Operative treatment of coronary atherosclerosis

The evolution of percutaneous intervention has reduced the prevalence of coronary bypass surgery in a patient population that is older, with more comorbidity and advanced coronary disease. Despite this less favorable group, perioperative mortality has continued to decline as the operation improves. The latter includes off-pump coronary grafting, smaller incisions, better intraoperative myocardial preservation, improving management of cardiopulmonary bypass, perioperative glucose control, and increasing use of arterial conduits as the radial artery comes of age and the gastroepiploic artery is reborn as a free graft. This brief review of the basics of coronary artery bypass is part experience with an effort to be fair-minded and balanced and to include that which is new and promising. It is imperative that we continue to innovate and distil the best from the old so that we can provide the optimal intervention for coronary artery disease.