She really is at high risk for heart attack, especially with the presence of anemia. Ideally, with your patient not responding to management of medical problems, she should be referred to nephrologist and cardiologist who should confer with the cardiac surgeon re perioperative concerns. I hope she can be optimized prior to surgery.

I'm no longer familiar with the latest in CABG surgery as we don't do it in our hospital.

regards,

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Angelina A. Gapay, MD