Physiology of in-situ arterial revascularization in coronary artery bypass grafting: Preoperative, intraoperative and postoperative factors and influences

Table 1 Factors and influences in arterial revascularization

Arterial revascularization in CABG

Emerging “standard of care” for CABG

Years of data to document benefits, but slow to adopt

Both based on long term survival outcomes

Mechanisms for increased survival based on traditional anatomic construct for surgical revascularization

Better long-term graft patency

Preoperative factors and influences

Effectiveness of GDMT - physiologic modulation of underlying ischemia

Extent of disease

Collateral development

Influence on myocardium

Impact on subsequent revascularization

ISCHEMIA trial

Equipoise issue

Implications for revascularization

Same physiologic principles impacting PCI must also impact CABG

Difference in anatomic extent of disease

Surgical revascularization not dependent on completeness of (anatomic) revascularization

Intraoperative factors and influences

Dynamic nature of in situ arterial grafts

Competitive flow in arterial grafts (vs vein grafts)

Incomplete revascularization vs appropriate incomplete revascularization

FFR-based revascularization

Postoperative factors and influences

Secondary prevention measures in CAD

DAPT

Secondary prevention efforts following CABG

CABG: Coronary artery bypass grafting; GDMT: Guideline directed medical therapy; PCI: Percutaneous cardiovascular intervention; DAPT: Dual anti-platelet therapy; FFR: Fractional flow reserve; ISCHEMIA: International Study of Comparative Health Effectiveness with Medical and Invasive Approaches.