Technical progress in coronary surgery.

This report reviews the most recent technical advances that improve the results of coronary artery bypass grafting and discusses advantages and limitations in revascularization by extensive employment of arterial grafts. There is evidence that the use of the second internal mammary artery for coronary grafting, in selected cases, gives excellent long-term results. The use of alternative arterial conduits in conjunction with both internal mammary arteries in order to achieve complete revascularization with arterial grafts only has yielded good short-term results. However, for late results further and larger studies are necessary. In diffuse coronary artery disease, complex vessel endarterectomy and reconstruction procedures are currently performed by several surgeons with low operative risk and good midterm clinical results. Favorable results concerning the patency of the endarterectomized coronary arteries and related grafts have been reported.