When was first cabg done

Role of percutaneous transluminal coronary angioplasty in the treatment of unstable angina. Analysis of trends in coronary artery bypass grafting and percutaneous coronary intervention rates in Washington state from to Coronary revascularization in the community.

A population-based study, to Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial.

The need for coronary artery surgery: expand or restrict? A European view. Critical analysis of coronary artery bypass graft surgery: a year journey. Functional, metabolic, and morphologic effects of potassium-induced cardioplegia. Is blood superior to crystalloid cardioplegia? A meta-analysis of randomized clinical trials. Is there any difference between blood and crystalloid cardioplegia for myocardial protection during cardiac surgery?

A meta-analysis of patients from 36 randomized trials. Pulsatile versus nonpulsatile flow during cardiopulmonary bypass: microcirculatory and systemic effects. Remote ischaemic preconditioning in coronary artery bypass surgery: a meta-analysis. Effect of adenosine-regulating agent acadesine on morbidity and mortality associated with coronary artery bypass grafting: the RED-CABG randomized controlled trial.

Coronary bypass graft fate: angiographic grading of consecutive grafts early after operation and of after one year. A randomized comparison of intraoperative indocyanine green angiography and transit-time flow measurement to detect technical errors in coronary bypass grafts. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Coronary bypass graft fate and patient outcome: angiographic follow-up of grafts related to survival and reoperation in patients during 25 years.

Aspirin plus clopidogrel versus aspirin alone after coronary artery bypass grafting: the clopidogrel after surgery for coronary artery disease CASCADE trial.

Influence of the internal-mammary-artery graft on year survival and other cardiac events. Long-term 5 to 12 years serial studies of internal mammary artery and saphenous vein coronary bypass grafts.

Intercostal artery: histomorphometric study to assess its suitability as a coronary bypass graft. Descending branch of lateral femoral circumflex artery as a free graft for myocardial revascularization: a case report. Inferior mesenteric artery as a free arterial conduit for myocardial revascularization.

Inferior epigastric artery as a free graft for myocardial revascularization. The aorta-to-coronary radial artery bypass graft.

A technique avoiding pathological changes in grafts. Gastroepiploic and inferior epigastric arteries for coronary artery bypass.

Early results and evolving applications. Arterial grafts for coronary artery bypass grafting: biological characteristics, functional classification, and clinical choice. Comparison of saphenous vein graft versus right gastroepiploic artery to revascularize the right coronary artery: a prospective randomized clinical, functional, and angiographic midterm evaluation.

Vasoreactivity of the radial artery. Comparison with the internal mammary and gastroepiploic arteries with implications for coronary artery surgery. Coronary artery bypass grafting using the radial artery: clinical outcomes, patency, and need for reintervention.

New approaches to prevention and treatment of radial artery graft vasospasm. Complex coronary anatomy in coronary artery bypass graft surgery: impact of complex coronary anatomy in modern bypass surgery? A new non-thrombogenic surface prepared by selective covalent binding of heparin via a modified reducing terminal residue. Direct coronary surgery with saphenous vein bypass without either cardiopulmonary bypass or cardiac arrest.

First-year outcomes of beating heart coronary artery bypass grafting using proximal mechanical connectors. Distal anastomotic patency of the Cardica C-PORT R xA system vs the hand-sewn technique: a prospective randomized controlled study in patients undergoing coronary artery bypass grafting.

Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. Minimally invasive direct coronary artery bypass grafting: two-year clinical experience.

Seven-year follow-up after minimally invasive direct coronary artery bypass: experience with more than patients. Minimally invasive direct coronary artery bypass grafting: a meta-analysis. One hundred sixty-four consecutive beating heart totally endoscopic coronary artery bypass cases without intraoperative conversion. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. Results of coronary artery surgery in patients with poor left ventricular function CASS.

Surgical survival benefits for coronary disease patients with left ventricular dysfunction. Coronary-artery bypass surgery in patients with left ventricular dysfunction.

Predicting therapeutic benefit from myocardial revascularization procedures: are measurements of both resting left ventricular ejection fraction and stress-induced myocardial ischemia necessary?

Follow-up results of distal coronary artery bypass for ischemic heart disease. Blacks in the coronary artery surgery study CASS : race and clinical decision making. Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database.

Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery. Long-term survival of young patients with coronary artery disease is best realized through surgical revascularization with mammary arteries.

