Cardiac Surgery Certification Exam Coronary Artery Bypass Grafting (CABG) 2 — Questions and Answers
Question 1: The proximal anastomosis of a saphenous vein graft in conventional CABG is most commonly placed on:
- The ascending aorta (Correct answer)
- The subclavian artery
- The internal mammary artery as a Y-graft
- The descending thoracic aorta
Correct answer: The ascending aorta
Proximal vein graft anastomoses are most commonly placed on the ascending aorta, though no-touch aortic techniques are increasingly used to reduce embolic risk.
Question 2: Intraoperative graft flow measurement using transit-time flowmetry is used to:
- Verify graft patency and detect technical errors before chest closure (Correct answer)
- Measure systemic cardiac output
- Assess valve function
- Monitor CPB flow rate
Correct answer: Verify graft patency and detect technical errors before chest closure
Transit-time flowmetry measures actual blood flow through each graft, identifying low-flow or pulsatility index abnormalities suggesting technical problems requiring revision.
Question 3: Perioperative myocardial infarction after CABG is most often caused by:
- Early graft occlusion or technical anastomotic failure (Correct answer)
- Prolonged CPB time alone
- Anesthesia complication
- Postoperative atrial fibrillation
Correct answer: Early graft occlusion or technical anastomotic failure
Early graft occlusion due to technical anastomotic issues, thrombosis, or spasm is the most common cause of perioperative MI after CABG.
Question 4: Aspirin after CABG should be initiated postoperatively primarily to:
- Improve saphenous vein graft patency and reduce cardiovascular events (Correct answer)
- Prevent sternal wound infection
- Reverse anticoagulation
- Treat postoperative fever
Correct answer: Improve saphenous vein graft patency and reduce cardiovascular events
Early aspirin initiation (within 6 hours postoperatively) improves vein graft patency by inhibiting platelet aggregation at anastomotic sites.
Question 5: The hybrid coronary revascularization approach combines:
- LIMA-to-LAD CABG with percutaneous coronary intervention (PCI) for non-LAD lesions (Correct answer)
- CABG with transcatheter valve replacement
- Off-pump CABG with intra-aortic balloon pump
- Robotic CABG with open sternotomy
Correct answer: LIMA-to-LAD CABG with percutaneous coronary intervention (PCI) for non-LAD lesions
Hybrid revascularization uses the durable LIMA-LAD surgical graft for the LAD territory and PCI stenting for other vessels, combining the best of both approaches.
Question 6: Which vessel is the preferred conduit when total arterial revascularization is planned for a bilateral CABG strategy?
- Bilateral internal mammary arteries (BIMA) (Correct answer)
- Bilateral radial arteries
- Combined IMA and gastroepiploic artery
- Bilateral saphenous veins
Correct answer: Bilateral internal mammary arteries (BIMA)
Bilateral IMA grafting provides the highest long-term patency rates for total arterial revascularization, though it increases the risk of sternal wound complications in diabetics.
Cardiac Surgery Certification Exam Coronary Artery Bypass Grafting (CABG) 2
The proximal anastomosis of a saphenous vein graft in conventional CABG is most commonly placed on: