Coronary artery surgery at the dawn of the 21st century

Since the 1970's coronary bypass surgery has evolved to become one of the commonest and most successful of all operative procedures. The symptomatic and survival benefit of this surgery is well recognised. However, developments in cardiological interventions, coupled with demographic and lifestyle changes, are altering the patient profile and referral pattern. Coronary surgery at the beginning of the new century frequently involves higher risk patients and more complex surgery as a result of changes in disease presentation and the success of competing cardiological interventional techniques for less extensive disease. Technological advances in endovascular devices are making significant inroads into traditional coronary surgical practice. Surgeons have responded by developing new strategies to maximise effectiveness of coronary surgery and minimise the injury associated with cardiopulmonary bypass. At the same time regulatory and media scrutiny is focussing attention on the cardiac surgeon, further adding to the stresses and complexity of cardiac surgical practice.