[Current strategy of surgical treatment for ischemic heart disease]

Coronary artery bypass grafting (CABG) surgery is the gold standard therapy for the complete revascularization of patients with multivessel coronary artery disease. Since off-pump CABG (OPCAB) began to be performed, to avoid any side effects from cardiopulmonary bypass, OPCAB is now performed in 66% of all isolated CABG in Japan, and this situation is markedly different from the procedures performed in North America and Europe. Furthermore, percutaneous coronary intervention (PCI) using drug eluting stents (DES) is now being increasingly performed for the treatment of patients with either left main trunk, diffuse or multivessel lesions. Under these circumstances, both the surgical treatment and indications for ischemic heart disease has also changed, and therefore what is asked of surgeons is how they can provide high quality treatment that maintains surgical quality. The strategy to be pursued by surgeons in the future is to perform treatment that is less invasive and provides maximum effects and it is believed that the following issues will become more important. (1) Using arterial grafts for various purposes to maintain high rates graft patency. (2) Successfully performing multivessel bypass procedures and achieving good complete revascularization rates. (3) Careful postoperative management and its complications.