Review Up-to-Date Coronary Artery Bypass Graft Surgery

Abstract

The experimental and clinical efforts of Demikov and Kolesov between 1952 and 1964 related to coronary anastomosis between the internal thoracic artery and left anterior descending artery on a beating heart. Sones and Shirey (Cleveland, 1962) were pioneers of selective coronary angiography. The first coronary artery bypass grafting using a saphenous vein graft was performed by Garrett, Dennis, and DeBakey in Houston in 1964. Since that time, coronary surgery has become one of the most frequently performed surgical procedures in the world.Coronarography can be considered the golden standard of diagnostics. Current supplements to coronarography are: functional assesment of the fractional flow reserve; intravascular ultrasound; and optical coherence tomography, for the estimation of atherosclerotic plaque. When combined, these techniques provide high-quality diagnoses. Diagnostic coronarography is followed by percutaneous coronary procedures, the results of which are comparable to those of coronary surgery.Prerequisites of coronary artery bypass grafting (CABG) are grafts and vascular conduits. Alternative flow into ischaemic myocardial territory takes place across these vascular conduits. Usage of the left internal mammary artery is a proven superior standard in operative surgery, due to its better survival rates and prevention of massive myocardial reinfarction. Saphenous vein grafts are most frequently used in the myocardial territory that is not supplied by the left anterior descending artery. In 2018, we will have the final results of the ART trial, which is testing the usage of arterial grafts in coronary surgery. Preliminary results show superiority of the right internal mammary artery as a graft when compared with other arterial grafts (except the left internal mammary artery).Nowadays, myocardial revascularisation with cardiopulmonary bypass is perfomed in 75-80% of cases. Off-pump coronary artery bypass (beating heart) surgery is performed in 20% of cases. Besides these procedures, there are less invasive procedures such as minimal invasive direct coronary bypass (MIDCAB), totally endoscopic coronary bypass (TECAB) and 71 myocardial laser revascularisation. Results of the perioperative application of stem cells and drugs for neoangiogenesis remain limited, in spite of some promising reports.International guidelines from 2011, 2012 and 2013 give us an excellent framework for routine daily practice, but trials such as SYNTAX I and II (2013) and FAME I and II (2013, 2015 will provide new inputs to diagnostic procedures, decision making processes, development, and the need for modern CABG.