New approaches to the surgical therapy of atherosclerotic coronary artery disease

Fundamental changes in the therapy of atherosclerotic coronary artery disease, in both technique and strategy, are occurring in the practice of cardiac surgery. New surgical approaches to coronary artery bypass grafting include the use of “mini” incisions and off-bypass techniques as well as the more widespread use of arterial conduits. Furthermore, the treatment of adult heart disease, in particular coronary artery disease, may be entering a period of fundamental change with the advent of nongrafting techniques, such as transmyocardial revascularization, therapeutic angiogenesis, and gene therapy. This article provides an overview of these new approaches, which involve either modifications of current coronary artery bypass grafting techniques or the novel use of biologic revascularization.