Coronary artery bypass surgery

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necessary. Surgeons check the anastomosis for patency (whether it is sufficiently open) or leaking. They then insert the graft within the pericardium, sometimes attached to the cardioplegic catheter. The anastomosis of the LIMA to the LAD is usually the last distal anastomosis to be constructed; while it is being constructed the blood rewarming process starts (by the CPB). After the anastomosis is completed and checked for leaks, the proximal anastomoses of the conduits, if any, are next. They can be done either with the clamp still on, or after removing the aortic clamp and isolating a small segment of the aorta by placing a partial clamp. That said, aortas burdened by plaques might be damaged or release atheromatous debris by being overhandled.

814: 1004:

is also dependent on whether it is isolated CABG (average, 4%, range, 0.3%–10%) or a combined operation (average, 2.0%, range, 0.7%–12%). New electrocardiogram features, such as Q waves or ultrasound-documented alternation of cardiac wall motions, are indicative. Ongoing ischemia might prompt emergency angiography and PCI or re-operation. Immediate coronary angiography offers the most expeditious modality not only for diagnosis but also for potential reintervention. Echocardiography is less valuable for the detection or confirmation of postoperative myocardial ischemia. Arrhythmias can also occur, most-commonly

790: 802: 778: 872:. CABG usually relieves angina, but in some patients it reoccurs. Around 60% of patients will be angina-free 10 years after their operation. Myocardial infarction is rare five years after a CABG, but its risk increases with time. The risk of sudden death for CABG patients is low. Quality of life is also high for at least five years, then can slowly start to decline. However, the use of bilateral mammary artery in patients of younger age and those without specific comorbidities (diabetes, obesity, steroid use) can provide excellent long-term survival and quality of life. 1132:(PCI) did not obsolesce CABG; rates of both procedures continued to increase, but PCIs grew more rapidly. In the following decades, CABG was extensively studied and compared to PCI. The absence of a clear advantage of CABG over PCI led to a small decrease in numbers of CABGs in some countries (like the US) by 2000. In Europe—mainly Germany—CABG was increasingly performed. As of 2023, research comparing the two techniques is continuing. Meta-analysis published in 2023 suggests that CABG provides a consistent survival benefit over PCI with drug-eluting stents (DES). 517: 49: 766: 642:, either from the arms or chest or from the leg, usually from the internal mammary artery or the saphenous vein. The LITA is harvested through the sternotomy. There are two common ways of mobilizing the LITA: the pedicle (i.e., a pedicle consisting of the artery plus surrounding fat and veins) and the skeletonized (i.e., freed of other tissues). Before the LITA is divided in its more distal part, the anticoagulant heparin is administered to the patient via a peripheral line, to prevent clots. 425:). Patients at risk of ongoing ischemia undergo PCI to restore blood flow and thus oxygen delivery to the struggling heart. If PCI failed to restore blood flow because of anatomical considerations or other technical problems, urgent CABG is indicated to save heart tissue. The timing of the operation plays a role in survival: It is preferable to delay the surgery if possible (three days if the infarction affecting the total thickness of the cardiac muscle, and six hours if it does not). 509: 242: 371:. An angiogram can provide detailed anatomy of coronary circulation and lesions. The significance of each lesion is determined by the diameter loss. A diameter loss of 50% translates to a 75% cross-sectional area loss, considered moderate by most groups. Severe stenosis constitutes a diameter loss of 2/3 or more—a greater-than-90% loss of cross-sectional area. To more accurately determine the severity of stenosis, interventional cardiologists may also employ 876:

improving for up to five years in some cases. Left-ventricle function and myocardial perfusion during exercise also improves after CABG. When the left ventricle is severely impaired before operation (ejection fraction below 30%), however, benefits are less impressive in terms of segmental wall movement but still significant because other parameters might improve as LV function improves; the pulmonary hypertension might be relieved and lengthen survival.

324:: the left main stem, left ascending artery, circumflex artery, and right coronary artery, and branches thereof. CAD symptoms vary from none, to chest pain only when exercising (stable angina), to chest pain even at rest (unstable angina). It can even manifest as a myocardial infarction; if blood flow to the heart is not restored within a few hours, whether spontaneously or by medical intervention, the blood-deprived part of the heart becomes 729:(IABP) might be inserted to relieve some of the burden of pumping blood, effectively reducing the amount of oxygen needed by myocardium. During operation, the standard practice is to place the patient on CPB as soon as possible and revascularize the heart with three saphenous veins. A calcified aorta also poses a problem because it is very dangerous to clamp. In this case, the operation can be done as an off-pump CAB using both 2544:

Nikola; Dambrink, Jan-Henk E.; Kala, Petr; Angerås, Oskar; MacCarthy, Philip; Wendler, Olaf; Casselman, Filip; Witt, Nils; Mavromatis, Kreton; Miner, Steven E.S.; Sarma, Jaydeep; Engstrøm, Thomas; Christiansen, Evald H.; Tonino, Pim A.L.; Reardon, Michael J.; Lu, Di; Ding, Victoria Y.; Kobayashi, Yuhei; Hlatky, Mark A.; Mahaffey, Kenneth W.; Desai, Manisha; Woo, Y. Joseph; Yeung, Alan C.; Pijls, Nico H.J. (2022-01-13).

3641: 289: 1015:—or type-2 global deficits such as delirium caused by CPB, hypoperfusion, or cerebral embolism. Cognitive impairment has been reported in up to 80% cases after CABG at discharge and lasts for a year in up to 40% of cases. The cause remains unclear; CPB is an unlikely cause because even in CABG patients without CPB, as in off-pump CABG, and PCI patients, the incidence is the same. 712:, or by placing stitches or incisions into the pericardium to help exposure. Snares and tapes are used to facilitate exposure. The aim is to avoid distal ischemia caused by blockage of the vessel supplying distal portions of the left ventricle, so usually LITA to LAD is the first to be anastomosed and others follow. For the anastomosis, a fine tube blowing humidified CO 1046: 2844: 840:, a beta agent, can increase the cardiac output and is administered some hours after the operation. Beta blockers are used to prevent atrial fibrillation and other supraventricular arrhythmias. Pacing wires attached to both atria, inserted during the operation, may help prevent atrial fibrillation. Aspirin (80 mg) is used to prevent graft failure. 755:(thoractomy), or even using an endoscope placed in the left chest. Robot-assisted coronary revascularization, which is not yet widely used, avoids the sternum incision to prevent infections and bleeding. Both conduit harvesting and the anastomosis are performed with the aid of a robot, through a thoracotomy. Usually, the procedure is combined with 482:

yields better long-term survival and outcomes. Strong indications for CABG also include symptomatic patients and impaired left ventricle function. CABG offers better results than PCI in left main disease and in CAD that affects multiple vessels, because of the protection arterial conduits offer to the native arteries of the heart, by producing

737:, lowering the temperature of the body to slightly above 20 °C (68 °F). In cases where a significant artery is totally blocked, it may be possible to remove the plaque and use the same hole in the artery to perform an anastomosis. This technique is called endarterectomy and is usually performed at the right coronary system. 705:(OPCAB) surgery avoids using the CPB machine by stabilizing small segments of the heart at a time. The surgical team and anesthesiologists must coordinate and take great care to not manipulate the heart too much, lest they compromise the stability of blood flow. Compromise should be detected immediately and appropriate action taken. 899:, and can easily be mobilized and anastomosed to the native target vessel of the heart. The left artery is most often used because it is closer to the heart, but the right artery is sometimes used, depending on patient and surgeon preferences. The ITAs are advantageous because of their endothelial cells, which produce 1084:

used skeletonized LITA, placing it in a small tunnel he created next to the LAD and hoping spontaneous collateral circulation would form. This occurred in canine experiments but not in humans. Goetz RH was the first to perform an anastomosis of the ITA to LAD in the 1960 using a sutureless technique.

