Paradigm Shift in Coronary Bypass Surgery: From Traditional Methods to Future Surgical Strategies

Coronary artery bypass grafting (CABG) remains the gold-standard revascularization strategy for patients with multivessel coronary artery disease, supported by ongoing advancements in surgical techniques, graft selection, and perioperative management. This review primarily focuses on CABG, with occasional comparisons to percutaneous coronary intervention (PCI) when clinically relevant. Traditional CABG techniques have been increasingly challenged by the emergence of minimally invasive, off-pump, and robotic-assisted approaches; however, the optimal strategy for long-term graft patency and improved survival continues to evolve. This review explores the evolution of CABG, with a particular emphasis on comparing arterial and venous grafts in terms of patency and survival outcomes. Meanwhile, while minimally invasive coronary artery bypass grafting and off-pump techniques have shown potential in reducing postoperative complications, their long-term patency rates remain a subject of debate. Robotic-assisted CABG provides enhanced surgical precision and accelerated recovery; however, its widespread adoption remains limited due to high costs and technical complexity. Subsequently, hybrid revascularization strategies, which combine coronary artery bypass grafting and percutaneous coronary intervention, have emerged as promising alternatives for selected patient populations. The future of CABG will likely be shaped by innovations such as bioengineered vascular grafts and artificial intelligence-assisted surgical planning, which have the potential to enhance graft patency, improve surgical precision, and enable more personalized interventions. Nonetheless, individualized surgical planning and optimal graft selection remain critical for achieving long-term success, highlighting the need for further research to establish standardized protocols for incorporating these emerging technologies into routine clinical practice.