Optimizing conduits and intraoperative graft quality in coronary artery bypass graft surgery

PURPOSE OF REVIEW: Optimization of conduits and intraoperative graft assessment remain central determinants of long-term success in coronary artery bypass grafting (CABG). This review is timely, given the recent publication of randomized data refining conduit selection, harvesting strategies, and modalities for physiologic graft verification. RECENT FINDINGS: Over the past year, accumulating randomized and registry-based evidence has strengthened support for multi-arterial revascularization, while clarifying the risks and benefits of certain arterial grafting and associated techniques. Parallel investigations have emphasized atraumatic great saphenous vein (GSV) harvesting and no-touch techniques, to mitigate endothelial injury and enhance patency. Intraoperative graft assessment has increasingly shifted toward routine use of objective physiologic tools, particularly transit-time flow measurement (TTFM) with adjunctive Doppler/ultrasound or fluorescence angiography, and emerging data refining quantitative thresholds and quality benchmarks. SUMMARY: Contemporary evidence underscores that durable surgical revascularization depends on integrated biologic, technical, and physiologic optimization. Standardizing conduit selection, minimizing conduit injury, and adopting routine intraoperative graft assessment may reduce early technical failure and improve long-term graft performance. Ongoing trials and implementation research will determine how best to translate these advances into consistent, high-quality CABG practice.