Coronary Artery Bypass Grafting (CABG) is a surgical procedure used to treat coronary artery disease (CAD), a condition where the blood vessels that supply the heart muscle with oxygen and nutrients become narrowed or blocked. CABG is typically considered in the following indications:
- Severe Coronary Artery Disease (CAD): CABG is often recommended when multiple coronary arteries are significantly narrowed or blocked, restricting blood flow to the heart muscle. It is a preferred option for patients with complex or diffuse CAD.
- Angina (Chest Pain) Not Responding to Medications: When angina (chest pain) is not effectively controlled with medications or other interventions and the quality of life is significantly affected, the aim of CABG is to enhance blood flow to the heart.
- Left Main Coronary Artery Disease: CABG is frequently recommended for patients with significant blockages in the left main coronary artery, as this vessel supplies a large portion of the heart. These blockages can pose a high risk of major cardiac events if left untreated.
- Failed Percutaneous Coronary Intervention (PCI): If a patient has undergone PCI (angioplasty and stent placement) but experiences recurrent blockages or complications, CABG may be considered a more durable and effective solution.
- Multi-vessel Coronary Artery Disease: CABG is often preferred for patients with blockages in multiple coronary arteries, especially if they are not amenable to PCI or if the likelihood of complete revascularization is low with angioplasty.
- Diabetes with Coronary Artery Disease: Patients with diabetes often have more diffuse and extensive coronary artery disease. CABG may be favored over PCI in diabetic patients as it has been associated with better long-term outcomes in this population.
- Reduced Left Ventricular Function: CABG may be considered in patients with reduced left ventricular function (ejection fraction) when medical therapy alone is insufficient to improve symptoms and prognosis.
- Unstable Angina or Acute Coronary Syndrome: In certain cases of unstable angina or acute coronary syndrome, CABG may be performed as an emergency procedure to address severe blockages and stabilize the patient’s condition.
- Complex Coronary Anatomy: CABG is often considered when the coronary anatomy is complex, involving multiple lesions, calcified vessels, or other factors that make PCI technically challenging or less likely to provide complete and durable revascularization.
The decision for CABG is typically made in collaboration between a cardiac surgeon, an interventional cardiologist, and other members of the heart team. It is crucial to consider the patient’s overall health, preferences, and the specific characteristics of their coronary artery disease when determining the most appropriate course of action.