Risk profile and 3-year outcomes from the SYNTAX percutaneous coronary intervention and coronary artery bypass grafting nested registries. Outcomes associated with bilateral internal thoracic artery grafting: the importance of age.

Transcatheter aortic valve implantation: year anniversary part II: clinical implications. Transcatheter aortic valve implantation year anniversary: review of current evidence and clinical implications. Percutaneous edge-to-edge MitraClip therapy in the management of mitral regurgitation.

The Society of Thoracic Surgeons cardiac surgery risk models: part 1—coronary artery bypass grafting surgery. Off-pump vs. Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. Stroke after cardiac surgery: a risk factor analysis of consecutive adult patients. Incidence, topography, predictors and long-term survival after stroke in patients undergoing coronary artery bypass grafting.

Association of myocardial enzyme elevation and survival following coronary artery bypass graft surgery. On- and off-pump coronary surgery and perioperative myocardial infarction: an issue between incomplete and extensive revascularization.

Perioperative myocardial infarction has negative impact on health-related quality of life following coronary artery bypass graft surgery. Current incidence and determinants of perioperative myocardial infarction in coronary artery surgery. Incidence, predictors, and significance of abnormal cardiac enzyme rise in patients treated with bypass surgery in the arterial revascularization therapies study ARTS. The effect of pre-operative aspirin on bleeding, transfusion, myocardial infarction, and mortality in coronary artery bypass surgery: a systematic review of randomized and observational studies.

Reoperation for bleeding in patients undergoing coronary artery bypass surgery: incidence, risk factors, time trends, and outcomes. Delayed re-exploration for bleeding after coronary artery bypass surgery results in adverse outcomes.

Coronary artery bypass graft: contemporary heart surgery center performance in China. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. A multicomponent intervention to prevent delirium in hospitalized older patients.

Risk factors for delirium in the elderly after coronary artery bypass graft surgery. Incidence and risk factors for delirium and other adverse outcomes in older adults after coronary artery bypass graft surgery. Preoperative and operative predictors of delirium after cardiac surgery in elderly patients. Effect of intensive care unit environment on in-hospital delirium after cardiac surgery.

Predictors of delirium after cardiac surgery delirium: effect of beating-heart off-pump surgery. The long-term effects of developing renal failure post-coronary artery bypass surgery, in patients with normal preoperative renal function.

Perioperative increases in serum creatinine are predictive of increased day mortality after coronary artery bypass graft surgery. Multivariable prediction of renal insufficiency developing after cardiac surgery. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Randomized trial to compare bilateral vs. A prospective randomized multicenter trial shows improvement of sternum related complications in cardiac surgery with the Posthorax support vest.

Superficial and deep sternal wound infection after more than coronary artery bypass graft CABG : incidence, risk factors and mortality. Bilateral internal thoracic artery harvest and deep sternal wound infection in diabetic patients. Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival.

Superficial and deep sternal wound complications: incidence, risk factors and mortality. New-onset postoperative atrial fibrillation after isolated coronary artery bypass graft surgery and long-term survival. New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft. N-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. Clinical outcomes in randomized trials of off- vs.

Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. Prediction of new onset atrial fibrillation after cardiac revascularization surgery. Risk of stroke with coronary artery bypass graft surgery compared with percutaneous coronary intervention. Coronary artery bypass surgery: Part 2—optimizing outcomes and future directions.

A systematic review of risk prediction in adult cardiac surgery: considerations for future model development. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score. The Society of Thoracic Surgeons: day operative mortality and morbidity risk models. The rationale for heart team decision-making for patients with stable, complex coronary artery disease.

Dynamic trends in cardiac surgery: why the logistic EuroSCORE is no longer suitable for contemporary cardiac surgery and implications for future risk models. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity.

Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates? Exploring the volume-outcome relationship for off-pump coronary artery bypass graft procedures. Limitations of hospital volume as a measure of quality of care for coronary artery bypass graft surgery.

Association of hospital coronary artery bypass volume with processes of care, mortality, morbidity, and the Society of Thoracic Surgeons composite quality score.

Shop for quality or volume? Volume, quality, and outcomes of coronary artery bypass surgery. Quality, not volume, determines outcome of coronary artery bypass surgery in a university-based community hospital network. Risk score for predicting long-term mortality after coronary artery bypass graft surgery. Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery.

Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study ARTS randomized trial. Cognitive and cardiac outcomes 5 years after off-pump vs on-pump coronary artery bypass graft surgery. Ten-year follow-up survival of the Medicine, Angioplasty, or Surgery Study MASS II : a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease.

