Current Status of the Surgical Treatment of Ischemic Heart Disease

Kim, Ki Bong

Abstract

The management of patients with ischemic heart disease is rapidly evolving. During the past several years, refinement of techniques related to mechanical revascularization (ie, percutaneous coronary intervention and coronary artery bypass grafting) for ischemic heart disease have resulted in improved patient outcomes and, subsequently, an increase in the number of patients undergoing therapeutic coronary artery interventions. Despite advances in cardiopulmonary bypass and myocardial protection, postoperative adverse events after coronary artery bypass grafting (CABG) are mostly related to the use of cardiopulmonary bypass, global cardiac arrest, and hypothermia. Through the recent development of effective devices for target vessel exposure and stabilization, off-pump coronary artery bypass grafting (OPCAB) has gained widespread use as an alternative technique and is now challenging conventional on-pump CABG as the standard for surgical therapy in multivessel disease. Use of the left internal thoracic artery (ITA) for the left anterior descending coronary artery with supplemental saphenous vein grafts has been the standard CABG. Development of a lower saphenous vein graft patency rate compared with that of ITA has encouraged surgeons to examine CABG with total arterial grafts to improve the long-term outcome of myocardial revascularization. Total arterial revascularisation offers further advantages over conventional CABG. The use of in situ or composite bilateral ITA grafts eliminates the need to manipulate on the aorta, which is a major cause of stroke after CABG. Total arterial revascularisation is compatible with, and may indeed facilitate, the rapidly increasing techniques of OPCAB. These recent advances in the field of CABG have resulted in improved patient outcome and improved long-term myocardial revascularization outcome.