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With the heart still, the tip of the heart is taken out of pericardium so that native arteries lying on the posterior side of the heart are accessible. Usually, distal anastomoses are constructed first (first to the right coronary system, then to the circumflex) and then the sequential anastomosis if

603:

A conduit can be used to graft one or more native arteries. In the latter case, an end-to-side anastomosis is performed. In the former, using a sequential anastomosis, a graft can then deliver blood to two or more native vessels of the heart. Also, the proximal part of a conduit can be anastomosed to

1003:

of more than 2.2 L/min/m. LCOS is often transient. Myocardial infarction can occur after the operation because of either technical or patient-specific factors. Its incidence is difficult to estimate due to varying definitions, but most studies place its occurrence at between 2% and 5%. The incidence

716:

keeps the surgical field clean of blood. Also, a shunt might be used so the blood can travel past the site of anastomosis. After the distal anastomoses are completed, proximal anastomoses to the aorta are constructed with a partially closed aortic clamp. The rest of the process is similar to on-pump

481:

CABG and percutaneous coronary intervention (PCI) are the two methods to restore blood flow caused by stenotic lesions of the coronary arteries. The choice of method is still a matter of debate, but it is clear that in the presence of complex lesions, significant left main disease, or diabetes, CABG

2854:

Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS Jr, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI

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In the late 1960s, after the work of René Favaloro, the operation was performed in only a few centers, but was anticipated to more broadly change the outcome of coronary artery disease. By 1979, there were 114,000 procedures per year in the US. The introduction of percutaneous coronary intervention

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CABG and PCI are the two methods to revascularize stenotic lesions of the cardiac arteries. The preferences for each patient is still a matter of debate but in the presence of complex lesions and significant Left Main Disease, and in diabetic patients, CABG seems to offer better results in patients

494:

A 2012 trial and followup in diabetic patients demonstrated a significant advantage to CABG over PCI. The relative advantage remained evident at 3.8-year and 7.5-year follow ups, which found particular benefits in smokers and younger patients. A 2015 trial compared CABG and the latest technological

490:

Patients with unprotected left main disease—when the runoff of the left main artery is not protected by a patent graft since a previous CABG operation—have been studied as a group. A 2016 European study found that in these patients, CABG outperforms PCI in the long run (5 years). Another 2016 study

392:

People with angina during exercise are usually first treated with medical therapy. Noninvasive tests help estimate which patients might benefit from undergoing coronary angiography. Generally, if portions of cardiac wall are receiving less blood than normal, coronary angiography is indicated; then,

1127:

The introduction of arresting the heart during operation (cardioplegia) made CABG much less risky. A major obstacle of CABG was ischemia and infarction occurring while the heart was stopped to allow surgeons to construct the distal anastomosis. In the 1970s, potassium-based cardioplegia was used.

2543:

Fearon, William F.; Zimmermann, Frederik M.; De Bruyne, Bernard; Piroth, Zsolt; van Straten, Albert H.M.; Szekely, Laszlo; Davidavičius, Giedrius; Kalinauskas, Gintaras; Mansour, Samer; Kharbanda, Rajesh; Östlund-Papadogeorgos, Nikolaos; Aminian, Adel; Oldroyd, Keith G.; Al-Attar, Nawwar; Jagic,

1135:

Favaloro's work is fundamental to the history of graft selection. He established the use of bilateral ITAs as superior to vein grafts. Surgeons examined the use of other arterial grafts—splenic, gastroepiploic mesenteric, subscapular and others—but none matched the patency rates of ITA. In 1971,

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in multivessel disease. Their results indicated that CABG is a better option for CAD patients. A trial published in 2021, comparing results after one year, also concluded that CABG is a safer option than PCI. A large study published in 2023 showed that PCI patients had higher mortality than CABG

599:

After the angiogram is reviewed by the surgical team, targets are selected (that is, which native arteries will be bypassed and where the anastomosis should be placed). Ideally, all major lesions in significant vessels should be addressed. Most commonly, the left internal thoracic artery (LITA;

875:

The beneficial effects of CABG are clear at the cardiac level. Left-ventricle function is improved and malfunctioning segments of the heart—dyskinetic (moving inefficiently) or even akinetic (not moving)—can show signs of improvement. Both systolic and diastolic functions are improved and keep

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using a solution high in potassium. Another purse string is placed in the right atrium for the venous cannula. Once the cannulas and the catheter are placed, cardiopulmonary bypass (CPB) is commenced. Deoxygenated blood arriving to the heart from veins is forwarded to the CPB machine to get

270:, the associated feeling of chest pain. The decision to perform surgery is informed by studies of CABG's efficacy in different patient subgroups, based on the lesions' anatomy or how well the heart is functioning. These results are compared with that of other strategies, most importantly 396:

CABG is generally preferred over PCI when there is a significant burden of plaque on the coronary arteries, that is extensive and complex, due to survival benefit. Other indicators that a patient will benefit more from CABG rather than PCI include: decreased left-ventricle function;

1703:

Neumann, Franz-Josef; Sousa-Uva, Miguel; Ahlsson, Anders; Alfonso, Fernando; Banning, Adrian P; Benedetto, Umberto; Byrne, Robert A; Collet, Jean-Philippe; Falk, Volkmar; Head, Stuart J; Jüni, Peter; Kastrati, Adnan; Koller, Akos; Kristensen, Steen D; Niebauer, Josef (2019-01-07).

218:, a common symptom of CAD) have been sought since the beginning of the 20th century. In the 1960s, CABG was introduced in its modern form and has since become the main treatment for significant CAD. Significant complications of the operation include bleeding, heart problems ( 685:

After the proximal anastomoses are done, the clamp is removed and the aorta and conduits de-aired. Pacing wires, which supply a current to assist the heartbeat, might be placed. If the heart and other systems are functioning, CPB is discontinued and cannulae are removed.

1008:(incidence of 20–40%) that is treated with correcting electrolyte balance, and rate and rhythm control. However, arrhythmia such as ventricular tachycardia or fibrillation can be a sign of postoperative myocardial ischemia that is treated depending on the cause. 759:, in which methods of CABG and PCI are both employed. Anastomosis of the LIMA to the LAD is performed in the operating theater and other lesions are treated with PCI—either at the operating room immediately following the anastomosis, or several days later. 417:, it is paramount to quickly restore blood flow to heart tissue. Typically, patients arrive at the hospital with chest pain. They are first treated with drugs, particularly the strongest drugs that prevent clots within vessels (dual anti-platelet therapy: 2311:

Urso, S; Sadaba, R; González-Martín, JM; Dayan, V; Nogales, E; Tena, MÁ; Abad, C; Portela, F (30 March 2023). "Coronary surgery provides better survival than drug-eluting stent: A pooled meta-analysis of Kaplan- Meier-derived individual patient data".

