Changing practice of coronary bypass surgery and its impact on early risk and long-term survival

Over the past 20 years, a steady evolution in cardiac surgical techniques for coronary bypass graft (CABG) surgery has occurred. Recent reports are refining our knowledge of early and late survival after CABG surgery. Studies have documented the changing importance of well-recognized risk factors. New models that take into account multiple factors and that predict early risk of CABG surgery with good reliability have been developed. Long-term survival has been related to factors such as age, gender, diabetes mellitus, race, smoking history, left ventricular function, estrogen treatment in women, and serum lipids. Several recent studies provide insight into decision making regarding CABG versus catheter interventions for both primary and secondary revascularization. Data concerning new techniques, such as minimally invasive surgery, document promising results but also the anticipated learning curve of new procedures. Overall, favorable short-term and long-term survival results after CABG surgery continue to be reported despite an increasing elderly and complex patient group undergoing cardiovascular surgical procedures.