ABSTRACT

Ischemic heart disease remains the leading cause of death throughout the developed world. The incidence of death from cardiovascular disease, however, continues to decline due to improved preventative strategies and better medical therapies. The development of coronary artery bypass grafting (CABG) surgery remains one of the greatest surgical achievements in medicine. Since the last edition of this book, CABG has seen a significant change in utilization in the United States. A review of the National Inpatient Sample reveals that the number of CABG procedures in the US decreased from 337 400 in 2003 to 202 900 in 2012, a 40% decrease. The rate of interventional therapy for coronary disease (percutaneous transluminal coronary angioplasty; PTCA) also has been decreasing since 2004, with an annual rate of decline of 2.5%. Explanations for the decrease in CABG and PTCA utilization include more aggressive risk factor reduction including decreasing rates of smoking and increased statin and antiplatelet usage. Although performed less frequently, and in higher risk patients than decades past, CABG will continue to be a routine part of the practice of cardiothoracic surgery. The surgical outcomes with coronary artery bypass (CAB) are carefully watched by patients, national and state regulators, insurance providers, and hospital administrators. National standards leave little room for error in the performance of CABG. Many states report individual surgeon risk-adjusted outcomes, and risk aversion may be an unintended consequence of well-intentioned transparency.