Contemporary Perspectives on Coronary Artery Bypass Grafting: Integrating Precision Medicine, Minimally Invasive Techniques, and Long-Term Outcomes
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Coronary artery bypass grafting is the gold standard for surgical revascularization of complex coronary artery disease. Three decades have passed since CABG was developed, and with it, there have been developments in choices of conduit, cardiopulmonary technology, and perioperative management that have significantly enhanced survival and quality of life. However, advanced technology and precision medicine are now transforming the CABG model from mass-produced surgical practice to more individualized, data-driven care. Post-genomic biomarker risk profiling, artificial intelligence-driven risk prediction, and machine learning-powered imaging have made patient-specific risk stratification and conduit optimization possible. This has been followed by minimally invasive direct CABG, robotically assisted CABG, and hybrid revascularization methods, expanding the therapeutic armamentarium with less injury and quicker rehabilitation, but with preserved long-term graft patency. They have performed equally or better in carefully chosen populations but have been encumbered by their wider application by procedure complexity, cost, and the unavailability of large-scale randomized trials with precision-guided methods. There is increasing evidence that the incorporation of multi-arterial grafting, AI-driven perioperative planning, and personalized pharmacogenomic therapy will continue to improve graft survival and long-term cardiovascular outcomes. However, there are significant knowledge gaps in how best to incorporate precision technologies, patient selection for minimally invasive operations, and the ethics of AI-driven decision-making. Coronary artery disease multivessel and complex revascularization by CABG are more or less the same, signifying long-term survival and durability. Sixty years since its beginning, Conclusion: CABG is still developing as a biological science of genomics, engineering, data science, and surgical innovation. In the modern era, the development of the specialty also marks the demise and death of one-size-fits-all medicine for a precision-based, patient-specific specialty, in which every aspect, from conduit selection to postoperative care, is tailored to the patient's biological and clinical profile.
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1. Pačarić S, Turk T, Erić I, et al. Assessment of the quality of life in patients before and after coronary artery bypass grafting (CABG): a prospective study. International journal of environmental research and public health 2020; 17(4): 1417.
https://doi.org/10.3390/ijerph17041417 DOI: https://doi.org/10.3390/ijerph17041417
2. Caliskan E, De Souza DR, Boening A, et al. Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nature Reviews Cardiology 2020; 17(3): 155–69.
https://doi.org/10.1038/s41569-019-0249-3 DOI: https://doi.org/10.1038/s41569-019-0249-3
3. Shawon MSR, Odutola M, Falster MO, Jorm LR. Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis. Journal of Cardiothoracic Surgery 2021; 16(1): 172.
https://doi.org/10.1186/s13019-021-01556-1 DOI: https://doi.org/10.1186/s13019-021-01556-1
4. Noor Hanita Z, Khatijah L, Kamaruzzaman S, Karuthan C, Raja Mokhtar R. A pilot study on development and feasibility of the ‘MyEducation: CABG application patients undergoing coronary artery bypass graft (CABG) surgery. BMC nursing 2022; 21(1): 40.
https://doi.org/10.1186/s12912-022-00814-4 DOI: https://doi.org/10.1186/s12912-022-00814-4
5. Leivaditis V, Maniatopoulos A, Mulita F, et al. Between Air and Artery: A History of Cardiopulmonary Bypass and the Rise of Modern Cardiac Surgery. Journal of Cardiovascular Development and Disease 2025; 12(9): 365.
https://doi.org/10.3390/jcdd12090365 DOI: https://doi.org/10.3390/jcdd12090365
6. Vallely MP, Hameed I, Gaudino M. Commentary: The evolution of coronary artery bypass surgery: Toward a better operation. The Journal of Thoracic and Cardiovascular Surgery 2021; 162(4): 1122–4. DOI: https://doi.org/10.1016/j.jtcvs.2020.01.007
7. Infante T, Del Viscovo L, De Rimini ML, Padula S, Caso P, Napoli C. Network medicine: a clinical approach for precision medicine and personalized therapy in coronary heart disease. Journal of Atherosclerosis and Thrombosis 2020; 27(4): 279–302.
https://doi.org/10.5551/jat.52407 DOI: https://doi.org/10.5551/jat.52407
8. Bertsimas D, Orfanoudaki A, Weiner RB. Personalized treatment for coronary artery disease patients: a machine learning approach. Health care management science 2020; 23(4): 482–506.
