Assessment of graft patency during coronary artery bypass graft surgery: mitigating the risk.

Graft patency and completeness of revascularization are major determinants of long-term outcome following coronary artery bypass graft (CABG) procedures (1,2). Even though the results of percutaneous coronary intervention are routinely assessed with on-table X-ray angiography, the patency of grafts is not routinely determined during either on-pump (ON-CABG) or off-pump (OP-CABG) revascularization. Methods to assess graft patency during coronary surgery suffer from some combination of being unreliable, cumbersome, timeconsuming, costly, or potentially dangerous. Yet in specific circumstances, there is value in intraoperative assessment of graft patency. If methods to document graft patency during CABG surgery were as easy and effective as those used during percutaneous coronary intervention, they would be routinely employed. Choosing the best available technology in the most critical situations may be the correct paradigm to ensure the best surgical outcomes.