Bypass Graft Conduit: Recommendations

Bypass Graft Conduit: Recommendations


CLASS I


 1. If possible, the left internal mammary artery (LIMA) should be used
to bypass the left anterior descending (LAD) artery when bypass of
the LAD artery is indicated. (Level of Evidence: B)

CLASS IIa

1. The right internal mammary artery (IMA) is probably indicated to
bypass the LAD artery when the LIMA is unavailable or unsuitable as
a bypass conduit. (Level of Evidence: C)

2. When anatomically and clinically suitable, use of a second IMA to
graft the left circumflex or right coronary artery (when critically
stenosed and perfusing LV myocardium) is reasonable to improve
the likelihood of survival and to decrease reintervention.
(Level of Evidence: B)

CLASS IIb


 1. Complete arterial revascularization may be reasonable in patients
less than or equal to 60 years of age with few or no comorbidities.
(Level of Evidence: C)

2. Arterial grafting of the right coronary artery may be reasonable
when a critical ( 90%) stenosis is present . (Level of Evidence: B)

3. Use of a radial artery graft may be reasonable when grafting
left-sided coronary arteries with severe stenoses ( 70%) and rightsided
arteries with critical stenoses ( 90%) that perfuse LV myocardium. (Level of Evidence: B)

CLASS III: HARM

1. An arterial graft should not be used to bypass the right coronary
artery with less than a critical stenosis ( 90%) (89). (Level of Evidence: C)
from 2011 ACCF/AHA CABG Guideline

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