[Considerations in coronary artery bypass grafting: problems for discussion]

Based on the experience in coronary artery bypass grafting (CABG), the author addresses some problems emerging from the practice of this surgery. The author proposes that (1) Coronary artery diseases with extensive myocardial infarction and chronic congestive heart failure may not be the absolute contraindications to CABG, and the decision for the operation should be derived from the presence of extensive stunned myocardium and a careful evaluation if the artery in the infarcted area can afford CABG. (2) To decide on the presence of stunned myocardium in the infarcted area, examination with positive electron tomography (PET) should be performed. (3) In recent years, CABG has been successfully performed in some cases of serious heart failure (with left ventricular eject fraction<30%) with the support of intraaortic balloon pump during and after operation. Intraaortic balloon pump has made off-pump CABG possible for patients that used to be denied this chance. (4) Similar to standard CABG procedures, off-pump CABG is by no means faultless and its indications at the time being have not yet been well defined. (5) Sequential anastomosis also has its disadvantages. When not a few large target arteries need anastomosis while graft vessels are not sufficient and serious atherosclerosis of the ascending aorta is present, this technique should been adequately applied. (6) Endarterectomy may give rise to thrombosis but in some cases it seems to be compulsory. The author suggests 3 indications for considering endarterectomy.