Where is the SVG to the LAD or diagonal branches typically located relative to other grafts?

• A. Typically placed below and posterior to the RCA graft
• B. Typically placed above and anterior to the existing RCA graft
• C. Positioned near the right coronary ostium
• D. Along the ascending aorta opposite the coronary ostia

Answer: (B)

In multivessel CABG, grafts are laid out on the heart to give each tunnel a straight, tension‑free path and to avoid crowding or compression from other grafts. The SVG to the LAD or diagonal branches is placed on the anterior surface and higher up (above) the RCA graft because the LAD runs along the anterior interventricular groove. Positioning the LAD/diagonal graft anteriorly and superiorly keeps it out of the deeper, posterior right coronary groove where the RCA graft sits, providing a shorter, less kinked course from the aorta to the LAD/diagonal targets and reducing interference with other grafts. The RCA graft tends to be placed more inferior and posterior, so this arrangement aligns with the heart’s surface anatomy.

Other options describe locations that don’t match the LAD’s anterior course or the typical spatial arrangement of multiple grafts, making them less practical for a secure, direct graft.