https://doi.org/10.1007/s10729-020-09522-4 DOI: https://doi.org/10.1007/s10729-020-09522-4
9. Baumann AA, Mishra A, Worthley MI, Nelson AJ, Psaltis PJ. Management of multivessel coronary artery disease in patients with non-ST-elevation myocardial infarction: a complex path to precision medicine. Therapeutic advances in chronic disease 2020; 11.
https://doi.org/10.1177/2040622320938527 DOI: https://doi.org/10.1177/2040622320938527
10. Hamilton DE, Albright J, Seth M, et al. Merging machine learning and patient preference: a novel tool for risk prediction of percutaneous coronary interventions. European Heart Journal 2024; 45(8): 601–9.
https://doi.org/10.1093/eurheartj/ehad836 DOI: https://doi.org/10.1093/eurheartj/ehad836
11. Singh P, Porta A, Ranucci M, et al. Identifying and preliminary validating patient clusters in coronary artery bypass grafting: integrating autonomic function with clinical and demographic data for personalized care. European Journal of Cardiovascular Nursing 2025: zvaf059.
https://doi.org/10.1093/eurjcn/zvaf059 DOI: https://doi.org/10.1093/eurjcn/zvaf059
12. Chaudhuri K, Pletzer A, Smith NP. A predictive patient-specific computational model of coronary artery bypass grafts for potential use by cardiac surgeons to guide selection of graft configurations. Frontiers in Cardiovascular Medicine 2022; 9: 953109.
https://doi.org/10.3389/fcvm.2022.953109
13. Chaudhuri K, Pletzer A, Waqanivavalagi SW, Milsom P, Smith NP. Personalized surgical planning for coronary bypass graft configurations using patient-specific computational modeling to avoid flow competition in arterial grafts. Frontiers in Cardiovascular Medicine 2023; 10: 1095678. DOI: https://doi.org/10.3389/fcvm.2023.1095678
https://doi.org/10.3389/fcvm.2022.953109 DOI: https://doi.org/10.3389/fcvm.2022.953109
14. Le NN, Frater I, Lip S, Padmanabhan S. Hypertension precision medicine: the promise and pitfalls of pharmacogenomics. Pharmacogenomics 2025: 1–24.
https://doi.org/10.1080/14622416.2025.2504865
15. Yeh C-H, Chou Y-J, Tsai T-H, et al. Artificial-intelligence-assisted discovery of genetic factors for precision medicine of antiplatelet therapy in diabetic peripheral artery disease. Biomedicines 2022; 10(1): 116. DOI: https://doi.org/10.3390/biomedicines10010116
https://doi.org/10.1080/14622416.2025.2504865 DOI: https://doi.org/10.1080/14622416.2025.2504865
16. Forte JC, Yeshmagambetova G, van der Grinten ML, et al. Comparison of machine learning models including preoperative, intraoperative, and postoperative data and mortality after cardiac surgery. JAMA Network Open 2022; 5(10): e2237970–e.
https://doi.org/10.1001/jamanetworkopen.2022.37970 DOI: https://doi.org/10.1001/jamanetworkopen.2022.37970
17. Montisci A, Palmieri V, Vietri MT, et al. Big Data in cardiac surgery: real world and perspectives. Journal of cardiothoracic surgery 2022; 17(1): 277.
https://doi.org/10.1186/s13019-022-02025-z DOI: https://doi.org/10.1186/s13019-022-02025-z
18. Stamate E, Piraianu A-I, Ciobotaru OR, et al. Revolutionizing cardiology through artificial intelligence—Big data from proactive prevention to precise diagnostics and cutting-edge treatment—A comprehensive review of the past 5 years. Diagnostics 2024; 14(11): 1103.
https://doi.org/10.3390/diagnostics14111103 DOI: https://doi.org/10.3390/diagnostics14111103
19. Skaria R. Machine Learning and Deep Phenotyping Towards Predictive Analytics and Therapeutic Strategy in Cardiac Surgery: The University of Arizona; 2020.
