<p>Based on their 30-year experience, the authors discuss the most important problems in coronary surgery. The modern view on the indications for surgery, as well as on patients selection is presented in the light of the most recent and complete studies. The authors also present the modern approach to surgical technique, choice of graft and describe opportunities offered by microsurgical technique.</p><p>Received 30 June 2017. Accepted 10 July 2017.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interests.</p>

<p><strong>Aim.</strong> Comparative assessment of the surgical strategies and one-year results of coronary artery bypass grafting (CABG) in patients with and without target artery distal calcinosis.</p><p><strong>Methods.</strong> A prospective study from January 2017 to October 2018 included 462 patients with coronary artery disease. All patients underwent CABG. Groups were formed according to coronary angiography data. Group 1 — patients with target artery distal calcinosis (n = 108). Group 2 — patients without any marks of coronary calcification (n = 354). To minimize systematic errors and maximize their comparability, computer correction was performed using propensity score matching (group 1, n = 106, group 2, n = 106). Intraoperative data and one-year outcomes were analyzed and compared.</p><p><strong>Results.</strong> Following the strategy for complete revascularization, we had to form a greater number of distal anastomosis in group 1 due to severe coronary atherosclerosis. The index of revascularization was higher in group 1 (4.4 ± 0.7 and 3.9 ± 0.8, p = 0.001). We registered a higher frequency of using prolonged patch-angioplasty (21.7 versus 1.8 %, p &lt; 0.001), anastomosis with artery diameter &lt; 1.5 mm (33.9 versus 16 %, p &lt; 0.003), coronary artery endarterectomy (13.2 versus 0.9%, p &lt; 0.001) in patients with coronary artery calcinosis. As well as the creation of composite grafts, such as Y-graft (33 versus 8.5 %, p &lt; 0.001) and sequential graft (13.9 versus 5.7 %, p = 0.03) were higher in group 1. The use of adjunctive surgical techniques in the main group significantly increased the duration of cardio-pulmonary bypass and aortic cross-clamp time. The primary endpoints – coronary ischemic events – angina recurrence (10.3 versus 6.3 %, p = 0.307), myocardial infarction (3.1 versus 2.1 %, p = 0.654), the need for re-revascularization (3.1 versus 1 %, p = 0.318) were comparable in 1 year after surgery. Overall mortality was relatively low in both groups.</p><p><strong>Conclusion.</strong> CABG in patients with target artery distal calcinosis is associated with similar one-year outcomes compared to CABG in patients without coronary artery calcification. The positive results of CABG in patients with target artery distal calcinosis indicate the benefits of complete myocardial revascularization, despite the long duration and complexity of interventions.</p><p>Received 29 September 2021. Revised 20 October 2021. Accepted 22 October 2021.</p><p><strong>Funding:</strong> The work was carried out within the framework of the state assignment (No. AAAA-A18-118022290040-7).</p><p><strong>Conflict of interest: </strong>Authors declare no conflict of interest.</p><p><strong>Contribution of the authors:<br /> </strong>Conception and study design: A.A. Shiryaev, G.B. Mayorov, D.M. Galayutdinov<br /> Data collection and analysis: G.B. Mayorov, S.K. Kurbanov, V.Yu. Zaikovkii<br /> Statistical analysis: S.K. Kurbanov, G.B. Mayorov<br /> Drafting the article: G.B. Mayorov, A.V. Andreev, S.K. Kurbanov<br /> Critical revision of the article: R.S. Akchurin, A.A. Shiryaev, D.M. Galayutdinov, V.P. Vasiliev<br /> Final approval of the version to be published: R.S. Akchurin, A.A. Shiryaev, D.M. Galayutdinov, V.P. Vasiliev, S.K. Kurbanov, A.V. Andreev, V.Yu. Zaikovkii, G.B. Mayorov</p>