ABSTRACT
The roles of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are evolving and being redefined. The initial strategy of PCI is leading to deferment of a definitive cardiac surgical procedure in many patients. Cardiac surgical patients are presenting later with more comorbidities. Despite this, with improved myocardial preservation and other bypass techniques, the results are unchanged. Adaptation of arterial grafting techniques in these elderly patients, using beating heart techniques, is resulting in less invasive and more durable procedures. This objective is being met by an extensive use of both internal thoracic arteries and free arterial grafts. Reduction in the use of cardiopulmonary bypass by off-pump techniques reduces the systemic inflammatory response to conventional CABG with early benefits. However, the quality of anastomoses using beating heart surgery needs evaluation.
