Current Concepts in Surgical Myocardial Revascularization

In this interview, O. P. Yadava of the National Heart Institute in New Delhi, India, and Massimo Lemma of the Jilin Heart Hospital in Changchun, China, discuss surgical myocardial revascularization. Dr Lemma stresses the importance of total arterial myocardial revascularization, commenting that both internal mammary arteries have equivalent patency rates and that the next best conduit of choice is the radial artery. They discuss why vein grafts are still used, given the superior patency of arterial grafts.

Drs Yadava and Lemma also discuss off-pump coronary artery bypass grafting (OPCAB), agreeing that it is an altogether different operation, and that surgeons should be trained specifically in OPCAB to produce optimal results. They mention the recently published results from the ROOBY trial, and Dr Lemma emphasizes the low number of operations that surgeons were required to have completed in order to participate in that trial.

Dr Yadava predicts that in the next 20 years better cell-based, molecular, and genetic options will make the current mechanical approaches to treating coronary artery disease obsolete. Dr Lemma expects that surgical and percutaneous options will persist but that hybrid techniques will become common.

O. P. Yadava is Editor-in-Chief of the Indian Journal of Thoracic and Cardiovascular Surgery, but has no conflict with this presentation.