Current trends and considerations in the surgical treatment of coronary artery disease

Management of coronary artery disease has changed greatly in the past three decades. Surgical treatment has improved, especially with the introduction of bypass conduits, like the internal mammary artery, which possess a patency rate far superior to that of the saphenous vein. Use of this arterial graft has so encouraged surgeons that other autologous arterial grafts are being tried. Grafts from nonautologous sources are being investigated, but none have yet been found to approach the excellent performance of the internal mammary artery. While the surgical treatment for myocardial ischemia has greatly improved, characteristics of the patient population have not. Patients presently sent for surgery are older, in worse general health, and have poorer cardiac function and coronary disease than their counterparts of several decades ago. Nevertheless, expansion of surgical options, including cardiac transplantation has allowed even the highest risk patients to be considered for surgical intervention.