Surgical coronary revascularization remains relevant in the era of stents

Purpose of review The high prevalence of coronary artery disease (CAD) has inspired the development of technologies and techniques for coronary revascularization, including coronary artery bypass grafting (CABG) and catheter-based interventions (CBIs). Recent findings Although CBIs allow the avoidance of general anesthesia, sternotomy, and cardiopulmonary bypass, CBIs-including those performed using drug-eluting stents-are associated with much higher rates of vascular reocclusion than is CABG. In addition, CBIs are not well suited to patients with diabetes or chronic total occlusion, both of which are extremely common in the CAD population. In contrast, CABG has proven effective for CAD patients with these conditions. The technology used in CABG continues to improve; ongoing innovations include off-pump coronary artery bypass; gene therapy to prevent restenosis; and endoscopic, video-assisted, and robot-assisted CABG using automated one-shot distal anastomotic devices. Summary Although CBIs for CAD are now performed more often than surgical procedures, surgery remains an important treatment option.