**4. Coronary artery bypass grafting (CABG)**

5.Cardiogenic shock after myocardial infarction (MI).

2. Severe renal insufficiency unless patient is on hemodialysis or has severe

6.Revascularization after successful resuscitation.

*The Current Perspectives on Coronary Artery Bypass Grafting*

**3.2 Absolute contraindication**

1.Lack of vascular access.

**3.3 Relative contraindications**

electrolyte abnormality.

6. Short life expectancy.

7.Difficult coronary anatomy.

4.Poor compliance with medicines.

5.Terminal illness (advanced or metastatic malignancy).

9. Severe cognitive dysfunction or advanced physical limitation.

**3.4 In view of the following conditions, patients should not go for PCI**

2.No objective evidence of ischemia with either noninvasive or invasive testing

4.Left main coronary artery (LM) or multivessel coronary artery disease with a

6.End-stage cirrhosis with portal hypertension resulting in encephalopathy or

8.Failed previous PCI or not amenable to PCI.

10.Other indication for open heart surgery.

1.Small area of myocardium is at risk.

(e.g., fractional flow reserve).

3.Less likelihood of technical success.

high SYNTAX score (better for CABG).

5. Insignificant stenosis (˂50% stenosis).

visceral bleeding.

**82**

1.Bleeding disorder.

3. Sepsis.

2.Active untreatable severe bleeding.

Coronary artery bypass grafting is a coronary revascularization by surgery. Dr Rene Favaloro performed his first coronary bypass operation in May 1967 with an interposed saphenous vein graft (SVG) and shortly thereafter used aortocoronary bypasses sutured proximally to the ascending aorta. In the words of Dr Denton Cooley, "Although he [Favaloro] was always hesitant to carry the moniker of 'father' of coronary artery bypass surgery, he is the surgeon we should credit with introducing coronary bypass surgery into the clinical arena" [9]. It has been shown to be highly effective in the relief of severe angina and under some circumstances has the capability for considerably prolonging useful life. The stenosed segment of the coronary artery is bypassed using an arterial or venous conduit, and by this it reestablishes the blood flow to the distal ischemic myocardial area. Many studies have shown that surgical revascularization is superior to medical and percutaneous interventional management for multivessel CAD. Full workup should be done before taking patient for surgery.
