Coronary artery bypass grafting—fifty years of quality initiatives since Favaloro

Abstract

Coronary artery bypass grafting (CABG) remains one of the most commonly performed major surgical procedures worldwide and the most common procedure performed by cardiac surgeons. Rene Favaloro is widely credited with recognizing the true potential of CABG and subsequently popularizing the technique in a broad manner. Since the era of Favaloro in the late 1960s, the evolution of CABG can be understood through a series of quality initiatives that have defined which patients can benefit from the procedure and via which technique(s) they will derive the greatest benefit. Herein, we will review some of the key developments in CABG over the last 50 years with a focus on ongoing quality initiatives that will continue to refine the optimal applications and outcomes of CABG for the next 50 years.

Trends in Characteristics and Outcomes of Hospital Inpatients Undergoing Coronary Revascularization in the United States, 2003-2016

“…These trends likely reflect the effect of the emerging data that suggest the incremental benefit of certain techniques or devices (eg, fractional flow reserve, drug-eluting stents, and arterial conduits) and the limited value of others (eg, off-pump bypass). [31][32][33][34][35][36][37][38] We hypothesized that the temporal decrease in PCI and CABG volume, as well as the accompanying changes in hospital inpatient risk profile and procedural characteristics, might have been associated with a change in procedural mortality over time. We thus evaluated crude and riskadjusted rates of in-hospital mortality of both procedures stratified by indication.…”

Internal mammary harvesting: Techniques and evidence from the literature

“…By standardizing revascularization surgery, there is an opportunity to promote improved outcomes in the field of cardiac surgery 59 . It has been recommended that the future direction of CABG development concentrates on the optimal use of surgical and interventional resources to provide the least invasive and long‐lasting treatment as possible 7 .…”

Respite for hybrid coronary revascularization

“…Autologous saphenous vein was the conduit used by Favaloro in his landmark CABG operation 50 years ago [21] . SVG still account for > 80% of conduits used in CABG surgery [22,23] .…”