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and minimize the demand for oxygen. A clamp is placed on the aorta between the cardioplegic catheter and aortic cannula, so that the flow of cardioplegic solution may be controlled by adjusting the clamp. Within minutes, the heart stops beating.

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Determining the total risk of the procedure is difficult because of the diversity of patients undergoing CABG; different subgroups have different risk, but younger patients see better results than older ones. A CABG using two, rather than one,

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formerly, left internal mammary artery, LIMA) is anastomosed to the left anterior descending artery (LAD) because the LAD is the most significant artery of the heart and supplies blood to a larger portion of myocardium than other arteries.

907:, protecting the artery from atherosclerosis and thus stenosis or occlusion. Disadvantages include a high rate of complications, such as deep sternal wound infections, in some subgroups of patients—mainly obese and diabetic ones. The 868:., patients 50–59 years old have an operative mortality rate of 1.8%, while patients older than 80 have a rate of 8.3%. Other factors that increase mortality are being female, re-operation, dysfunction of the left ventricle, and 833:(ICU), where intubations are removed if not already done in the operating theater. They usually exit the ICU by the following day, and four days later, if no complications occur, the patient is discharged from the hospital. 1076:—to a native artery in the heart of a dog, but the experiment could not be reproduced. In the mid-20th century, revascularization efforts continued. Beck C. S. used a carotid conduit to connect the descending aorta to the 744:

is used. The heart may be covered with strong adhesions to adjusting structures. Doctors must decide whether aging grafts should be replaced. Manipulation of vein grafts is avoided because it risks dislodgement of plaque.

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After the discharge, patients may experience insomnia, low appetite, decreased sex drive, and memory problems. This effect is usually transient and lasts 6 to 8 weeks. A tailored exercise plan is usually beneficial.

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guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79:e21-e129

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rupture or myocardial rupture). There are no absolute contraindications of CABG, but severe disease of other organs such as the liver or brain, limited life expectancy, and patient fragility are considered.

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factors and preventing the advancement of plaques. Studies published in 2023 show that CABG in patients with left main disease is associated with lower mortality and fewer adverse events compared to PCI.

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that supplies the heart—or pericardial abrasion, with the hope adhesions would create significant collateral circulation. Sympathectomy produced disappointing and inconsistent results. French surgeon

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Re-operations of CABG (another CABG operation after a previous one) pose difficulties. The heart may be positioned too close to the sternum and thus at risk when cutting the sternum again, so an

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Cardioplegia minimized the oxygen demands of the heart, thus reducing the effects of ischemia. Refinement of cardioplegia in the 1980s made CABG less risky, lowering mortality during operation.

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Carpentier introduced the use of the radial artery, which was initially prone to failure, but the development of harvesting techniques in the following 20 years significantly improved patency.

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and others—will stop taking them several days before, to prevent excessive bleeding during and after the operation. Warfarin is also stopped for the same reason and the patient starts taking

1024:, and may complicate the post-operation process. The harvesting of both two thoracic arteries is a risk factor because it significantly impairs the perfusion of blood through the sternum. 622:. Lines (e.g., peripheral IV cannulae, central lines such as internal jugular cannulae) are inserted for drug administration and monitoring. A description of a traditional CABG follows. 748: 196: 992:, an intra-aortic balloon pump (IABP), optimization of pre-load and afterload, or correction of blood gauzes and electrolytes. The aim is to maintain a systolic blood pressure above 90 864:

CABG is the best procedure to reduce mortality from severe CAD and improve quality of life. Operative mortality strongly relates to the patient's age. According to a study by Eagle

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Conduits that can be used for CABG may be arteries or veins. Arteries have a superior long-term patency (expandedness), but veins are more commonly used due to their practicality.

2715:

Mick, Stephanie; Keshavamurthy, Suresh; Mihaljevicl, Tomislav; Bonatti, Johannes (2016). "Robotic and Alternative Approaches to Coronary Artery Bypass Grafting". In Frank Sellke;

813: 751:(MIDCAB) strives to avoid a large incision in the sternum. It utilizes off-pump techniques to place a graft, usually of the LIMA at the LAD. The LIMA is freed through an 561:

Routine preoperative examination aims to check the status of systems and organs besides the heart. The examination typically includes a chest X-ray to check the lungs, a

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Postoperative bleeding occurs in 2–5% of cases and may require returning to the operating room; the most common indicator is the amount of blood being drained by

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When CABG is performed as an emergency because of a myocardial infarction, the highest priority is to salvage the struggling myocardium. Before operation, an

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Pigs, sheep, and dogs have been used as experimental models, for the development of CABG. Performing CABG to treat a sick animal though is extremely rare.

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effect, which occurs when the anti-coagulant heparin is administered at the beginning of surgery and reappears in the blood after its neutralization by

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Illustration of a typical coronary artery bypass surgery. A vein from the leg is removed and grafted to the coronary artery to bypass a blockage at LAD.

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helped medical doctors to identify patients in need of operation, and which native heart vessels should be bypassed. In 1964, Soviet cardiac surgeon

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oxygenated, then delivered to the aorta to keep the rest of the body saturated. The blood is often cooled to 32–34 °C (90–93 °F) to slow

379:, the pressure after the stenosis is compared to mean aortic pressure. If the ratio is less than 0.80, then the stenosis is deemed significant. 3409: 2999: 1011:

Adverse neurological effects occur after CABG in about 1.5% of patients. They can manifest as type-1 deficits—focal deficits such as stroke or

98: 3284: 2728: 2705: 2428: 2407: 565:, and kidney and liver function tests. Physical examination to determine the quality of the grafts or the safety of removing them, such as 1741: 915:

can be also used. Long-term patency is influenced by the type of artery used and intrinsic factors of the cardiac arterial circulation.

900: 429: 970:, the anastomosis, an insufficiently sealed branch of the conduit, or from the sternum. Other causes include platelet abnormalities or 765: 3534: 3210: 3115: 1064:

In the early 20th century, surgical interventions aiming to relieve angina and prevent death were either sympathectomy — a cut on the

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Farina, Piero; Gaudino, Mario Fulvio Luigi; Taggart, David Paul (2020). "The Eternal Debate With a Consistent Answer: CABG vs PCI".

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Persson, J; Yan, J; Angerås, O; Venetsanos, D; Jeppsson, A; Sjögren, I; Linder, R; Erlinge, D; Ivert, T; Omerovic, E (8 June 2023).

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Persson, J; Yan, J; Angerås, O; Venetsanos, D; Jeppsson, A; Sjögren, I; Linder, R; Erlinge, D; Ivert, T; Omerovic, E (8 June 2023).

756: 183:, a machine which takes over the functions of the heart and lungs during surgery by circulating blood and oxygen. With the heart in 339:

There are various methods of detecting and assessing CAD. Apart from history and clinical examination, noninvasive methods include

2873: 2848: 405:; and complex triple system disease (including LAD, Cx and RCA), especially when the lesion in the LAD is at its proximal part. 375:, which can determine the severity and provide information on the composition of the atheromatous plaque. With the technique of 3422: 3229: 2740:"Pivotal contemporary trials of percutaneous coronary intervention vs. coronary artery bypass grafting: a surgical perspective" 845: 702: 192: 3522: 593: 180: 83: 2480: 53:

Early in a coronary artery bypass operation, during vein harvesting from the legs (left of image) and the establishment of

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the side of another conduit. It is preferred not to harvest too much conduit because it might necessitate re-operation.

