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Coronary artery bypass grafting (CABG) was introduced in the 1960s as the first procedure for direct coronary artery revascularization and rapidly became one of the most common surgical procedures worldwide, with an overall total of more than 20 million operations performed. CABG continues to be the most common cardiac surgical procedure performed and has been one of the most carefully studied therapies. Best CABG techniques, optimal bypass conduits, and appropriate patient selection have been rigorously tested in landmark clinical trials, some of which have resolved controversy and most of which have stoked further debate and trials. The evolution of CABG cannot be properly portrayed without presenting it in the context of the parallel development of percutaneous coronary intervention. In this Historical Perspective, we a provide a broad overview of the history of coronary revascularization with a focus on the foundations, evolution, best evidence, and future directions of CABG.
“The 2021 guidelines were controversial, and they were largely controversial because of the downgrading of coronary artery bypass surgery (CABG) in patients with stable triple-vessel ischemic heart disease—from a class 1 recommendation, which is a very strong recommendation, to a 2B. To justify this, they used the ISCHEMIA study, which in our opinion should not have been used.”
Mack et al. (Thu,) studied this question.