Cardiac Catheterization after Bypass Surgery

Abstract

After coronary artery bypass graft (CABG) surgery, the typical patient will have progression of the original native coronary disease as well as atherosclerosis of the bypass grafts. When this leads to angina or myocardial infarction, repeat cardiac catheterization may be necessary. However, the risks of catheterization in post-CABG patients are higher than in non-CABG patients, and the benefits are smaller, so optimal medical therapy should be employed and clear indications should be present before post-CABG catheterization is undertaken. In the past decade, two advancements have been made in strategies for post-CABG catheterization. First, for patients with a left internal mammary artery graft, left radial access should be routinely used and is safer than femoral access. Second, diseased saphenous vein bypass grafts may offer a retrograde approach to chronic total occlusions of the native artery. When successful, retrograde stenting of the bypassed native coronary artery is more durable than interventions on the saphenous vein graft supplying it. This chapter summarizes indications, techniques, and tricks of catheterization and strategies for coronary intervention in patients with prior CABG.