Coronary artery bypass procedures

An estimated 12 million people have coronary artery disease (CAD) in the USA. While the majority of patients are treated conservatively with pharmacologic and percutaneous interventions (percutaneous transluminal coronary angioplasty (PTCA) and/or coronary stents) by cardiologists, over 1.4 million patients have undergone surgical revascularization for their CAD over the past decade. Coronary artery bypass grafting (CABG) is performed for the relief of anginal symptoms and to prolong life. Extended relief of angina can be expected in approximately 90% of those with reasonable distal vessel targets. Coronary artery bypass surgery is indicated in patients with angiographically proven CAD with unstable angina refractory to medical therapy or PTCA, positive results on exercise or thallium stress testing, significant left main coronary artery disease, or complex double or triple-vessel CAD. Coronary artery bypass, when compared with medical therapy, has been shown to provide a survival advantage in patients with left main coronary artery stenosis, triple-vessel disease, double-vessel disease with proximal left anterior descending (LAD) artery stenosis, and in patients with depressed left ventricular function. In those patients presenting with chest pain and an evolving myocardial infarction of less than 6 hours duration, either percutaneous or surgical revascularization are plausible treatment modalities. Intractable ventricular arrhythmias may be an additional indication for emergent surgical intervention, since control of arrhythmias and ultimate survival may occur despite the grave prognosis.