Surgical therapy for complex coronary artery disease.

Recent advances in medical therapy, percutaneous myocardial revascularization, and coronary artery bypass grafting have allowed patients to live longer without eliminating the underlying pathology of coronary artery disease. In this review the authors discuss surgical options, perioperative assessment, procedural details, and outcomes after repeated coronary artery bypass surgery and coronary endarterectomy, in patients with severe coronary artery disease that is not suited for further percutaneous coronary intervention. Furthermore, the authors also discuss the role of transmyocardial revascularization and protein/gene therapy in those extreme situations where complex coronary artery disease is no longer amenable to traditional surgical intervention.