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What will surgical coronary revascularization look like in 25 years?

Caliskan, Etema,b; Emmert, Maximilian Y.a,b; Falk, Volkmara,b,c,d

doi: 10.1097/HCO.0000000000000680

Purpose of review Coronary artery bypass grafting evolved in incremental but significant steps since its introduction. Here, we provide an update on operative techniques, choice of conduits, patient selection/decision-making and primary and secondary prevention measures with potential of influencing the future of coronary artery bypass grafting (CABG) surgery.

Recent findings Associated mortality of off-pump CABG (OPCAB) procedures performed in high-volume OPCAB centers (≥164 cases per year) and by experienced surgeons (≥48 cases per year) was reduced compared with on-pump CABG with two or more grafts suggesting a volume-based dependency of outcomes in CABG procedures with high-technical complexity. Ten-year results from the recent Arterial Revascularization Trial showed no significant between-group difference for the primary and secondary outcome. Total arterial revascularization using composite bilateral internal mammary artery-Y-conduits through a limited access mini-thoracotomy was not only shown to be feasible but a safe and reproducible procedure with excellent midterm outcomes. The most recent Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass (REGROUP) trial demonstrated no significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the occurrence of major adverse cardiac events.

Summary Adherence to the most recent guidelines on myocardial revascularization is a key component for providing state-of the CABG surgery. Trends to lesser invasiveness in surgical coronary revascularization will gain momentum and is expected – with further improvements – to be the mainstay of future surgical coronary revascularization strategies.

aDepartment of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin

bDepartment of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin

cDZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany

dDepartment of Health Sciences and Technology, ETH Zurich, Translational Cardiovascular Technologies, Zurich, Switzerland

Correspondence to Etem Caliskan, MD, Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany. Tel: +00 49 30 450 665020; e-mail:

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