Complete surgical myocardial revascularization: shift of paradigm of the gold standard in the current era

Abstract

Coronary artery bypass surgery is recommended for the patients with symptomatic coronary artery disease or patients having critical left main trunk stenosis. From the inception of the procedure it has undergone several modifications during different time periods evolving into the safe, durable and effective procedure that is to-day. Complete myocardial revascularization (CR) restores blood supply to all the territories in the myocardium that are ischemic because of narrowed blood vessels. Earlier clinical studies from the1980s showed that patients who had CR had better quality of life free of angina with less major adverse coronary events and had survival benefit when followed at 5 years and 10 years compared to the patients who had incomplete myocardial revascularization. According to the coronary artery surgery study registry the benefit is more pronounced when patients had severe triple vessel disease, class III-IV angina and decreased ejection fraction.

Keywords

Coronary artery disease / complete myocardial revascularization / off-pump surgery / on-pump surgery / percutaneous coronary intervention

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