Surgical treatment of ischemic heart disease continues to evolve, and specific criteria are available to guide management. The benefit of placing the left internal mammary artery to the left anterior descending artery is well known, and there are newer data, not including survival benefit, supporting the use of two internal mammary arteries. The role of more than two arterial conduits remains to be established. It is hoped that greater use of arterial conduits will reduce the need for reoperation due to saphenous vein graft closure. Operations on older patients and on those with severe impairment of left ventricular function continue to increase. These cases present an ongoing challenge, as do those when operation for acute failure of angioplasty is required.
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