Current controversies in the conduct of the coronary bypass operation

Recent reports comparing medical versus surgical management of patients with ischemic heart disease highlight the importance of technical quality in the interpretation of surgical results. This review is an attempt to examine current controversies in the conduct of coronary artery bypass with the purpose of suggesting strengths and weaknesses of alternative approaches. Topics include cold cardioplegia versus intermittent aortic occlusion, left ventricular venting, anastomotic technique, optical magnification, "complete vascularization," sequential versus individual grafting, internal mammary artery versus saphenous vein as conduits and the choice of alternative conduits when saphenous vein is unavailable.