The risk of stroke following coronary revascularization—a population-based long-term follow-up study. These include the presence of peripheral artery disease, COPD, concomitant valvular heart disease, previous cardiac surgery, preoperative AF, and pericarditis.

Male gender and advanced age are also risk factors for AF. Postoperative AF almost always occurs within 5 days of surgery peaking on postoperative day 2 [ 63 ]. Multiple pharmacologic interventions have been attempted, but only perioperative beta blockade and amiodarone have been shown to be effective in reducing AF [ 64 ]. As such, rate control with beta blockers or conversion with amiodarone is the first line of treatment [ 65 ].

Postoperative anticoagulation may be warranted in rate controlled patients still in fibrillation. Advances in medical therapy and percutaneous intervention have led to ever shrinking numbers of CABG being performed each year.

Furthermore, the patients undergoing these procedures have a much more complicated combination of disease processes. The future of coronary artery bypass grafting is making these difficult procedures better tolerated by this complex subset of patients through smaller incisions or without any incision.

Operative changes and challenges are trying to be addressed. Minimally invasive procedures and approaches will continue to be developed. Robotic intervention strives for a totally endoscopic CABG. Anastomotic devices are being researched to make this goal more feasible. However, most of these devices are infrequently utilized and are in the infancy of their potential development [ 66 ]. Additionally, many of the patients have extensive coronary artery disease with prior attempts at revascularization.

The determination of graft patency, intraoperatively, in these patients is vital. For this reason, several techniques using transit-time flow and intraoperative fluorescence imaging are being developed. However, neither method has been proven to be adequate in the assessment of small abnormalities in graft patency [ 67 ]. This has been proposed to decrease the morbidity rate of traditional CABG in high-risk patients. The National Institutes of Health has sponsored a randomized control trial to evaluate the hybrid procedure versus CABG or stenting alone [ 66 ].

Additionally, nonoperative placement of substances known to promote myocardial regeneration and angiogenesis is being researched [ 68 , 69 ].

With the success of stem cell therapy and molecular medicine in other fields of science and medicine, this has great potential for myocardial repair. In a little over a century, heart surgery has gone from prohibitive to commonplace. Major advances have made the CABG a much safer and more accepted procedure. Continued research into different approaches, methods and medical interventions may make cardiac surgery less invasive and safer in the future.

The benefits and risks for each patient must be evaluated with a team approach to determine which method is best for that patient. Even with paradigm shifts in medical treatments and stenting, the continued development of coronary surgery is vital for those patients who cannot be managed nonsurgically. As surgical interventions become relatively less common, the issue of how many and how to train future cardiac surgeons may become an issue.

Furthermore, as the procedures and patients become more complex, the development of different specialized postoperative strategies will need to be considered.

Lastly, the field of cardiac surgery will need to become more specialized as people are surviving cardiac operations for longer period of time and may need further interventions such as higher risk reinterventions. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Michael Diodato 1 and Edgar G. Academic Editor: H. Received 27 Jun Accepted 25 Jul Published 02 Jan Abstract The development of the heart-lung machine ushered in the era of modern cardiac surgery. Methods Although the fundamental basis of CABG is to reestablish perfusion to the myocardium, there are several different approaches to accomplish this goal.

Conduits Multiple conduits may be employed to establish cardiac revascularization. Future Directions Advances in medical therapy and percutaneous intervention have led to ever shrinking numbers of CABG being performed each year.

Summary In a little over a century, heart surgery has gone from prohibitive to commonplace. Conflict of Interests The authors have no financial interests to disclose. References S. Davies and A. Longmire, J. Cannon, and A.

View at: Google Scholar R. Goetz, M. Rohman, J. Haller, R. Dee, and S. View at: Google Scholar W. Proudfit, E. Shirey, and F. Sones Jr. View at: Google Scholar A. View at: Google Scholar G. View at: Google Scholar J. Cremer and S. Duhaylongsod, W.

Mayfield, and R. Falk, A. Diegler, T. Walther, R. Autschbach, and F. Prasad, C. Ducko, E. Stephenson, C. Chambers, and R. Damiano Jr. Gaziano, K. Reddy, F. Paccaud, S. Horton, and V. Jamison, J. Breman, A. Measham et al. View at: Google Scholar F. Benetti, G. Naselli, M. Wood, and L. View at: Google Scholar E.

