Advances in coronary artery bypass grafting (CABG) graft preservation are crucial for improving patient outcomes in cardiac surgery. CABG, first pioneered in the 1960s, is a widely recognized surgical procedure aimed at alleviating symptoms and enhancing survival rates in patients suffering from coronary artery disease.[1][2] The importance of effective graft preservation lies in its significant impact on long-term graft patency and the prevention of major adverse cardiac events (MACE), such as myocardial infarction and the need for repeat revascularization, which are influenced by the quality of preservation strategies employed during surgery.[3][4]Recent advancements in graft preservation techniques have introduced innovative methods aimed at mitigating the damage that grafts endure during the surgical process. Notably, the introduction of specialized preservation solutions, such as DuraGraft, has shown promise in enhancing the viability of vascular conduits by protecting endothelial integrity and reducing ischemic reperfusion injury.[3][5] Despite the potential benefits of these advanced techniques, traditional preservation methods, including saline and autologous whole blood, remain prevalent in clinical practice, raising concerns about the long-term implications for graft functionality.[3][6] Controversies surrounding graft preservation practices include debates over the efficacy of newer solutions versus established methods and the implications of surgical techniques on graft longevity. Studies indicate that inadequate preservation practices can lead to a high incidence of vein graft failure, which compromises the long-term success of CABG procedures.[4][6] This ongoing discourse highlights the need for greater awareness among clinicians regarding the critical role of graft preservation in optimizing surgical outcomes, as well as the necessity for further research and clinical trials to validate the efficacy of innovative preservation solutions.[3][5]In summary, the evolution of graft preservation in CABG not only reflects advancements in surgical techniques but also underscores the importance of addressing persistent challenges in graft management to improve patient care in cardiac surgery. As research continues to evolve, the integration of effective preservation strategies may play a pivotal role in enhancing graft longevity and minimizing complications, ultimately contributing to better overall outcomes for patients undergoing CABG.[3][6]