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Technical Aspects of Modern Coronary Artery Bypass Surgery

By: , Posted on: December 7, 2020

Figure 1. An anomalous origin of the right coronary artery.

Coronary artery bypass grafting (CABG) is the most common adult cardiac surgery procedure performed globally and the foundation of adult cardiac surgery. Modern CABG entails a wide spectrum of conduits, techniques, and approaches aimed at providing the best possible revascularization at the lowest risk to each patient. Mastering the technique and the strategy is an art that requires time, dedication, and humility and is not for cavaliers or for surgeons obsessed by the clock.

In recent years, percutaneous coronary intervention (PCI) has progressed and interventional cardiologists, armed with industry funding, evolving technology and a less invasive strategy for coronary revascularization have been considered the new “heart heroes”. By studying their craft carefully in large, multicenter, randomized trials, they have convinced their clinical colleagues and the public that it is a good or better option than traditional mammary-and-vein CABG. Consequently, PCI has expanded, and many surgeons have lamented the end of the CABG era.

Figure 2. A complex radial artery graft.

While the conventional mammary-and-veins CABG is highly reproducible and technically simple, this operation does not represent modern coronary surgery and should not be the standard of care for most patients.

CABG at its best is not an easy operation and requires considerable technical skill for optimal outcomes. The performance of an internal thoracic artery side-to-side anastomosis on the lateral wall is not easier than the reimplantation of the aortic valve or the repair of the mitral valve with Barlow’s disease. Similarly, bleeding from the aortic root may be more easily manageable than bleeding from an in situ right internal thoracic artery-obtuse marginal artery anastomosis. Technical Aspects of Modern Coronary Artery Bypass Surgery is a book developed to remind everyone of the technical complexity and beauty of modern CABG which is a surgery comprising innumerable variations to benefit patients.

The issues surrounding the lack of evolution in CABG, like in many other aspects of cardiac surgery, originate from the lack of dedication and technical preparation that are required to perform what in fact is the most common, yet one of the most difficult cardiac surgery procedures. This is a completely different type of textbook to what most surgeons are used to; this is a book that is focused on the technical challenges, pitfalls, and recommendations that are key for any surgeon who wants adopt any of the steps (conduit selection and configuration, platform, etc.) to modernize their approach to CABG.

Take a deeper dive into the discussion by accessing a complementary chapter, Chapter 2 “Surgical strategy in multiple arterial grafting”.

Ready to read more about this subject?

Technical Aspects of Modern Coronary Artery Bypass Surgery, aims to expand on both the basics and complexities of the technical aspects of coronary surgery. It serves as an up to date resource that illustrates and details the advancement and techniques in this field which may soon become a separate super-specialty.

Technical Aspects of Modern Coronary Artery Bypass Surgery is available now on ScienceDirect. Or purchase your own copy from the bookstore and save 30% + get free shipping with promo code STC30.

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