Surgical Revascularization of the Ischemic Myocardium in the third millennium

Sixty-four years ago, Robert Goetz performed the first direct surgical myocardial revascularization in the history of cardiac surgery. This was the beginning of a long journey that remains ongoing. Surgical myocardial revascularization was the only treatment for myocardial ischemia for decades, but in the previous twenty years it has had to share the floor with percutaneous intervention. This apparent “competition” has led both surgeons and cardiologists to improve techniques in order to improve outcomes, both in the early stages and in the long term.

For us cardiac surgeons, there are still many aspects of our specialty that have not yet been fully answered.
1) Is there still a role for revascularization of the myocardium on the beating heart?
2) Which revascularization strategy, surgical alone or hybrid, achieves the best long-term results?
3) Is there a role for the great saphenous vein, which remains the most commonly used graft for revascularization of stenotic coronaries?
4) Can a multiple arterial graft strategy provide the best clinical results or is it overestimated?
5) Is it possible to use a strategy that combines surgery and interventional cardiology?
6) Does robotic surgery have a role to play?
7) What is the most effective postoperative antiplatelet treatment?
8) Is coronary surgery a subspecialty?
These and other questions are still subject to debate and there is still room for improvement in our era where we strive for evidence-based medicine.

The aim of this Research Topic is to analyze what the state of the art is today, where we stand in the search for the best surgical treatment of ischemic cardiopathy, and how we can combine the tools at our disposal (surgical, interventional, medical) to achieve the best outcome for our patients. We also need to consider the impact of the new mechanical forces caused by changes in distal perfusion on the biology of the endothelial cells lining the inside of the conduits. String sign and accelerated atherosclerosis may be the undesirable consequences of choosing a graft whose properties are not suitable for a particular area. Choosing the best conduit for the specific coronary anatomy is the key to long-term success.

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Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Policy and Practice Reviews
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: aorto-coronary bypass grafting, arterial conduits, saphenous vein graft, hybrid revascularization, myocardial revascularization on- or off-pump

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