[The recent trend of coronary surgery]

As the use of PTCA (Percutaneous Transluminal Coronary Angioplasty) is progressively widespread, the indication of CABG (Coronary Artery Bypass Grafting) and its candidates are changing accordingly. At present the candidates for CABG have left main trunk disease or severe triple-vessel disease, which are difficult or too dangerous to undergo PTCA. We should also note the population of operative candidates is becoming gradually older than before. The results from CABG appear to be limited according to the random follow-up studies in Europe and United States. The recurrence of angina and myocardial infarction tends to happen after five years. Our follow-up study shows the same tendency as those studies abroad. In order to improve the long-term results of CABG, we recommend the use of arterial grafts such as internal mammary artery, opt to the complete revascularization, and follow the patients postoperatively maximum medical therapy. At the same time, we should stress the importance of deciding the best operative opportunity, and not hesitate to make the decision for reoperation if it became necessary. Older candidates have tendency to suffer from neurological or respiratory complications during the postoperative period. If the risk of those complications appears great from the preoperative examination, we must make efforts to prevent those complications and finish CABG in the shortest possible time. Recently the cases for emergent CABG are decreasing for unstable angina or acute myocardial infarction, because PTCA is more effective for a short time. Time appears to be the most limiting factor for emergent coronary revascularization. Therefore the indication of emergent CABG is left only for left main trunk disease or severe triple vessel disease with complete occlusion of two coronary vessels. As a conclusion, CABG should be considered as only a palliative therapy same as PTCA and other medical treatments. Therefore the treatment of ischemic heart disease must be constituted by a integrated strategy including PTCA and drug therapy arranged for each patient.