Unlocking Insights: The Future of CABG Surgery

Case

A new publication by Ghandakly, Iacona, and Bakaeen from the Cleveland clinic titled “Coronary Artery Surgery: Past, Present, and Future” gives a very insightful and interesting view on CABG surgery. As stated by the article “The CABG procedure is the most commonly performed major cardiac operation and the most studied intervention worldwide. With well over 20,000 cited articles on PubMed, there is no other intervention in adult cardiac surgery that has been more extensively studied.” 

For such a well-studied procedure the past is bound to hold interesting stories and the authors present these along with the present and future in a good way. In the conclusion they point out that “… Intraoperative graft patency assessment is gaining a foothold and is a critical adjunct for complex multiarterial grafting and minimally invasive techniques.” 

The article states that the development of intraoperative quality control methods has also contributed to the evolution of streamlined techniques and improved outcomes. One example is transit time flow measurement (TTFM), which allows for intraoperative evaluation of coronary graft flow wherein an ultrasound probe facilitates measurement of blood flow volume through the graft. A systematic review (1) yielded an expert consensus that use of TTFM has a favorable cost-benefit ratio based on evidence supporting an association between TTFM readings of graft patency and postoperative clinical outcomes. 

Abstract

Coronary artery bypass grafting (CABG) is the most commonly performed and studied major cardiac operation worldwide. An understanding of the evolution of CABG, including the early days of cardiac surgery, the first bypass operation, continuous improvements in techniques, and streamlining of the operation, is important to inform current trends and future innovations. This article will examine how CABG evolved (from techniques to conduits), describe current trends in the field, and explore what lies on the horizon for the future of CABG. 

The article concludes with an inspirational quote by Dr. Favaloro and points to more collaboration and innovation as key to future development. 

““Medicine depends on evolution … by means of the work of many contributors. I could claim many ‘firsts.’ I never did, because to me ‘we’ is more important than ‘I.’” It is from this foundation of collaboration and innovation that CABG will continue to evolve.” 

Link to full article: Coronary Artery Surgery: Past, Present, and Future (rmmj.org.il)

(1): Gaudino M, Sandner S, Di Giammarco G, Di Franco A, Arai H, Asai T, Bakaeen F, Doenst T, Fremes SE, Glineur D, Kieser TM, Lawton JS, Lorusso R, Patel N, Puskas JD, Tatoulis J, Taggart DP, Vallely M, Ruel M. The Use of Intraoperative Transit Time Flow Measurement for Coronary Artery Bypass Surgery: Systematic Review of the Evidence and Expert Opinion Statements. Circulation. 2021 Oct 5;144(14):1160-1171. doi: 10.1161/CIRCULATIONAHA.121.054311.  

Reference

Ghandakly EC, Iacona GM, Bakaeen FG. Coronary Artery Surgery: Past, Present, and Future. Rambam Maimonides Med J 2024;15 (1):e0001. Review. doi:10.5041/RMMJ.10515