Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright- Permission-Guidelines_UCM_300404_Article.jsp. A link to the Copyright Permissions Request Form appears on the right side of the page. 2011 by the American College of Cardiology Foundation and the American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0b013e31823c074e Table of Contents Preamble e654 1. Introduction e656 1.1. Methodology and Evidence Review e656 1.2. Organization of the Writing Committee e657 1.3. Document Review and Approval e657 2. Procedural Considerations e657 2.1. Intraoperative Considerations e657 2.1.1. Anesthetic Considerations: Recommendations e657 2.1.2. Use of CPB e659 2.1.3. Off-Pump CABG Versus Traditional On-Pump CABG e659 2.1.4. Bypass Graft Conduit: Recommendations e660 2.1.4.1. Saphenous Vein Grafts e661 2.1.4.2. Internal Mammary Arteries e661 2.1.4.3. Radial, Gastroepiploic, and Inferior Epigastric Arteries e661 2.1.5. Incisions for Cardiac Access e661 2.1.6. Anastomotic Techniques e662 2.1.7. Intraoperative TEE: Recommendations e662 2.1.8. Preconditioning/Management of Myocardial Ischemia: Recommendations e663 2.2. Clinical Subsets e664 2.2.1. CABG in Patients With Acute MI: Recommendations e664 2.2.2. Life-Threatening Ventricular Arrhythmias: Recommendations e666 2.2.3. Emergency CABG After Failed PCI: Recommendations e666 2.2.4. CABG in Association With Other Cardiac Procedures: Recommendations e667 3. CAD Revascularization e667 3.1. Heart Team Approach to Revascularization Decisions: Recommendations e668 3.2. Revascularization to Improve Survival: Recommendations e668 3.3. Revascularization to Improve Symptoms: Recommendations e671 3.4. CABG Versus Contemporaneous Medical Therapy e671 3.5. PCI Versus Medical Therapy e671 3.6. CABG Versus PCI e672 3.6.1. CABG Versus Balloon Angioplasty or BMS e672 3.6.2. CABG Versus DES e672 3.7. Left Main CAD e673 3.7.1. CABG or PCI Versus Medical Therapy for Left Main CAD e673 3.7.2. Studies Comparing PCI Versus CABG for Left Main CAD e673 3.7.3. Revascularization Considerations for Left Main CAD e674 3.8. 