Coronary artery bypass grafting (CABG)

The developments of coronary artery bypass grafting (CABG), the fundamental surgical procedure of a cardiac surgeon's daily practice, are outlined and CABG procedures for minimized cardiopulmonary bypass (MCPB), unfortunately a significantly less utilized option, are described. The basic concept of MCPB is a closed-loop or semi closed-loop bypass circuit driven by a centrifugal pump and these systems are at a high risk of exposure to aspiration and air embolization. The progress made in increasing de-airing capabilities and safety features is outlined and the advantages of MCPB in creating less hemodilution and low flow perfusion are explored. Recommendations are made for the meticulous surgical technique that is essential in off-pump coronary artery bypass (OPCAB) procedures, such as setting up a rapid cell saver machine or a conventional pericardial suction line in case of excessive bleeding. Results are presented from previous studies which confirm both the safety and efficacy of MCPB for a large number of cardiac patients.