Surgical Myocardial Revascularization: With or Without the Use of Cardiopulmonary Bypass

Coronary artery disease is one of the most common causes of death in the developed world. Atherosclerotic plaque progresses to a point at which the artery is critically stenosed. Surgical myocardial revascularization has developed in 1960s; the operation was called coronary artery bypass grafting. The first revascularization was performed on a beating heart. However, due to technical limitations this technique was quickly abandoned. Conventional coronary artery bypass grafting with the use of extracorporeal circulation and cardioplegic arrest became the forefront of surgical revascularization. In the late 1970’s, percutaneous coronary intervention appeared, which, in comparison to surgical revascularization, is much less invasive. Quickly evolving interventional cardiology and well-known adverse effects of extracorporeal circulation forced surgeons to develop a less invasive surgical treatment of coronary artery disease. In the 1990’s, beating heart coronary artery bypass grafting without the use of extracorporeal circulation redeveloped. The so-called off-pump coronary artery bypass grafting appeared to be an equivalent technique to on-pump coronary artery bypass grafting, which is already well-established. The article describes advantages and disadvantages of both techniques.