal
mammary a
Radial a
Right
gastroepiploic
a
Inferior
epigastric a
Splenic a
Types of graft
18. Dissection of Heart : Post CABG
Lee AH, Gallagher PJ. Post‐mortem examination after cardiac surgery.
Histopathology. 1998 Nov 1;33(5):399-405.
19. Dissection of Heart : Post CABG
Lee AH, Gallagher PJ. Post‐mortem examination after cardiac surgery.
Histopathology. 1998 Nov 1;33(5):399-405.
20. Dissection of Heart : Post CABG
Lee AH, Gallagher PJ. Post‐mortem examination after cardiac surgery.
Histopathology. 1998 Nov 1;33(5):399-405.
Transverse sections at
site of anastomoses and
from graft vessel and
occluded coronary
22. Kainuma S, Masai T, Yamauchi T, Takeda K, Iwakura K, Ito H, Abe K, Sawa Y.
Chronic expanding intrapericardial hematoma after coronary artery bypass
surgery presenting with congestive heart failure. Annals of thoracic and
cardiovascular surgery. 2008 Feb 1;14(1):52.
24. Steal – phenomenon
Takach TJ, Reul GJ, Cooley DA, Duncan JM, Livesay JJ, Ott DA, Gregoric ID.
Myocardial thievery: the coronary-subclavian steal syndrome. The Annals of
thoracic surgery. 2006 Jan 31;81(1):386-92.
25. Post graft atherosclerosis
Bernad SI, Totorean AF, Vekas L. Particles deposition induced by the
magnetic field in the coronary bypass graft model. Journal of Magnetism
and Magnetic Materials. 2016 Mar 1;401:269-86.
27. Otsuka F, Yahagi K, Sakakura K, Virmani R. Why is the mammary artery so
special and what protects it from atherosclerosis?. Annals of cardiothoracic
surgery. 2013 Jul;2(4):519.
Fibro-intimal hyperplasia at 1 week post CABG
28. Internal mammary a. is better than saphenous v.
Otsuka F, Yahagi K, Sakakura K, Virmani R. Why is the mammary artery so
special and what protects it from atherosclerosis?. Annals of cardiothoracic
surgery. 2013 Jul;2(4):519.
29. Internal mammary a. is better than saphenous v.
Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease:
pathogenesis, predisposition, and prevention. Circulation 1998;97:916-31.
IMA Saphenous vein
Anatomic properties
Endothelial fenestrations Few Many
Intercellular (IC) processes Many Few
IC junction permeability Low High
Internal elastic lamina (IEL) Well defined Poorly defined
Heparan sulfate in IEL/media High Low
Dependence on vasa vasorum Minimal High
Valves Absent Present
Size match with grafted native
vessel
Good Poor
Resistance to trauma of harvesting High Low
30. Internal mammary a. is better than saphenous v.
Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease:
pathogenesis, predisposition, and prevention. Circulation 1998;97:916-31.
IMA Saphenous vein
Physiological properties
Flow reserve High Low
Shear stress High Low
Nitric oxide/prostacyclin production High Low
Vasomotor response to thrombin Relaxation Constriction
Vasoconstrictor sensitivity Low High
Vasodilator sensitivity High Low
Basic fibroblast growth factor
receptors
Few Many (8× IMA)
Lipolysis Rapid Slow
Lipid synthesis Less active More active
Lipid uptake Slow Rapid
