Uncertainty continues with regard to the utility of PAC in low-risk patients undergoing CABG.712 Several observational studies suggest that such patients can be managed only with monitoring of central venous pressure, with insertion of a PAC held in reserve should the need arise. In fact, it has even been suggested that patients in whom a PAC is placed incur greater resource utilization and more aggressive therapy, which may lead to worse outcomes and higher costs. The reported rates of PAC use range from 10% in a combined private academic setting to 90% in patients in the Depart- ment of Veterans Affairs health system.61,639,701,702,713 Aside from providing an indirect assessment of left atrial pressure and the presence and severity of pulmonary hyper- tension, PAC can be used to measure cardiac output (by thermodilution) and to monitor the mixed venous oxygen saturation information that may be helpful in the manage- ment of high-risk patients.712,714 The need for careful consid- eration of baseline patient risk, the planned procedure, and the patient setting before use of a PAC are outlined in several opinion pieces, consensus documents, the Practice Guide- lines for Pulmonary Artery Catheterization: An Updated Report by the American Society of Anesthesiologists, and the 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guide- lines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. 699,712,714 716 Pulmonary artery per- foration or rupture is fatal in 50% of patients in whom it occurs. 