461:(cavity) and diminishes blood delivery to the heart. Such a dissection may be caused by pregnancy, tissue diseases like 200: 2394:

Al-Atassi, Talal; Toeg, Hadi D.; Chan, Vincent; Ruel, Marc (2016). "Coronary Artery Bypass Grafting". In Frank Sellke;

462: 3644: 2866: 32:"Heart bypass" redirects here. For the technique to take over the function of the heart and lungs during surgery, see 1116:

performed the first successful internal thoracic artery–coronary artery anastomosis. The same year, American surgeon

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Sef, D; Szavits-Nossan, J; Predrijevac, M; Golubic, R; Sipic, T; Stambuk, K; Korda, Z; Meier, P; Turina, MI (2019).

516: 48: 1077: 912: 730: 360: 352: 333: 3169: 2675:

Smith, Peter K.; Schroder, Jacob N. (2016). "On-Pump Coronary Artery Bypass Grafting". In Josef E. Fischer (ed.).

3476: 3366: 3120: 2910: 985: 881: 726: 433: 966:, which are inserted during the operation to drain fluid or air from the chest. Bleeding may originate from the 3663: 3555: 3539: 3006: 2989: 2123:

Laflamme, M; DeMey, N; Bouchard, D; Carrier, M; Demers, P; Pellerin, M; Couture, P; Perrault, LP (April 2012).

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is administered to reverse the effect of the anticoagulant heparin. After possible bleeding sites are checked,

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sutures are placed in the aorta to prepare the insertions of the cannula into the aorta, and a catheter which

1810:"Bilateral internal thoracic artery use in coronary artery bypass grafting in the post-ART era – Perspective" 943:

than PCI. Strong indications for CABG also include symptomatic patients and those with impaired LV function.

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found that PCI has similar results to CABG at 3 years, but that CABG becomes better than PCI after 4 years.

414: 376: 368: 263: 157: 533: 195:(OPCAB), these anastomoses are constructed while the heart is still beating. The anastomosis supplying the 3597: 1163: 1158: 1053: 1029: 613: 450: 449:

CABG is also performed when a patient is to undergo another cardiac surgical procedure, most commonly for

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Arterial grafts originate from the part of the internal thoracic artery (ITA) that runs near the edge of

3628: 3432: 3353: 1073: 1020: 996: 923: 908: 521: 317: 219: 2174:"Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery" 1018:

Infections, such as wound infections in the sternum (superficial or deep) are most commonly caused by

508: 187:, harvested arteries and veins are used to connect across problematic regions—a construction known as 3602: 3159: 2972: 2967: 1057: 919: 562: 454: 321: 293: 250: 208: 188: 3481: 3459: 3145: 2984: 2957: 1005: 952: 830: 340: 241: 573:

in the arm is performed to be sure that blood supply to the arm will not be critically disturbed.

320:, the interruption of blood supply to the heart. CAD can occur in any of the major vessels of the 3464: 3377: 3373: 3319: 3314: 3255: 3176: 3084: 3033: 2947: 2824: 2583: 2531: 2337: 2105: 2056: 2007: 1839: 1096:

performed the first successful internal thoracic artery–coronary artery anastomosis, followed by

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is harvested for use. Other commonly employed sources are the right internal mammary artery, the

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have been described and are most commonly due to medications administered during the operation.

988:(LCOS) can occur in up to 14% of CABG patients. According to its severity, LCOS is treated with 848:

are used to control blood pressure, especially in patients with low cardiac function (<40%).

453:, and angiography reveals a significant lesion of the coronary arteries. CABG can also address 3507: 3453: 3383: 3291: 3279: 3140: 3130: 3125: 3028: 2979: 2890: 2816: 2808: 2779: 2761: 2724: 2716: 2701: 2680: 2663: 2655: 2626: 2618: 2575: 2567: 2523: 2515: 2467: 2424: 2403: 2395: 2329: 2203: 2154: 2097: 2048: 1999: 1831: 1733: 1725: 1506: 1383: 1065: 869: 639: 631: 619: 398: 356: 305: 297: 169: 93: 1705: 3607: 3512: 3250: 3180: 3163: 3095: 3068: 3063: 2800: 2769: 2751: 2695: 2647: 2608: 2557: 2507: 2457: 2321: 2193: 2185: 2144: 2136: 2087: 2038: 1989: 1821: 1717: 1496: 1486: 1373: 1363: 1121: 1101: 1056:

and educator best known for his pioneering work on coronary artery bypass surgery using the

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Keeping a healthy heartbeat may involve maneuvers like placing atrial wires to protect from

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caused by CAD, slow the progression of CAD, and increase life expectancy. It aims to bypass

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standardized the procedure. Their advances made CABG the standard of care of CAD patients.

852:, a calcium channel blocker, is used for patients whose radial artery was used as a graft. 3579: 3501: 3348: 3338: 3324: 3215: 3185: 3091: 2920: 2905: 1117: 1113: 1097: 1093: 1081: 741: 537: 466: 458: 161: 654:—the sac that surrounds the heart—is opened and stay sutures are placed to keep it open. 1501: 1474: 1378: 1351: 3486: 3471: 3267: 3244: 3075: 3059: 2994: 2774: 2739: 2198: 2173: 2149: 2124: 1595: 1593: 566: 541: 529: 525: 253:

grafts – one to the right coronary artery system and one to the obtuse marginal system.

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Head, S. J.; Kieser, T. M.; Falk, V.; Huysmans, H. A.; Kappetein, A. P. (2013-10-01).

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used a saphenous vein to create an aorta-coronary artery bypass. Argentinean surgeon

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from other parts of the body, thus restoring adequate blood supply to the previously

288: 3388: 1924: 1922: 1855: 1853: 1779: 1777: 1764: 1762: 1760: 1758: 1674: 1672: 1670: 1668: 1553: 1551: 1549: 1547: 1545: 1543: 1541: 1539: 1537: 1535: 1318: 1316: 1314: 1312: 1310: 971: 904: 659: 655: 635: 483: 184: 62: 2511: 1246: 1244: 1231: 1229: 1216: 1214: 884:(IMAs) may offer greater protection from CAD, but results are not yet conclusive. 125: 2418: 1124:

advanced and standardized the CABG technique using the patient's saphenous vein.

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The most common complications of CABG are postoperative bleeding, heart failure,

111: 3565: 3308: 3272: 2952: 2937: 2325: 2189: 2092: 2075: 2043: 2026: 1994: 1977: 1491: 1368: 1153: 1089: 931: 752: 734: 709: 651: 581: 422: 344: 119: 27:

Surgical procedure to restore normal blood flow to an obstructed coronary artery

2694:

Kouchoukos, Nicholas; Blackstone, E. H.; Hanley, F. L.; Kirklin, J. K. (2013).

