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A standard from the classical period
  1. W O Myers
  1. Correspondence to:
    Dr William O Myers, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA;

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New developments in bypass grafting and percutaneous interventions should increase the safety and tolerability of coronary revascularisation. But how long does the benefit last?

Dating from the late 1960s, coronary artery bypass grafting (CABG) remained a standard practice for a good 30 years. Percutaneous approaches came along halfway through that period, but the CABG operation did not change much. The widespread adoption of the internal thoracic artery (ITA) conduit to supply the left anterior descending coronary artery was the most significant modification, but was itself a return to pioneer work in the field.

Coronary artery intervention is currently changing almost by the day. Now CABG with minimally invasive and increasingly off-pump application fills the programmes of surgical scientific meetings. We hear about the possibility of non-sewn anastomoses, and hints of robotic surgery somewhere over the horizon. Plain old balloon angioplasty is entering the arena of multivessel disease, and is rapidly being supplanted by intracoronary stenting. New stent materials and new stent coatings are continually coming on line. Temporary filter devices are being developed to catch debris stirred up by manipulating a degenerating vessel. Antiplatelet and other new drugs are being utilised to prevent subsequent stenosis. All these new developments should increase the safety and tolerability of getting one’s coronary arteries opened. The question is: how long does the benefit last? And how do the new techniques compare with what we did before?

This issue of Heart presents a population based study by Bradshaw and colleagues on their experience during 13 years of CABG service (1980 to 1993).1 Significantly, the report covers a stable population in Western Australia that had only one centre, the Royal Perth Hospital, supplying all CABG services. Such an area of relative isolation with a single source for high level service is ideal for population based …

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