Quadruple Coronary Artery Bypass Grafting: A Cadaveric Study and Anatomical Implications

Document Type

Article

Publication Date

7-1-2025

Publication Title

Developmental Dynamics

Abstract

Introduction: Coronary artery bypass grafting (CABG) is a surgical intervention for treating coronary artery disease (CAD). Approximately 400,000 CABGs are performed annually in the US, with Caucasians and males representing the predominant racial and sexual demographics of patients, respectively. CABG involves manipulating vasculature to establish collateral circulation distal to coronary occlusion. Multiple arterial grafts are correlated with better patient outcomes than single arterial grafts. Research Aim/Objective: Despite its prevalence, there has been limited exploration of multiple CABGs in medical education. This study aims to describe the procedure and anatomical features of multiple CABGs observed during cadaveric dissection and investigate its integration in medical education. Materials and Methods: Twenty-two full-body cadaveric dissections were performed by first year medical students at Oakland University William Beaumont School of Medicine. Donor hearts were evaluated for anatomical variation and evidence of prior surgical procedures, particularly CABGs. Results: Three donors had undergone cardiac interventions, including one (79-year-old male) who received a “quadruple bypass.” Four grafts were observed: The left internal mammary artery (LIMA) was grafted to the left anterior descending (LAD) artery at the anterior aspect of the interventricular groove; A second graft connected the ascending aorta with the diagonal artery on the anterior aspect of the left ventricle; A third graft connected the ascending aorta with the left marginal artery on the posterolateral aspect of the L ventricle; The fourth graft connected the ascending aorta with the posterior interventricular artery within the posterior interventricular groove. This donor had a wired sternum with fibrosis along the left parasternal anterior thoracic wall. Examination of the left great saphenous vein (GSV) revealed an excised segment, with cauterizations at the inferomedial aspect of the left leg and anteromedial aspect of the left thigh. Discussion: These findings are consistent with standard CABG techniques including the use of reversed GSV segments to accommodate venous valves and ensure proper blood flow. The LIMA-to-LAD grafting observed in this donor is strongly correlated with improved patient outcomes and superior long-term patency compared to other CABG conduits. Significance and Implications: It is imperative that healthcare professional students educate themselves about common procedures such as CABG. Seeing evidence of this procedure in the gross anatomy lab provides a visual for students to thoroughly understand the presentation of this procedure. This type of first-hand resource is crucial in the education of future healthcare providers.

Volume

254

Issue

7

DOI

10.1002/dvdy.70043

ISSN

10588388

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