2024-2025 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Cardio Thoracic Surgery / Coronary Artery Bypass Grafting (CABG) 2024-2025 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Cardio Thoracic Surgery / Coronary Artery Bypass Grafting (CABG) 2024-2025 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Cardio Thoracic Surgery / Coronary Artery Bypass Grafting (CABG) 1 CABG vs. PCI: A Comprehensive Analysis of Indunil Karunarathna 1 , T Hapuarachchi 1 , P Gunasena 1 , P Aluthge 1 , N Perera 1 , S Gunathilake 1 , Kapila De Alvis 1 , K Gunawardana 1 , S Rajapaksha 1 , A Warnakulasooriya 1 , P Athulgama 1 , Sanjeewa Dius 1 , R Ranwala 1 , Sau Bandara 1 , Sanjaya Godage 1 , PN Rodrigo 1 , Asoka Jayawardana 1 , U Vidanagama 1 , C Fernando 1 , U Ekanayake 1 , 1. Ministry of Health / Teaching Hospital Badulla / University of Colombo. 2024-2025 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Cardio Thoracic Surgery / Coronary Artery Bypass Grafting (CABG) Abstract: Coronary Artery Bypass Grafting (CABG) remains a cornerstone in the management of complex coronary artery disease (CAD), particularly for patients with multivessel disease, left main coronary artery disease, or diabetes. This comprehensive review explores the evolution, techniques, outcomes, and clinical implications of CABG. Highlighting evidence from landmark trials, including FREEDOM and SYNTAX, it underscores CABG's superiority over percutaneous coronary intervention (PCI) in certain patient populations. Detailed discussions of surgical techniques, conduit selection, and emerging methods like off- pump and robotic-assisted CABG provide insight into operative advancements. Post-operative complications, including stroke, acute kidney injury, and sternal wound infections, are examined alongside strategies for prevention and management. The role of interprofessional collaboration in optimizing outcomes is emphasized, with a focus on nursing, allied health, and team-based interventions. This review also contextualizes CABG within modern cardiology, addressing evolving practices and persistent challenges. CABG continues to demonstrate its life-saving potential while serving as a testament to the importance of multidisciplinary care and evidence-based practice. Key Words: Coronary Artery Bypass Grafting (CABG), Coronary Artery-Disease (CAD), Revascularization, SYNTAX Trial, FREEDOM Trial, Cardiopulmonary Bypass, Off-Pump CABG, Robotic-Assisted CABG, Surgical Conduits, Postoperative Complications Key Points Efficacy of CABG: Proven superiority over PCI for complex coronary artery disease, particularly in patients with diabetes, multivessel, or left main disease. Conduit Selection: The left internal mammary artery (LIMA) is the preferred conduit due to superior long-term patency, while saphenous vein grafts exhibit reduced patency. Emerging Techniques: Off-pump and robotic- assisted CABG are promising alternatives for select patients, minimizing inflammatory and neurocognitive complications. Postoperative Risks: Key complications include myocardial infarction, stroke, acute kidney injury, and sternal wound infections, necessitating vigilant monitoring and interprofessional collaboration. Landmark Trials: Data from trials like FREEDOM and SYNTAX highlight CABG's enduring role in the treatment of advanced CAD.