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Coronary Artery Disease

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Cardiac Surgery

Abstract

Coronary bypass surgery (CABG) forms the majority of all cardiac surgical procedures. This is due to the high incidence of coronary vessel disease in the western nations and their ageing populations.

Since its clinical implementation in the late 1960s, coronary bypass surgery underwent continuous development and refinements. Nowadays it represents the gold standard of surgical treatment of coronary disease.

Evolution of this procedure involved mainly the choice of grafts, patient selection and development of beating-heart procedures. Arterial grafts proved to be superior regarding long-term patency. Especially arterial revascularisation of the anterior myocardial wall showed to be crucial for the long-term outcome in patients with multi-vessel disease.

Myocardial revascularisation with extracorporeal circulation and cardioplegic arrest still constitutes the standard procedure and dominates clearly alternative techniques. These mainly comprise beating-heart procedures which disclaim extracorporeal circulation. OPCAB surgery mainly addresses high-risk patients and should lower the incidence of organ failure and cerebral thromboembolic events. MIDCAB surgery is mainly directed to complex single-vessel disease of the anterior wall. In combination with interventional procedures, it can be part of hybrid revascularisation techniques.

Current studies, especially the SYNTAX and the FREEDOM trial, demonstrate that especially patients with complex multi-vessel disease, diabetes and poor ventricular function benefit from surgical revascularisation. These findings are incorporated in the current interdisciplinary national and international guidelines on myocardial revascularisation.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany

    Jochen T. Cremer MD, PhD & Jan Schöttler MD

  2. Department of Cardiac and Vascular Surgery, University of Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany

    Grischa Hoffmann MD

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  1. Jochen T. Cremer MD, PhD
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  2. Jan Schöttler MD
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  3. Grischa Hoffmann MD
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Correspondence to Jochen T. Cremer MD, PhD .

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  1. Department of Surgery, The University of Chicago, Chicago, IL, USA

    Gerhard Ziemer

  2. HTTG - Surgery, Medizinische Hochschule Hannover, Hannover, Germany

    Axel Haverich

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Cremer, J.T., Schöttler, J., Hoffmann, G. (2017). Coronary Artery Disease. In: Ziemer, G., Haverich, A. (eds) Cardiac Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52672-9_22

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-52670-5

  • Online ISBN: 978-3-662-52672-9

  • eBook Packages: MedicineMedicine (R0)

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