Preoperative Assessment for Coronary Artery Bypass Graft: Going Back to the Basics

As doctors increasingly rely on technological advancements, ever-improving laboratory techniques, and imaging modalities, the importance of a thorough physical evaluation and bedside manner has been noticeably diminished. When it comes to patients scheduled for coronary artery bypass graft (CABG), the preoperative bilateral arm blood pressure (BP) measurement is often omitted; thus, sinister signs of atherosclerotic disease like the brachial gradient are neglected and the surgical plan is jeopardized. We present the case of a 72-year-old male listed for CABG, stressing the necessity of meticulous clinical examination and the routine use of color Doppler ultrasonography (CDUS), prior to surgery. This case aims to highlight the major role of thorough preoperative clinical assessment. The bilateral BP measurement and CDUS are two reliable, expeditious, noninvasive preoperative screening methods, which can detect patients with generalized atherosclerosis, altering, if necessary, the surgical plan, and aiming for the best possible outcome, without complications.

[1]  Zhou Zhao,et al.  The Role of Color Doppler Ultrasonography in the Perioperative Period of Coronary Artery Bypass Grafting: Comparison with Transit-Time Flow Measurement , 2021, Cardiology.

[2]  M. D. Tanrıöver,et al.  “COVID‐19: The final nail in the coffin for physical examination” Evaluation of the effects of COVID‐19 pandemic on physical examination habits of residents in a university hospital: A cross‐sectional survey , 2021, International journal of clinical practice.

[3]  J. Pepper,et al.  Bilateral versus Single Internal‐Thoracic‐Artery Grafts at 10 Years , 2019, The New England journal of medicine.

[4]  Z. Il'giovine,et al.  Screening for subclinical subclavian artery stenosis before coronary artery bypass grafting: Should we do it? , 2017, Echocardiography.

[5]  J. Ioannidis,et al.  Inadequacies of Physical Examination as a Cause of Medical Errors and Adverse Events: A Collection of Vignettes. , 2015, The American journal of medicine.

[6]  C. Feddock The lost art of clinical skills. , 2007, The American journal of medicine.

[7]  J. Rogers,et al.  Diagnosis and Management of Subclavian Artery Stenosis Prior to Coronary Artery Bypass Grafting in the Current Era , 2007, Journal of cardiac surgery.

[8]  J. Lemke,et al.  Routine visualization of the left internal mammary artery before bypass surgery: is it necessary? , 2005, The Journal of invasive cardiology.

[9]  B. Westbrook,et al.  Brachial Gradient in Cardiac Surgical Patients , 2002, Circulation.