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CABG 1984: technical aspects of bypass surgery.

During the past 15 years coronary artery bypass surgery (CABG) has evolved into a procedure with low operative mortality and morbidity resulting in excellent improvement in lifestyle and improved longevity in some instances. Operative risk factors have been identified. Their significance has changed during this time. Currently, clinical congestive heart failure and emergency operation are the most commonly observed adverse results. Since the patients being operated upon, especially those emergent, are sicker, the improvements in mortality and morbidity with CABG are not due to patient selection, but rather to improvement in preoperative, intraoperative, and postoperative management. The major areas of management that have been responsible for the current status of CABG are myocardial protection, conduit selection and preservation, blood conservation, anesthetic management, pulmonary arterial catheter monitoring, pharmacologic unloading, intraaortic balloon assistance, cardiac assist devices, and arrhythmia control.