Long-term results of coronary artery surgery

The management of coronary artery disease is constantly being refined and, as a consequence, the long-term results of coronary artery surgery are under intense and continuous scrutiny. An appreciation of the long-term results of different surgical strategies in selected subgroups of patients with ischaemic heart disease is important in deciding which is the most appropriate treatment option between surgery, angioplasty, and continued medical treatment. It also permits the patient to make an informed choice when that choice may influence the treatment. Interventional cardiology is encroaching onto traditionally surgical territory, and what effect these changes have on long-term results remains to be seen. Operative management continues to improve, and the use of arterial conduits may have a survival advantage; however, attention to the secondary prevention of cardiac risk factors will have the most influence on the long-term results of surgery. A clearer understanding of the importance of risk-factor management, in particular lipid reduction by drug treatment, will improve the long-term results for patients undergoing operations, probably both in late mortality and in clinical events, including the need for further intervention.