2651: 2613: 2597:"Coronary artery bypass grafting: Part 1—the evolution over the first 50 years" 2596: 1826: 1809: 1721: 3560: 3427: 3332: 3100: 2231: 2229: 963: 849: 837: 691: 664: 585: 570: 457:

of coronary arteries, where a rupture of the coronary layers creates a pseudo-

329: 223: 2812: 2765: 2659: 2638:"Corrigendum to: 2018 ESC/EACTS Guidelines on myocardial revascularization". 2622: 2571: 2546:"Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery" 2519: 1729: 351:

can quantify heart functioning by measuring, for example, enlargement of the

2756: 1475:"PCI or CABG for left main coronary artery disease: the SWEDEHEART registry" 1352:"PCI or CABG for left main coronary artery disease: the SWEDEHEART registry" 1025: 979: 687: 246: 231: 2820: 2791:

Welt, Frederick G.P. (2022-01-13). "CABG versus PCI — End of the Debate?".

2783: 2667: 2630: 2579: 2527: 2471: 2333: 2207: 2158: 2140: 2101: 2052: 2003: 1880: 1878: 1876: 1874: 1872: 1870: 1868: 1835: 1737: 1510: 1387: 1045: 160:(CAD), the buildup of plaques in the arteries of the heart. It can relieve 2843: 2562: 2545: 2076:"Postcardiac surgery myocardial ischemia: Why, when, and how to intervene" 2027:"Postcardiac surgery myocardial ischemia: Why, when, and how to intervene" 1978:"Postcardiac surgery myocardial ischemia: Why, when, and how to intervene" 2804: 2270: 2268: 989: 470: 402: 325: 313: 309: 173: 165: 2125:"Management of early postoperative coronary artery bypass graft failure" 1580: 1578: 1201: 1199: 1197: 1195: 975: 927: 896: 589: 577: 469:, cocaine abuse, or PCI. A coronary aneurysm may also indicate CABG: A 418: 69:

are on the upper right. The patient's head (not seen) is at the bottom.

135: 3224: 1112:

The modern era of the CABG began in 1964 when Soviet cardiac surgeon

956: 733:(IMA) or Y, T and sequential grafts. Deep arrest may be induced with 393:

lesions are identified and inform a decision to undergo PCI or CABG.

267: 227: 215: 2446:"The Development of Coronary Artery Surgery: Personal Recollections" 520:

Coronary artery bypass surgery during mobilization (freeing) of the

17: 1659: 1647: 959:, kidney dysfunction, and infection of the wound near the sternum. 3573: 3403: 3234: 3079: 2894: 1044: 967: 836:

A series of drugs are commonly used in early post-operative care.

549: 545: 515: 507: 328:(dies) and is scarred. It may lead to other complications such as 287: 240: 1928: 1859: 1795: 1783: 1768: 1690: 1678: 1635: 1623: 1599: 1557: 1322: 1250: 1235: 1220: 552:

is cross-clamped. The patient's head (not seen) is at the bottom.

1012: 2862: 2074:

Robinson, NB; Sef, D; Gaudino, M; Taggart, DP (February 2023).

2025:

Robinson, NB; Sef, D; Gaudino, M; Taggart, DP (February 2023).

1976:

Robinson, NB; Sef, D; Gaudino, M; Taggart, DP (February 2023).

1947: 1945: 1943: 1941: 1939: 1937: 1897: 1895: 1893: 1460: 829:

After the procedure, the patient is usually transferred to the

1285: 1283: 1080:, the biggest vein of the heart. In the "Vineberg Procedure", 1706:"2018 ESC/EACTS Guidelines on myocardial revascularization" 646:

Catheterization and establishment of cardiopulmonary bypass

2481:"Veterinarians, MDs team up for canine open-heart surgery" 1333: 1331: 262:

Coronary artery bypass surgery aims to prevent death from

156:, pronounced "cabbage"), is a surgical procedure to treat 473:

might develop within the vessel and travel downstream.

2354: 2298: 2286: 2274: 2259: 2235: 2738:

Ngu, Janet M. C.; Sun, Louise Y.; Ruel, Marc (2018).

2420:

Manual of Perioperative Care in Adult Cardiac Surgery

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was the first to anastomose a vessel—a branch of the

