[Coronary surgery in the stenting era].
In recent years, the intensive use of coronary stents has had more of a qualitative than a quantitative impact on the practice of coronary bypass surgery. Whereas the general tendency, which started with balloon angioplasty alone, to select the most severe cases for surgery has without doubt increased, some surgical indications (emergency bypass for acute post-angioplasty occlusion) have disappeared, others have changed (reoperations where stenting has become an alternative to surgery for venous graft stenosis), and still others have appeared (single bypass for intra-stent stenosis). The first randomised trials to compare balloon angioplasty and surgery, clearly showed the benefits of the latter technique with respect to the reduction of recurrent coronary events requiring repeat revascularisation procedures. The problem now is to determine whether these conclusions have to be revised in view of the reduction in risk of post-angioplasty stenosis with the use of stents. To date, this has not been proved. On the one hand, the superiority of stenting over balloon angioplasty alone has only been established in very selected groups of patients not representative of everyday practice, and, on the other hand, the increasing use of arterial grafts should improve the long-term results of surgery. These questions should be answered by on-going trials comparing coronary bypass surgery and stenting. Hopefully, they should also clarify the respective indications of these two effective methods which are without doubt more complementary than competitive.
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Service de chirurgie cardiovasculaire, hôpital Lariboisière, Paris.
D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000517:prevention & control; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods*; D018579:Patient Selection; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome
La chirurgie coronaire à l'ère des endoprothèses.