Coronary artery surgery: now and in the next decade

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Internal mammary artery grafts demonstrate superior 10-year survival in coronary artery surgery.
• Bilateral internal mammary artery grafting is associated with better outcomes than single grafting.
• Coronary artery bypass grafting (CABG) faces competition from interventional cardiology, yet excels in specific patient groups.

Purpose of the Study:

• To review the evolution and current standing of coronary artery bypass grafting.
• To compare on-pump versus off-pump revascularization techniques.
• To explore future trends in coronary artery surgery, including minimally invasive and robotic approaches.

Main Methods:

• Literature review of landmark studies and ongoing discussions in coronary artery surgery.
• Comparison of outcomes between different CABG strategies (e.g., single vs. bilateral IMA, on-pump vs. off-pump).
• Analysis of evidence supporting CABG over percutaneous coronary intervention for specific conditions like left main and triple-vessel disease.

Main Results:

• Coronary artery bypass grafting shows better long-term outcomes for patients with triple-vessel and/or left main disease compared to repeat revascularization.
• Off-pump CABG, particularly with aortic no-touch and total arterial revascularization in experienced hands, may reduce mortality, stroke, and major adverse cardiac and cerebral events.
• While results vary, experienced centers may find off-pump CABG superior.

Conclusions:

• Coronary artery bypass grafting remains a vital treatment, especially for complex coronary artery disease.
• Minimally invasive techniques, robotics, and hybrid approaches are expected to shape the future of coronary artery surgery.
• Sustained innovation and a shift towards less disruptive surgical strategies are crucial for the evolution of CABG.