The role of beating heart coronary artery bypass grafting in the current era: a point of view.
Despite coronary artery revascularization on the beating heart was originally introduced in the 1960's, its further development was halted for several decades by advances in medical technology and by the development of the extracorporeal circulation. It is only in recent years that coronary artery bypass grafting on the beating heart has gained a secure role in the armamentarium of cardiac surgeons, mainly as a result of the popularization of new techniques of coronary exposure and stabilization. In later years, the expansion of interventional cardiology and the refinement of catheter-based techniques for treating coronary artery disease have corresponded to a substantial decline in the overall number of patients referred for surgery. Additionally, more and more patients have extensive disease and concomitant risk factors. These factors have made the future of coronary artery surgery uncertain. As these trends are likely to persist, and probably become more prominent in the future, it is essential for surgeons to embrace changes that may lead to improved surgical outcomes after coronary revascularization. In this article the authors review some of the aspects that have contributed to the popularization of off-pump coronary artery bypass and speculate on the importance of embracing innovative techniques in the field of coronary artery surgery.
Moussa
F
F
Division of Cardiothoracic Surgery, University of Miami School of Medicine, Jackson Memorial Medical Center, Miami, FL 33136, USA.
Lombardi
P
P
Salerno
T A
TA
Ricci
M
M
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000592:standards / Q000639:trends; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology; D006084:Graft Rejection; D006085:Graft Survival; D006355:Heart-Lung Machine; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011859:Radiography; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome