Current status of MIDCAB procedure

The advent of cardiopulmonary bypass in the early 1960s allowed surgeons to safely perform complex reconstructions on the heart. Since then, the field of cardiac surgery has progressed to where surgical myocardial revasculari zation, or coronary artery bypass grafting (CABG), has become the most exha ustively studied operation in the history of surgery, and it has achieved w idespread use because its benefits have been so thoroughly documented. The paradoxical fact is that more elderly and debilitated patients benefit the most from cardiac surgery compared with medical therapy, yet they sustain g reater risk of morbidity and mortality after cardiac surgery. Most of the r ecent innovations and refinements in the treatment of coronary artery disea se aim toward reduction of trauma without deviating much from the safety an d efficacy of the conventional procedures. As a consequence, a greater numb er of high-risk elderly patients have become candidates for coronary artery bypass grafting (CABG). All of the amendments are caused by changing clini cal scenarios brought on by an increased number of aging patients, a greate r number of patients requiring re-operations, cost containment, increased d iscernment about outcome assessment, and also the dominance of coronary byp ass being threatened by the success of interventional cardiology. (C) 2001 Lippincott Williams & Wilkins, Inc.