Current status of coronary artery bypass grafting.

The number of cases of coronary artery bypass grafting (CABG) reached more than 21 000 in Japan in 2002, and the operative mortality decreased to less than 1%, including emergency operations. The annual number of CABGs in Japan declined 17% after 2003 to 18 000 cases in 2005 owing to unrestricted percutaneous coronary intervention (PCI) with drug-eluting stents. However, CABG is the best treatment for multivessel coronary artery disease based on the comparative data of PCI versus CABG. There have been two trends in CABG during the last decade. One is the widespread use of off-pump (OP) CABG, and the other is multiple coronary artery revascularization. In 2004 and 2005, approximately 60% of all isolated CABG procedures in Japan were performed without cardiopulmonary bypass. In a study of long-term outcomes comparing PCI with drug-eluting stents versus CABG with only arterial grafts, the latter was carried out in 52% of total cases and in 66% of OPCAB cases. OPCAB with multiple arterial grafts has become the standard CABG in Japan.