What is the role coronary artery bypass grafting (CABG) in the treatment of coronary artery disease (CAD)?

Updated: Dec 04, 2019
  • Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

Coronary artery bypass grafting (CABG) is performed for patients with coronary artery disease (CAD) to improve quality of life and reduce cardiac-related mortality. CAD is the leading cause of mortality in the United States [9] and the developed world, [10] and 16.5 million US adults (age ≥20 years) are affected by this disease annually. [9]  It alone accounts for 530,989 deaths each year in the United States, and the long-term manifestations of CAD with left ventricular dysfunction and heart failure are projected to affect over 8 million people aged at least 18 years by 2030. [9]

CABG was introduced in the 1960s with the aim of offering symptomatic relief, improved quality of life, and increased life expectancy to patients with CAD. [11, 12] By the 1970s, CABG was found to increase survival rates in patients with multivessel disease and left main disease when compared with medical therapy. [13]

The new paradigm for treatment of CAD calls for a heart team approach that involves the cardiologist and the cardiac surgeon evaluating the coronary angiogram together and offering the best possible option to the patient to achieve coronary revascularization, whether it be placement of a percutaneous coronary stent or CABG. At present, the typical patient for CABG is older, is more likely to have undergone previous percutaneous coronary intervention (PCI), and has significantly more comorbidities. Despite these adverse risk factors, CABG continues to be one of the most important surgical procedures in the history of modern medicine and probably has prolonged more lives and provided more significant symptomatic relief than any other major operation in medicine. New less-invasive options, advancement in anesthetic and intensive care unit (ICU) management, and technological advances are pushing the boundaries of this procedure to new heights.


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