Coronary Artery Bypass Surgery: Evidence-Based Practice

Area of Science:

• Cardiology
• Cardiovascular Surgery

Background:

• Coronary artery bypass graft (CABG) surgery is a primary treatment for complex multivessel and left main coronary artery diseases, providing symptomatic relief and improved prognosis.
• Patient hesitancy towards CABG, influenced by psychological factors or knowledge gaps, persists despite clear guideline recommendations favoring it over percutaneous coronary intervention (PCI) in certain cases.

Purpose of the Study:

• To critically review current guidelines, practices, and outcomes of CABG surgery.
• To explore advancements in CABG techniques aimed at improving short-term and long-term results.
• To discuss hybrid coronary revascularization, shared decision-making, and the role of the heart team.

Main Methods:

• Comprehensive literature review of prevailing guidelines, modern surgical practices, and outcomes related to CABG.
• Analysis of various CABG techniques, including on-pump and off-pump procedures.
• Examination of conduit selection (e.g., bilateral internal mammary artery, radial artery), graft evaluation, minimally invasive approaches (robotic-assisted), and hybrid strategies.

Main Results:

• Review synthesizes current CABG practices and outcomes, highlighting advancements in surgical techniques.
• Exploration of diverse surgical approaches, conduit choices, and graft assessment methods.
• Discussion of minimally invasive and robotic-assisted CABG, alongside hybrid coronary revascularization strategies.

Conclusions:

• CABG surgery remains a vital intervention for complex coronary artery disease, with ongoing advancements enhancing its efficacy.
• Modern surgical techniques, including minimally invasive options and strategic conduit selection, are crucial for optimizing patient outcomes.
• Shared decision-making and a multidisciplinary heart team approach are essential for tailoring revascularization strategies to individual patient needs.