926:. Their patency rate is lower than that of arteries. 1436: 1412: 1400: 544:, which receives blood from the body. The patient's 3616: 3588: 3445: 3300: 3196: 2936: 2929: 1088:The development of coronary angiography in 1962 by 118: 104: 92: 82: 74: 41: 2314:The Journal of Thoracic and Cardiovascular Surgery 2080:The Journal of Thoracic and Cardiovascular Surgery 2031:The Journal of Thoracic and Cardiovascular Surgery 1982:The Journal of Thoracic and Cardiovascular Surgery 1814:International Journal of Surgery (London, England) 214:Effective ways to treat chest pain (specifically, 1169:Totally endoscopic coronary artery bypass surgery 500:patients with left main coronary artery disease. 2607:(37). Oxford University Press (OUP): 2862–2872. 749:Minimally invasive direct coronary artery bypass 528:(yellow). The tube visible at the bottom is the 316:(narrowing) in one or more arteries and risking 179:There are two main approaches. The first uses a 2500:Seminars in Thoracic and Cardiovascular Surgery 2129:Interactive Cardiovascular and Thoracic Surgery 681:Weaning from cardiopulmonary bypass and closure 363:. The most accurate ways to detect CAD are the 842:Angiotensin-converting enzyme (ACE) inhibitors 819:Coronary artery bypass graft, quadruple bypass 2874: 2799:(2). Massachusetts Medical Society: 185–187. 2556:(2). Massachusetts Medical Society: 128–137. 1951: 1901: 1289: 974:—perhaps due to the bypass or to the rebound 721:Alternative approaches and special situations 608:With cardiopulmonary bypass machine (on-pump) 199:is the most significant one and usually, the 168:in heart arteries by using arteries or veins 8: 2697:Kirklin/Barratt-Boyes Cardiac Surgery E-Book 2677:Master Techniques in Surgery CARDIAC SURGERY 795:Coronary artery bypass graft, double bypass. 807:Coronary artery bypass graft, triple bypass 783:Coronary artery bypass graft, single bypass 2933: 2916:Cardiology diagnostic tests and procedures 2881: 2867: 2859: 1448: 1424: 47: 3012:Transcatheter pulmonary valve replacement 2773: 2755: 2721:Sabiston and Spencer Surgery of the Chest 2612: 2561: 2461: 2400:Sabiston and Spencer Surgery of the Chest 2197: 2148: 2091: 2042: 1993: 1825: 1500: 1490: 1377: 1367: 430:mechanical complications of an infarction 266:and improve quality of life by relieving 3055:shunt from heart chamber to blood vessel 2366: 1100:in the United States. Argentine surgeon 618:The intubated patient is brought to the 3155:shunt from blood vessel to blood vessel 2479:Cordova, Melanie Greaver (2020-05-05). 2378: 1179: 930:protects grafts from occlusion; adding 761: 304:Coronary artery disease is caused when 245:Three coronary artery bypass grafts, a 2750:(4). AME Publishing Company: 527–532. 694:are placed and the sternum is closed. 495:advancement of PCI, second-generation 428:CABG is also indicated when there are 413:During an acute heart event, known as 343:(ECG) at rest or during exercise, and 38: 3285:Valve-sparing aortic root replacement 3024:enlargement of existing septal defect 1274: 1262: 1028:can also occur. Complications in the 557:Preoperative examination and strategy 536:. The tube above it (obscured by the 191:. In the second approach, called the 7: 3019:production of septal defect in heart 1337: 846:angiotensin receptor blockers (ARBs) 901:endothelium-derived relaxing factor 131: 3116:transposition of the great vessels 3041:creation of septal defect in heart 1808:Sef, D; Raja, SG (February 2021). 1437:Farina, Gaudino & Taggart 2020 1413:Farina, Gaudino & Taggart 2020 1401:Farina, Gaudino & Taggart 2020 272:percutaneous coronary intervention 25: 3416:Cardiac resynchronization therapy 757:hybrid coronary revascularization 3640: 3639: 2842: 2744:Annals of Cardiothoracic Surgery 2444:Connolly, John E. (2001-03-25). 812: 800: 788: 776: 764: 576:A patient taking anticoagulants— 3423:Left atrial appendage occlusion 2793:New England Journal of Medicine 2550:New England Journal of Medicine 1744:from the original on 2024-01-30 703:Off-pump coronary artery bypass 532:, which returns blood from the 197:left anterior descending branch 193:off-pump coronary artery bypass 753:incision between the left ribs 334:papillary muscles of the heart 181:cardiopulmonary bypass machine 146:Coronary artery bypass surgery 42:Coronary artery bypass surgery 1: 3545:Radionuclide ventriculography 2512:10.1053/j.semtcvs.2019.08.009 2450:Texas Heart Institute Journal 660:temporarily arrests the heart 3530:Myocardial perfusion imaging 771:Coronary artery bypass graft 731:inferior mesenteric arteries 201:left internal mammary artery 150:coronary artery bypass graft 78:Coronary artery bypass graft 2326:10.1016/j.jtcvs.2023.03.020 2190:10.1136/openhrt-2019-001027 2093:10.1016/j.jtcvs.2021.05.052 2044:10.1016/j.jtcvs.2021.05.052 1995:10.1016/j.jtcvs.2021.05.052 986:Low cardiac output syndrome 359:, and the situation of the 176:(deprived of blood) heart. 3680: 3137:for univentricular defect 2700:(4th ed.). Elsevier. 1827:10.1016/j.ijsu.2020.12.007 913:left gastroepiploic artery 611: 296:, stenotic lesions of the 281: 31: 3637: 3477:Implantable loop recorder 3121:Arterial switch operation 2911:Interventional cardiology 2901: 2506:(1). Elsevier BV: 14–20. 1952:Smith & Schroder 2016 1902:Smith & Schroder 2016 1492:10.1093/eurheartj/ehad369 1369:10.1093/eurheartj/ehad369 1290:Smith & Schroder 2016 882:internal mammary arteries 727:intra-aortic balloon pump 434:ventricular septal defect 132: 46: 3556:Coronary catheterization 3046:Blalock–Hanlon procedure 3007:Mitral valve replacement 2990:Aortic valve replacement 2652:10.1093/eurheartj/ehz507 2646:(37): 3096. 2019-10-01. 2614:10.1093/eurheartj/eht330 1722:10.1093/eurheartj/ehy394 1449:Ngu, Sun & Ruel 2018 1425:Ngu, Sun & Ruel 2018 955:(a form of arrhythmia), 934:does not improve rates. 922:and, in some cases, the 567:varicosities in the legs 373:intravascular ultrasound 308:of the heart accumulate 3552:Cardiac catheterization 3494:Electrophysiology study 3394:Radiofrequency ablation 3359:Alcohol septal ablation 2757:10.21037/acs.2018.05.12 632:incision in the sternum 463:Ehlers–Danlos syndromes 415:acute coronary syndrome 409:Acute coronary syndrome 377:fractional flow reserve 369:coronary CT angiography 278:Coronary artery disease 264:coronary artery disease 158:coronary artery disease 61:(bottom of image). The 3598:Impedance cardiography 3220:Coronary artery bypass 2849:Coronary artery bypass 2723:. pp. 1603–1615. 