Buffalo, J. Branco, C. Teles, L. Aguiar, and W. Penninga, J. Wetterslev, D. Afilalo, M. Rasti, S. Ohayon, A. Shimony, and M. View at: Google Scholar S. Forouzannia, M. Abdollahi, S. Mirhosseini et al. View at: Google Scholar O. Yadava, A. Prakash, A. Kundu, and M. Shroyer, F. Grover, B. Hattler et al. Mack, T. Acuff, P. Yong, G. The high mortality associated with direct coronary patching led to the use of the saphenous vein. Initially, in May , the saphenous vein was used in an end-to-end fashion to replace an occluded segment of the right coronary artery and then soon after as a free aorto-coronary bypass graft to the LAD By October Favolaro reported the use of the saphenous vein graft in direct coronary surgery in patients This was an important landmark in the birth of modern coronary surgery.

Although the origins of coronary surgery began with the arterial graft, the saphenous vein, with its technical ease of harvest, its robust handling characteristics and its versatility as an aorto-coronary graft, simplified the conduct of the operation and allowed for widespread reproducibility. However, even in the early days of saphenous grafting it was recognized that the saphenous vein was prone to failure, with pathological reports of intimal and medial thickening and graft thrombosis Over time it has become apparent that because of accelerated intimal hyperplasia and premature atherosclerosis, the SVG has a significantly lower patency than its arterial counterparts In combination with the excellent outcomes seen with widespread introduction of ITA grafting, the limitations associated with the SVG have fueled the interest in arterial grafting in contemporary surgical practice.

Alain Carpentier first used the RA in However, within 2 years of adopting the RA there were reports of early failure rates 24 and significant intimal hyperplasia 25 , which resulted in almost complete abandonment of its use as a graft. Techniques of early RA harvest, particularly skeletonization, resulted in vessel trauma and spasm.

When this was combined with the use of mechanical dilatation it likely led to endothelial injury and subsequent early graft failure. Further reports of excellent outcomes with the RA 27 , 28 coupled with a number advantageous characteristics for example, ease of harvest, ability to reach all coronary territories, size match with the coronary arteries, uniform caliber along length of graft led to the widespread adoption of the RA as the second or third arterial graft of choice.

The excellent patency of the SVG seen in these compared to historical reports 22 may possibly be explained by the meticulous selection, atraumatic harvest and pharmacological preparation and storage prior to grafting in contemporary practice Coupled with improved post-operative medical management and secondary cardiovascular protection measures the SVG may prove to be a reasonable graft choice at least in mid-term follow-up.

However, as vein graft patency declines dramatically in the year period following surgery 39 , it may be that final reports of long-term follow-up may yield superior results with the RA. RA harvest allows for quicker and easier ambulation following surgery and is associated with fewer wound complications and higher patient satisfaction in both the short- and long-term 40 - These clinical outcomes must not be forgotten, as they are often extremely important to patients.

While the ITA was routinely used by surgeons as early as the s, it was not until the mids that the significant influence its use had on clinical outcome was recognized. Floyd Loop and the Cleveland Clinic group were the first to report improved clinical outcomes with the use of the ITA when compared to vein grafting alone They showed that ITA use was associated with improved survival, reduced risk of myocardial infarction, reduced risk of hospitalization and a reduced requirement for repeat revascularization over 10 years.

With increasing use of the ITA it also became apparent that it was not only associated with a long-term survival advantage but also with improved early outcomes and a reduction in early peri-operative death. This finding was seen in both low- and high-risk individuals A sentinel paper by the Cleveland group in confirmed that BITA grafting was associated with greater survival and reduced need for repeat revascularization when compared to single ITA grafting Many groups, including our own, reported suboptimal results when an in situ RITA was grafted to the right coronary system 50 and equivalent patency rates when comparing a free ITA and the RA grafted in a non-LAD territory It is likely that the best outcomes from BITA grafting are seen when the ITAs are used to graft the left system and the right coronary supplemented with a radial graft.

There are a number of perceived disadvantages to BITA grafting, including the increased length of operative time and the requirement for an in situ RITA to cross the midline or to go through the transverse sinus to reach the LAD or circumflex systems.

Probably the most frequently cited reason for not using BITA is the increased risk of sternal wound breakdowns. It is apparent that in certain groups harvesting bilateral ITAs may lead to an increased risk of sternal wound problems from sternal devascularization and surgical trauma associated with harvest.

This is particularly apparent in those with severe airways disease, the obese and in diabetics The use of a skeletonized harvest technique, however, has been shown to reduce the risk of sternal wound complications