Alternatives to traditional coronary bypass surgery.
Over 1 million percutaneous coronary interventions (PCI) and a half million surgical coronary artery bypass grafting procedures (CABG) are performed in the United States annually for treatment of coronary artery disease. With recent advances in anti-restenosis strategies, the number of PCIs is expected to increase dramatically. Still, these therapies treat relatively discrete coronary lesions. However, there is a relatively large number of patients for whom traditional therapies are not optimal, either because there are diffuse coronary artery lesions, because there are chronic total occlusions, or because, in the instance of bypass surgery, creating proximal or distal anastomoses is problematic. We review three strategies in various stages of development aimed at treating patients not optimally served by traditional forms of revascularization: transmyocardial laser revascularization, angiogenic therapies, and direct ventricle-to-coronary artery bypass.
Lowe
Harry C
HC
Division of Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Oesterle
Stephen N
SN
Burkhoff
Daniel
D
D000818:Animals; D003331:Coronary Vessels / Q000187:drug effects / Q000601:surgery; D006133:Growth Substances / Q000627:therapeutic use*; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D009204:Myocardial Revascularization / Q000379:methods* / Q000639:trends; D018919:Neovascularization, Physiologic / Q000187:drug effects
D006133:Growth Substances