2640:European Heart Journal 2601:European Heart Journal 1929:Kouchoukos et al. 2013 1860:Kouchoukos et al. 2013 1796:Kouchoukos et al. 2013 1784:Kouchoukos et al. 2013 1769:Kouchoukos et al. 2013 1710:European Heart Journal 1691:Kouchoukos et al. 2013 1679:Kouchoukos et al. 2013 1636:Kouchoukos et al. 2013 1624:Kouchoukos et al. 2013 1600:Kouchoukos et al. 2013 1558:Kouchoukos et al. 2013 1479:European Heart Journal 1356:European Heart Journal 1323:Kouchoukos et al. 2013 1251:Kouchoukos et al. 2013 1236:Kouchoukos et al. 2013 1221:Kouchoukos et al. 2013 1159:Cardiothoracic surgery 1061: 1050:René Gerónimo Favaloro 1030:gastrointestinal tract 918:Veins used are mostly 672:Anastomosis (grafting) 650:After harvesting, the 614:Cardiopulmonary bypass 553: 513: 301: 284:Coronary heart disease 254: 55:cardiopulmonary bypass 34:Cardiopulmonary bypass 3629:Transcutaneous pacing 3433:Heart transplantation 3354:Ventricular reduction 3170:Blalock–Taussig shunt 2563:10.1056/nejmoa2112299 2301:, pp. 2863–2865. 2248:Al-Atassi et al. 2016 2238:, pp. 2862–2863. 2221:Al-Atassi et al. 2016 1964:Al-Atassi et al. 2016 1914:Al-Atassi et al. 2016 1885:Al-Atassi et al. 2016 1662:, pp. 1606–1608. 1650:, pp. 1603–1605. 1612:Al-Atassi et al. 2016 1585:Al-Atassi et al. 2016 1570:Al-Atassi et al. 2016 1529:, Surgical Technique. 1527:Al-Atassi et al. 2016 1403:, pp. 1 & 6. 1302:Al-Atassi et al. 2016 1206:Al-Atassi et al. 2016 1189:, pp. 1553–1554. 1187:Al-Atassi et al. 2016 1048: 1021:Staphylococcus aureus 972:their failure to clot 924:lesser saphenous vein 920:great saphenous veins 540:on the right) is the 524:from its surrounding 522:right coronary artery 519: 511: 445:Other cardiac surgery 318:myocardial infarction 291: 244: 236:injury to the kidneys 3603:Ballistocardiography 3160:systemic circulation 2851:at Wikimedia Commons 2805:10.1056/nejme2117325 2417:Bojar, R.M. (2021). 2141:10.1093/icvts/ivr127 1058:great saphenous vein 563:complete blood count 383:Indications for CABG 322:coronary circulation 310:atheromatous plaques 294:coronary angiography 249:LITA to LAD and two 230:, infections (often 209:great saphenous vein 189:surgical anastomosis 3482:Cardiac stress test 3460:Electrocardiography 3399:Pacemaker insertion 3146:Kawashima procedure 3110:compound procedures 2985:Aortic valve repair 2958:Mitral valve repair 2320:(6): 2138–2146.e3. 1693:, pp. 404–405. 1602:, pp. 374–376. 1463:, pp. 128–129. 1427:, pp. 527–531. 1340:, pp. 185–186. 1164:Dressler's syndrome 1006:atrial fibrillation 953:atrial fibrillation 831:intensive care unit 825:Post-operative care 548:is stopped and the 497:drug-eluting stents 341:electrocardiography 336:, or sudden death. 185:cardioplegic arrest 57:by placement of an 3535:Cardiovascular MRI 3465:Vectorcardiography 3320:Pericardial window 3315:Pericardiocentesis 3256:Drug-eluting stent 3085:Rastelli procedure 3034:Balloon septostomy 2679:. Wolters Kluwer. 1461:Fearon et al. 2022 1062: 909:left radial artery 554: 534:heart–lung machine 514: 365:coronary angiogram 345:X-ray of the chest 302: 255: 67:heart-lung machine 3651: 3650: 3508:Angiocardiography 3454:Electrophysiology 3441: 3440: 3384:Catheter ablation 3367:Conduction system 3292:LeCompte maneuver 3280:Bentall procedure 3141:Norwood procedure 3131:Senning procedure 3126:Mustard procedure 3029:Atrial septostomy 2980:Valve replacement 2847:Media related to 2730:978-0-323-24126-7 2717:Pedro J. del Nido 2707:978-1-4160-6391-9 2485:Cornell Chronicle 2430:978-1-119-58255-7 2409:978-0-323-24126-7 2396:Pedro J. del Nido 1485:(30): 2833–2842. 1362:(30): 2833–2842. 1066:sympathetic chain 1052:was an Argentine 870:left main disease 620:operating theater 596:falls below 2.0. 399:left main disease 357:ejection fraction 332:, rupture of the 306:coronary arteries 298:coronary arteries 143: 142: 16:(Redirected from 3671: 3643: 3642: 3608:Cardiotocography 3576: 3540:Ventriculography 3513:Echocardiography 3504: 3456: 3372:Maze procedure ( 3369: 3335: 3311: 3264: 3263:Obstacle removal 3251:Bare-metal stent 3247: 3207: 3164:pulmonary artery 3156: 3111: 3096:pulmonary artery 3069:Fontan procedure 3064:pulmonary artery 3056: 3020: 2934: 2883: 2876: 2869: 2860: 2846: 2832: 2787: 2777: 2759: 2734: 2711: 2690: 2671: 2634: 2616: 2591: 2565: 2539: 2494: 2492: 2491: 2475: 2465: 2440: 2438: 2437: 2413: 2382: 2376: 2370: 2364: 2358: 2355:Head et al. 2013 2352: 2346: 2345: 2308: 2302: 2299:Head et al. 2013 2296: 2290: 2287:Head et al. 2013 2284: 2278: 2275:Head et al. 2013 2272: 2263: 2260:Head et al. 2013 2257: 2251: 2245: 2239: 2236:Head et al. 2013 2233: 2224: 2218: 2212: 2211: 2201: 2169: 2163: 2162: 2152: 2120: 2114: 2113: 2095: 2071: 2065: 2064: 2046: 2022: 2016: 2015: 1997: 1973: 1967: 1961: 1955: 1949: 1932: 1926: 1917: 1916:, pp. 1561. 1911: 1905: 1899: 1888: 1882: 1863: 1857: 1848: 1847: 1829: 1805: 1799: 1793: 1787: 1781: 1772: 1766: 1753: 1752: 1750: 1749: 1700: 1694: 1688: 1682: 1676: 1663: 1660:Mick et al. 2016 1657: 1651: 1648:Mick et al. 2016 1645: 1639: 1633: 1627: 1621: 1615: 1609: 1603: 1597: 1588: 1582: 1573: 1567: 1561: 1555: 1530: 1524: 1515: 1514: 1504: 1494: 1470: 1464: 1458: 1452: 1446: 1440: 1434: 1428: 1422: 1416: 1410: 1404: 1398: 1392: 1391: 1381: 1371: 1347: 1341: 1335: 1326: 1320: 1305: 1299: 1293: 1287: 1278: 1277:, pp. 7–10. 1272: 1266: 1260: 1254: 1248: 1239: 1233: 1224: 1218: 1209: 1203: 1190: 1184: 995: 816: 804: 792: 780: 768: 590:heparin products 438:papillary muscle 349:Echocardiography 148:, also known as 136:edit on Wikidata 128: 114: 51: 39: 21: 3679: 3678: 3674: 3673: 3672: 3670: 3669: 3668: 3664:Cardiac surgery 3654: 3653: 3652: 3647: 3633: 3612: 3584: 3580:Phonocardiogram 3572: 3502:Cardiac imaging 3500: 3452: 3437: 3365: 3349:Septal myectomy 3339:Cardiomyoplasty 3331: 3325:Pericardiectomy 3307: 3296: 3262: 3243: 3203: 3197:Cardiac vessels 3192: 3186:Glenn procedure 3154: 3109: 3092:right ventricle 3054: 3018: 2940: 2925: 2921:Cardiac imaging 2906:Cardiac surgery 2897: 2887: 2839: 2790: 2737: 2731: 2714: 2708: 2693: 2687: 2674: 2637: 2594: 2542: 2497: 2489: 2487: 2478: 2443: 2435: 2433: 2431: 2416: 2410: 2393: 2390: 2385: 2377: 2373: 2365: 2361: 2357:, p. 2868. 