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Updated: Aug 10, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Controversies in myocardial revascularization: coronary artery surgery for single-vessel disease
1Department of Surgery, Massachusetts General Hospital, Boston 02144.
Insights
Coronary artery bypass surgery initially focused on single-vessel disease, particularly in the anterior descending artery. Percutaneous transluminal coronary angioplasty (PTCA) later showed good short-term results but often required reintervention for single-vessel coronary disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Early coronary artery bypass surgery (CABS) prioritized patients with single-vessel disease due to perceived lower risk.
- Anterior descending artery disease was a key focus due to its poorer prognosis with medical management.
- Randomized trials comparing CABS to medical treatment for single-vessel disease often lacked statistically significant advantages for surgery.
Purpose of the Study:
- To evaluate the long-term outcomes of percutaneous transluminal coronary angioplasty (PTCA) versus coronary artery bypass surgery (CABS) for single-vessel coronary disease.
- To compare the effectiveness of revascularization strategies in patients with anterior descending artery disease.
Main Methods:
- Review of historical surgical data and early randomized trials comparing CABS with medical therapy.
- Analysis of studies evaluating the long-term results of PTCA in single-vessel coronary disease.
- Comparative assessment of PTCA and CABS outcomes over extended follow-up periods.
Main Results:
- While CABS showed better results for anterior descending disease, especially with internal mammary artery grafts, overall trial comparisons to medical treatment were often not statistically significant.
- PTCA demonstrated good in-hospital success rates for single-vessel disease, with improving technology.
- Longer-term follow-up of PTCA revealed a significant need for reintervention and a failure to achieve sustained event-free intervals compared to CABS.
Conclusions:
- Despite initial focus on single-vessel disease, CABS did not consistently show a statistically significant advantage over medical therapy in early trials.
- PTCA, while less invasive, proved less durable for single-vessel coronary disease, frequently necessitating repeat procedures.
- Operative revascularization, particularly for anterior descending artery disease, generally offered superior long-term outcomes compared to PTCA in single-vessel disease.
Abstract:
In the early years of coronary artery bypass surgery, patients with single-vessel disease dominated the operative groups because of the presumed lower operative risk for a new surgical procedure. Of these patients, presence of disease in the anterior descending artery was particularly selected because the natural history studies of single-vessel coronary artery disease had identified that cohort as carrying a poorer long-term prognosis with medical treatment. Although subsequent surgical studies showed the best results with operative revascularization were obtained with anterior descending disease, especially when the internal mammary artery was used as the conduit for revascularization, comparison of the surgical results to medical treatment in the randomized trials usually failed to yield a statistically significant advantage for surgical intervention. The results were obviously better for surgical compared with medical treatment if only anterior descending coronary disease was evaluated. In the late 1970s the advent of PTCA as a less invasive and expensive intervention brought new attention to patients with single-vessel coronary disease. Although inhospital success rates were good for PTCA patients with single-vessel disease, and continued to improve with the evolving technology, few reports truly evaluated the later results of the procedure. Of those that assessed the longer-term results, all identified a significant requirement for reintervention. As several studies began to evaluate the longer-term effects of PTCA compared with operative revascularization, the failure of PTCA to achieve an event-free interval, even with single-vessel coronary disease, became increasingly apparent.(ABSTRACT TRUNCATED AT 250 WORDS)
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