Coronary Artery Bypass Surgery

Surgical treatment of coronary artery disease should increase regional coronary flow reserve and not increase any early or late morbidity and mortality more than the other treatment modalities. In the past 50 years, surgical treatment of coronary artery disease has been adapted rapidly worldwide and several techniques have been developed to decrease total surgical risks and to improve early and late results with the highest level of quality of life. In spite of the last guidelines that offer stents for single or multiple vessels disease, the fact is that surgical revascularization has better outcomes in all groups of coronary artery patients. In the past two decades, the main target has been to limit or eliminate side effects of extracorporeal circulation and cardioplegia (off-pump), and general anesthesia (awake coronary bypass). The prime goal of surgical revascularization is to obtain complete revascularization by bypassing all severe stenotic coronary arteries having a diameter larger than 1 mm. Surgical revascularization with cardiopulmonary bypass through a full sternotomy remains the most widely used surgical technique. With the development of stabilization devices, off-pump procedures can be safely performed in most patients with single or multivessel disease. Minimal invasive and/or robotic surgery is an attractive procedure to catch invasive cardiology. The gold standard strategy involves single graft to single target vessel bypass, especially the left internal mammary artery to the left anterior descending artery. The early cumulative mortality rate is below 3%, but lower than 1% in lower-risk patients. There are some variables most predictive of early mortality: older age, female, reoperation, non-elective surgery, left ventricular dysfunction, accelerated atherosclerosis. The survival rate is higher than 65% for 15 years. Late mortality is dependent not only on non-use of internal mammarian artery, closure of grafts, progression of native arterial disease but also on comorbidities. Satisfactory quality of life after surgery depends on the long-term duration of the freedom from angina, heart failure, rehospitalization and reintervention, and improvement of the exercise capacity. Return of angina during the first 6 months depends on incomplete revascularization or graft failure, whereas progression of native-vessel disease and grafts are serious risk factors for the late recurrence of angina. Venous graft occlusion is the most common reason for reintervention, and native vessel disease is the second.