State-of-art treatments for coronary artery disease an AATS focus. (CDU at the American Association for Thoracic Surgery).(American Association for Thoracic Surgery )

BOSTON, Massachusetts -- The 83rd annual meeting of the American Association for Thoracic Surgery (AATS; Beverly, Massachusetts) provided one of the first forums for cardiac surgeons to discuss the future impact of the new drug-eluting coronary stents on patient management. In addition, advances in anastomotic devices and experimental coronary artery disease (CAD) were presented at an afternoon forum during the four-day AATS meeting held in early May at Hynes Convention Center.

Bruce Lytle, MD, of the Cleveland Clinic Foundation (Cleveland, Ohio), highlighted key benefits of coronary artery bypass graft (CABG) surgery in terms of longer life expectancy for those groups of patients with severe coronary artery disease (such as LAD lesions, multi-vessel disease, abnormal left ventricular function [LVF]) and superior angina relief in comparison with medical therapy.

Complete revascularization was presented as a key factor in positive long-term outcomes for CABG. For example, from the CASS study, for patients with abnormal LVF, survival rates at five and six years were superior for patients who had complete revascularization rather than incomplete revascularization. Lytle emphasized that out to 20 to 25 years, the difference in survival rates between patients with complete vs. incomplete revascularization is significant and continues to widen.

"We also know from those early days that vein graft failure is the Achilles' heel of bypass surgery," he said. Solving this dilemma was the development of the left internal mammary artery (IMA) graft to the left anterior descending (LAD) coronary artery, a technique Lytle believes to be the best anatomic treatment of any kind in coronary artery disease.

He said that the left internal thoracic artery (ITA) to LAD graft--the "gold standard" procedure for coronary bypass surgery--does not just stay patent more often but leads to better survival rates. Patients undergo fewer re-operations, have less angina and have fewer cardiac events than treatment with vein grafts or percutaneous therapy. "That …