The following are key points to remember from a European clinical consensus statement on intra-operative and post-operative management of conduits for coronary artery bypass grafting (CABG):

1. The structural and functional integrity of conduits used for CABG is critical for graft patency. This document discusses the scientific evidence underlying the key aspects of intra- and post-operative management of conduits for CABG.
2. Disruption of endothelial integrity and endothelial dysfunction is incurred during conduit harvesting subsequent to mechanical or thermal injury and during conduit storage prior to grafting, leading to acute thrombosis and early graft failure.
3. Use of the skeletonized technique to harvest the internal thoracic artery (ITA) in patients at high risk of sternal wound complications, particularly when harvesting bilateral ITAs, is recommended.
4. Use of an endoscopic saphenous vein graft (SVG) harvesting technique in patients at risk of leg wound complications, considering harvester experience, is recommended. Furthermore, an open, preferably no-touch, SVG harvesting technique in patients at low risk of leg wound complications is recommended. High-pressure distension of SVGs using a pressure-controlling syringe should be avoided when possible.
5. Use of buffered solutions for storage of SVGs and asanguineous solutions for storage of the radial artery is preferred to reduce susceptibility to spasm.
6. Intra-operative management includes appropriate selection of conduit-specific harvesting techniques and storage solutions. Arterial grafts are prone to vasospasm subsequent to surgical manipulation, and application of intra-operative vasodilatory protocols is critical.
7. Post-operative management includes continuation of oral vasodilator therapy and selection of antithrombotic and lipid-lowering agents to attenuate atherosclerotic disease progression in conduits.
8. Late graft failure, in particular that of vein grafts, is precipitated by progressive atherogenesis. Consider oral calcium channel blockers (amlodipine or diltiazem) for 1 year post-operatively after radial artery grafting. Initiate aspirin (100–325 mg once daily) within 6 hours post-operatively to reduce the risk of SVG occlusion. Consider clopidogrel or ticagrelor in addition to aspirin in the first post-operative year in patients who are not at high bleeding risk to reduce the risk of SVG failure, irrespective of the use of cardiopulmonary bypass. Use high-intensity or maximally tolerated statin therapy to reduce low-density lipoprotein cholesterol (LDL-C) and the risk of SVG disease progression.
9. Low-grade systemic inflammation is a more powerful determinant of recurrent cardiovascular events and death than LDL-C in patients with stable atherosclerotic cardiovascular disease. The clinical benefit of targeted inflammation inhibition has been shown in particular for low-dose colchicine. Given the pro-inflammatory mechanisms implicated in graft failure subsequent to endothelial injury, further studies are needed to determine whether patients after CABG would benefit from the addition of these pharmacotherapies to reduce the risk of graft failure.
10. Finally, the best practice clinical consensus statements outlined in this document provide a comprehensive, evidence-based approach to the intra-operative and post-operative management of conduits for CABG surgery. These strategies can serve as a valuable resource for multidisciplinary heart teams, facilitating more informed and effective treatment planning tailored to individual patient needs and local practices.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and SIHD

Keywords: Cardiac Surgical Procedures, Coronary Artery Bypass, Tissue and Organ Harvesting

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