Conventional Coronary Artery Bypass Grafting

: It was in 1969 that Dr. René Favaloro first used a saphenous vein graft the way we use it today to perform an aorto-coronary bypass. Since then, there have been plenty of trials in the literature trying to prove the inferiority or not of conventional coronary artery bypass grafting. Left internal mammary artery to left anterior descending coronary artery anastomosis and saphenous vein grafts to other coronary artery targets performed through full median sternotomy in a safe, motionless and bloodless environment provided by cardiopulmonary bypass and cardioplegic arrest is typical of conventional coronary artery bypass grafting. Non-conventional approaches include bilateral internal mammary artery harvesting or total arterial revascularization instead of saphenous vein grafts, off-pump coronary artery bypass grafting avoiding the use of cardiopulmonary bypass machine and minimally invasive direct coronary artery bypass or hybrid coronary revascularization instead of full median sternotomy. However, conventional coronary artery bypass grafting appears non-inferior to any of the aforementioned approaches in terms of mortality and major morbidity. On the other hand, only highly selected patients can benefit from non-conventional approaches. Furthermore, experience is critical for achieving optimal outcomes with any of these approaches. High-volume centres with expert surgeons can offer the best results. Conventional coronary artery bypass grafting continuously competes with modern alternative approaches. However, which of these is the best remains a contentious affair.