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Machiraju. Vessel Plus 2019;3:25 Vessel Plus
DOI: 10.20517/2574-1209.2019.008

Review Open Access

Complete surgical myocardial revascularization:
shift of paradigm of the gold standard in the current

era

Venkat R. Machiraju

Department of Thoracic surgery, University of Pittsburgh Medical center, Pittsburgh, PA 15238, USA.
Correspondence to: Prof. Venkat R. Machiraju, Department of Thoracic surgery, University of Pittsburgh Medical center,
Machiraju, 534 Squaw run road east, Pittsburgh, PA 15238, USA. E-mail: vrmachiraju@aol.com
How to cite this article: Machiraju VR. Complete surgical myocardial revascularization: shift of paradigm of the gold standard in
the current era. Vessel Plus 2019;3:25. http://dx.doi.org/10.20517/2574-1209.2019.008
Received: 12 Apr 2019 First Decision: 8 May 2019 Revised: 14 May 2019 Accepted: 10 Jul 2019 Published: 20 Jul 2019

Science Editor: Mario F. L. Gaudino Copy Editor: Jia-Jia Meng Production Editor: Jing Yu

Abstract
Received: First Decision: Revised: Accepted: Published: x
Coronary artery bypass surgery is recommended for the patients with symptomatic coronary artery disease or
Science Editor: Copy Editor: Production Editor: Jing Yu
patients having critical left main trunk stenosis. From the inception of the procedure it has undergone several
modifications during different time periods evolving into the safe, durable and effective procedure that is to-day.
Complete myocardial revascularization (CR) restores blood supply to all the territories in the myocardium that
are ischemic because of narrowed blood vessels. Earlier clinical studies from the1980s showed that patients who
had CR had better quality of life free of angina with less major adverse coronary events and had survival benefit
when followed at 5 years and 10 years compared to the patients who had incomplete myocardial revascularization.
According to the coronary artery surgery study registry the benefit is more pronounced when patients had severe
triple vessel disease, class III-IV angina and decreased ejection fraction.

Keywords: Coronary artery disease, complete myocardial revascularization, off-pump surgery, on-pump surgery,
percutaneous coronary intervention

INTRODUCTION
Both medical and surgical therapeutic interventions of coronary artery disease (CAD) are extensively
studied by the patients, physicians, hospital administrators, epidemiologists, and the insurance companies
because of the risks involved to the patient on one side and the cost of care on the other side. CAD still

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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