Coronary Artery Bypass Grafting Surgery

Coronary artery bypass grafting (CABG) surgery is frequently the preferred choice of therapy for individuals with multi-vessel coronary heart disease, narrowing of the proximal left main coronary artery, and extensive atherosclerosis in the presence of left ventricular dysfunction or debilitating angina.

Following CABG surgery, individuals are at less risk of sudden death than those who are treated medically. Most drivers who undergo CABG surgery are able to return to work. A longer waiting period is recommended to allow sternal incision healing. The sternum should be completely healed before certifying a driver.

A significant risk associated with CABG surgery is the high long-term reocclusion rate of the bypass graft.

Waiting period

Minimum — 3 months regardless of type of CABG surgery performed

NOTE: If more than one waiting period applies (because of multiple cardiac conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.

Decision

Maximum certification period — 1 year

Recommend to certify if:

The driver:

• Is asymptomatic.
• Tolerates cardiovascular medications with no orthostatic symptoms.
• Has a left ventricular ejection fraction (LVEF) greater than or equal to 40%.
• Is examined and approved by a cardiologist for medical fitness to drive.
• Has a healed sternum.

Recommend not to certify if:

The driver:

• Is symptomatic.
• Has orthostatic symptom side effects from cardiovascular medication.
• Has an LVEF less than 40%.
• Is examined and is not approved by a cardiologist for medical fitness to drive.
• Has a sternum that has not healed.

Monitoring/Testing

Because of the risk of reocclusion over time, 5 years post-CABG surgery, the driver should obtain:

• Annual exercise tolerance test.
• Imaging stress test, if indicated.

Follow-up

The driver should have an annual medical examination.

Commercial Drivers With Known CHD Recommendation Tables (PDF) — Post CABG