CORONARY ARTERY BYPASS SURGERY: NEW SURGICAL APPROACHES

In April 1968, Renee Favaloro published the first series of coronary artery bypass graft surgeries. Over the years since that landmark publication, coronary artery bypass graft sur-gery has been enthusiastically embraced by cardiac surgeons around the world. Currently, according to the most recent data from Brazilian registries and the American database of the Society of Thoracic Surgeons, most cardiac surgery procedures in adults are coronary artery bypass graft operations. Over five decades since the first Favaloro procedure, coronary artery bypass graft surgery has witnessed substantial changes and evolution. Continuous technical and technological improvements have made the operation safer and less invasive. Surgeries without cardiopulmonary bypass, by miniaccess, with a greater number of arterial grafts, hybrid revascularization, and surgeries with robotic assistance represent the extreme evolution of the procedure originally described in 1968. All these new techniques share the issue of increasing technique and logistics, and more limited evidence of support and applicability compared to standard operations. However, these techniques have been developed in a safe and less aggressive way, making them more attractive for patients with coronary artery disease who need surgical treatment. In this article, the techniques are reviewed and a summary of different state-of-the-art approaches to coronary artery bypass graft surgery is provided.