Surgical coronary revascularization remains relevant in the era of stents.
OBJECTIVE
The high prevalence of coronary artery disease (CAD) has inspired the development of technologies and techniques for coronary revascularization, including coronary artery bypass grafting (CABG) and catheter-based interventions (CBIs).


RESULTS
Although CBIs allow the avoidance of general anesthesia, sternotomy, and cardiopulmonary bypass, CBIs-including those performed using drug-eluting stents-are associated with much higher rates of vascular reocclusion than is CABG. In addition, CBIs are not well suited to patients with diabetes or chronic total occlusion, both of which are extremely common in the CAD population. In contrast, CABG has proven effective for CAD patients with these conditions. The technology used in CABG continues to improve; ongoing innovations include off-pump coronary artery bypass; gene therapy to prevent restenosis; and endoscopic, video-assisted, and robot-assisted CABG using automated one-shot distal anastomotic devices.


CONCLUSIONS
Although CBIs for CAD are now performed more often than surgical procedures, surgery remains an important treatment option.
Cohn
William E
WE
Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas 77225, USA. wcohn@hear.thi.tmc.edu
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods; D001026:Coronary Artery Bypass / Q000295:instrumentation* / Q000379:methods; D003327:Coronary Disease / Q000628:therapy*; D023921:Coronary Stenosis / Q000628:therapy; D006801:Humans; D015607:Stents