2353: 2349: 2310: 2309: 2305: 2297: 2293: 2289:, p. 2865. 2285: 2281: 2277:, p. 2863. 2273: 2266: 2262:, p. 2862. 2258: 2254: 2250:, p. 1551. 2246: 2242: 2234: 2227: 2223:, p. 1552. 2219: 2215: 2171: 2170: 2166: 2122: 2121: 2117: 2073: 2072: 2068: 2024: 2023: 2019: 1975: 1974: 1970: 1962: 1958: 1950: 1935: 1927: 1920: 1912: 1908: 1900: 1891: 1883: 1866: 1858: 1851: 1807: 1806: 1802: 1794: 1790: 1782: 1775: 1767: 1756: 1747: 1745: 1702: 1701: 1697: 1689: 1685: 1677: 1666: 1658: 1654: 1646: 1642: 1634: 1630: 1622: 1618: 1614:, p. 1563. 1610: 1606: 1598: 1591: 1587:, p. 1564. 1583: 1576: 1572:, p. 1562. 1568: 1564: 1556: 1533: 1525: 1518: 1472: 1471: 1467: 1459: 1455: 1451:, pp. 529. 1447: 1443: 1439:, pp. 4–5. 1435: 1431: 1423: 1419: 1415:, pp. 1–2. 1411: 1407: 1399: 1395: 1349: 1348: 1344: 1336: 1329: 1321: 1308: 1304:, p. 1556. 1300: 1296: 1288: 1281: 1273: 1269: 1265:, pp. 4–9. 1261: 1257: 1249: 1242: 1234: 1227: 1219: 1212: 1208:, p. 1554. 1204: 1193: 1185: 1181: 1177: 1150: 1142: 1118:Michael DeBakey 1114:Vasilii Kolesov 1110: 1098:Michael DeBakey 1094:Vasilii Kolesov 1082:Arthur Vineberg 1054:cardiac surgeon 1043: 1038: 993: 949: 940: 938:Compared to PCI 890: 862: 827: 820: 817: 808: 805: 796: 793: 784: 781: 772: 769: 742:oscillating saw 723: 715: 700: 616: 610: 559: 506: 479: 477:CABG versus PCI 467:Marfan syndrome 447: 411: 390: 388:Stable patients 385: 300:are identified. 286: 280: 260: 139: 124: 110: 70: 37: 28: 23: 22: 15: 12: 11: 5: 3677: 3675: 3667: 3666: 3656: 3655: 3649: 3648: 3638: 3635: 3634: 3632: 3631: 3626: 3620: 3618: 3614: 3613: 3611: 3610: 3605: 3600: 3594: 3592: 3590:Function tests 3586: 3585: 3583: 3582: 3577: 3569: 3568: 3563: 3558: 3549: 3548: 3547: 3537: 3532: 3527: 3526: 3525: 3520: 3510: 3505: 3497: 3496: 3491: 3490: 3489: 3487:Bruce protocol 3479: 3474: 3472:Holter monitor 3469: 3468: 3467: 3457: 3449: 3447: 3443: 3442: 3439: 3438: 3436: 3435: 3430: 3425: 3419: 3418: 3413: 3407: 3401: 3396: 3391: 3386: 3381: 3370: 3362: 3361: 3356: 3351: 3346: 3341: 3336: 3328: 3327: 3322: 3317: 3312: 3304: 3302: 3298: 3297: 3295: 3294: 3288: 3287: 3282: 3276: 3275: 3270: 3268:Endarterectomy 3265: 3259: 3258: 3253: 3248: 3245:Coronary stent 3240: 3239: 3238: 3237: 3232: 3227: 3213: 3208: 3200: 3198: 3194: 3193: 3191: 3190: 3189: 3188: 3174: 3173: 3172: 3157: 3151: 3150: 3149: 3148: 3143: 3135: 3134: 3133: 3128: 3123: 3112: 3106: 3105: 3104: 3103: 3089: 3088: 3087: 3076:left ventricle 3073: 3072: 3071: 3057: 3051: 3050: 3049: 3048: 3038: 3037: 3036: 3031: 3021: 3015: 3014: 3009: 3004: 3003: 3002: 2997: 2995:Ross procedure 2987: 2982: 2977: 2976: 2975: 2970: 2960: 2955: 2950: 2944: 2942: 2931: 2927: 2926: 2924: 2923: 2918: 2913: 2908: 2902: 2899: 2898: 2893:involving the 2888: 2886: 2885: 2878: 2871: 2863: 2857: 2856: 2852: 2838: 2837:External links 2835: 2834: 2833: 2788: 2735: 2729: 2712: 2706: 2691: 2685: 2672: 2635: 2592: 2540: 2495: 2476: 2441: 2429: 2414: 2408: 2389: 2386: 2384: 2383: 2371: 2359: 2347: 2303: 2291: 2279: 2264: 2252: 2240: 2225: 2213: 2184:(1): e001027. 2164: 2115: 2086:(2): 687–695. 2066: 2037:(2): 687–695. 2017: 1988:(2): 687–695. 1968: 1956: 1954:, p. 565. 1933: 1931:, p. 403. 1918: 1906: 1904:, p. 566. 1889: 1864: 1862:, p. 401. 1849: 1800: 1798:, p. 399. 1788: 1786:, p. 397. 1773: 1771:, p. 388. 1754: 1695: 1683: 1681:, p. 387. 1664: 1652: 1640: 1638:, p. 386. 1628: 1626:, p. 348. 1616: 1604: 1589: 1574: 1562: 1560:, p. 367. 1531: 1516: 1465: 1453: 1441: 1429: 1417: 1405: 1393: 1342: 1327: 1325:, p. 409. 1306: 1294: 1292:, p. 549. 1279: 1267: 1255: 1253:, p. 357. 1240: 1238:, p. 356. 1225: 1223:, p. 405. 1210: 1191: 1178: 1176: 1173: 1172: 1171: 1166: 1161: 1156: 1149: 1146: 1141: 1138: 1109: 1106: 1078:coronary sinus 1074:carotid artery 1042: 1039: 1037: 1034: 948: 945: 939: 936: 889: 886: 861: 858: 826: 823: 822: 821: 818: 811: 809: 806: 799: 797: 794: 787: 785: 782: 775: 773: 770: 763: 722: 719: 713: 699: 696: 683: 682: 674: 673: 648: 647: 634:is made while 628: 627: 609: 606: 558: 555: 542:venous cannula 530:aortic cannula 526:adipose tissue 505: 502: 478: 475: 446: 443: 410: 407: 389: 386: 384: 381: 353:left ventricle 282:Main article: 279: 276: 259: 256: 251:saphenous vein 141: 140: 133: 130: 129: 122: 116: 115: 108: 102: 101: 96: 90: 89: 86: 80: 79: 76: 72: 71: 59:aortic cannula 52: 44: 43: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 3676: 3665: 3662: 3661: 3659: 3646: 3636: 3630: 3627: 3625: 3624:Cardioversion 3622: 3621: 3619: 3615: 3609: 3606: 3604: 3601: 3599: 3596: 3595: 3593: 3591: 3587: 3581: 3578: 3575: 3571: 3570: 3567: 3564: 3562: 3559: 3557: 3553: 3550: 3546: 3543: 3542: 3541: 3538: 3536: 3533: 3531: 3528: 3524: 3521: 3519: 3516: 3515: 3514: 3511: 3509: 3506: 3503: 3499: 3498: 3495: 3492: 3488: 3485: 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1160: 1157: 1155: 1152: 1151: 1147: 1145: 1140:Other animals 1139: 1137: 1133: 1129: 1125: 1123: 1122:René Favaloro 1119: 1115: 1107: 1105: 1103: 1102:René Favaloro 1099: 1095: 1091: 1086: 1083: 1079: 1075: 1071: 1070:Alexis Carrel 1067: 1059: 1055: 1051: 1047: 1040: 1035: 1033: 1031: 1027: 1023: 1022: 1016: 1014: 1009: 1007: 1002: 1001:cardiac index 998: 991: 987: 983: 981: 977: 973: 969: 965: 960: 958: 954: 947:Complications 946: 944: 937: 935: 933: 929: 925: 921: 916: 914: 910: 906: 902: 898: 893: 887: 885: 883: 877: 873: 871: 867: 859: 857: 853: 851: 847: 843: 839: 834: 832: 824: 815: 810: 803: 798: 791: 786: 779: 774: 767: 762: 760: 758: 754: 750: 746: 743: 738: 736: 732: 728: 720: 718: 711: 706: 704: 697: 695: 693: 689: 680: 679: 678: 671: 670: 669: 666: 661: 657: 653: 645: 644: 643: 641: 637: 633: 625: 624: 623: 621: 615: 607: 605: 601: 597: 595: 591: 587: 583: 579: 574: 572: 568: 564: 556: 551: 547: 543: 539: 535: 531: 527: 523: 518: 510: 503: 501: 498: 492: 488: 485: 476: 474: 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Coronary artery bypass surgery

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