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Coronary artery bypass surgery (CABG) is a commonly used as a treatment for severe coronary artery disease. This is a surgical procedure in which the narrowed native arteries are ‘bypassed’ by adding new arteries and vein beyond the blockages. ‘Grafts’, are harvested from the patient’s leg, inner chest and arm and used as conduits to take blood from the aorta into the heart arteries, beyond where they have become blocked with atherosclerosis.
CABG is offered to patients in a variety of situations. Patients with severe disease that affects multiple blood vessels, those with severe left main stem blockages and those with diabetes are likely to be treated with CABG. It is also offered when patients have concomitant valvular heart disease and they need surgery for their valve.
It is a common misunderstanding that patients with prior CABG cannot have percutaneous coronary intervention (PCI), or that those with prior PCI cannot have CABG. In fact, both options do remain available when needed.
Vein grafts can fail over time, and when they do so, PCI may be required. PCI can be performed to the vein grafts or the native vessels themselves. Treatment to the native vessels may be more complex and require advanced techniques including rotablation – a high speed diamond drill, or Shockwave lithotripsy devices. Treatment to the native vessels may be more durable than PCI to vein grafts but more studies are needed to understand this. Your Cardiologist will discuss the options with you.