20. Johnson KW. Applications of Data Science for Precision Cardiology: Icahn School of Medicine at Mount Sinai; 2020.
21. Raja SG. New Clinical Advances in Minimally Invasive Coronary Surgery. Journal of Clinical Medicine 2025; 14(9): 3142.
https://doi.org/10.3390/jcm14093142 DOI: https://doi.org/10.3390/jcm14093142
22. Marin-Cuartas M, Sá MP, Torregrossa G, Davierwala PM. Minimally invasive coronary artery surgery: robotic and nonrobotic minimally invasive direct coronary artery bypass techniques. JTCVS techniques 2021; 10: 170.
https://doi.org/10.1016/j.xjtc.2021.10.008 DOI: https://doi.org/10.1016/j.xjtc.2021.10.008
23. Ersoy B, Onan B. Robotic cardiac surgery: Advancements, applications, and future perspectives. Handbook of Robotic Surgery: Elsevier; 2025: 505–11.
https://doi.org/10.1016/B978-0-443-13271-1.00009-1 DOI: https://doi.org/10.1016/B978-0-443-13271-1.00009-1
24. Fatehi Hassanabad A, Kang J, Maitland A, Adams C, Kent WD. Review of contemporary techniques for minimally invasive coronary revascularization. Innovations 2021; 16(3): 231–43. DOI: https://doi.org/10.1177/15569845211010767
25. Sivertsson BCP, Gartner AV. Implementation of a Telerehabilitation Device for Post-Coronary Artery Bypass Graft Patients in a Rehabilitation Program on The Faroe Islands: Exploring Opportunities and Barriers.
26. Pearse BL. Implementation Of Bleeding Management in Adult Cardiac Surgery Units in Australia. 2021.
https://dx.doi.org/10.25904/1912/4304
27. Almoghairi AM. Barriers and Facilitators to Uptake of Cardiac Rehabilitation Following Percutaneous Coronary Intervention in Saudi Arabia: Queensland University of Technology; 2025.
28. Subih M, Elshatarat RA, Sawalha MA, et al. Exploring the Impact of Cardiac Rehabilitation Programs on Health-Related Quality of Life and physiological outcomes in patients Post Coronary artery bypass grafts: a systematic review. Reviews in cardiovascular medicine 2024; 25(4): 145.
https://doi.org/10.31083/j.rcm2504145 DOI: https://doi.org/10.31083/j.rcm2504145
29. Schaefer A, Conradi L, Schneeberger Y, et al. Clinical outcomes of complete versus incomplete revascularization in patients treated with coronary artery bypass grafting: insights from the TiCAB trial. European Journal of Cardio-Thoracic Surgery 2021; 59(2): 417–25.
https://doi.org/10.1093/ejcts/ezaa330 DOI: https://doi.org/10.1093/ejcts/ezaa330
30. Samant S, Panagopoulos AN, Wu W, Zhao S, Chatzizisis YS. Artificial Intelligence in Coronary Artery Interventions: Preprocedural Planning and Procedural Assistance. Journal of the Society for Cardiovascular Angiography & Interventions 2025; 4(3): 102519.
https://doi.org/10.1016/j.jscai.2024.102519 DOI: https://doi.org/10.1016/j.jscai.2024.102519
31. Miller CL, Kocher M, Koweek LH, Zwischenberger BA. Use of computed tomography (CT) for preoperative planning in patients undergoing coronary artery bypass grafting (CABG). Journal of Cardiac Surgery 2022; 37(12): 4150–7.
https://doi.org/10.1111/jocs.17000 DOI: https://doi.org/10.1111/jocs.17000
32. Nedadur R, Bhatt N, Liu T, Chu MW, McCarthy PM, Kline A. The emerging and important role of artificial intelligence in cardiac surgery. Canadian Journal of Cardiology 2024; 40(10): 1865–79.
https://doi.org/10.1016/j.cjca.2024.07.027 DOI: https://doi.org/10.1016/j.cjca.2024.07.027
33. Raja SG. Global trends and practices in coronary artery bypass surgery. Academia Medicine 2025; 2(3). DOI: https://doi.org/10.20935/AcadMed7806
https://www.doi.org/10.20935/AcadMed7806
34. Wang X, Zhu H. Artificial intelligence in image-based cardiovascular disease analysis: A comprehensive survey and future outlook. arXiv preprint arXiv:240203394 2024.
https://doi.org/10.48550/arXiv.2402.03394
35. Sulague RM, Beloy FJ, Medina JR, et al. Artificial intelligence in cardiac surgery: A systematic review. World Journal of Surgery 2024; 48(9): 2073–89.
https://doi.org/10.1002/wjs.12265 DOI: https://doi.org/10.1002/wjs.12265
36. Lin T-H, Wang C-W, Shen C-H, et al. Clinical outcomes of multivessel coronary artery disease patients revascularized by robot-assisted vs conventional standard coronary artery bypass graft surgeries in real-world practice. Medicine 2021; 100(3): e23830.
https://doi.org/10.1097/MD.0000000000023830 DOI: https://doi.org/10.1097/MD.0000000000023830
37. Mastroiacovo G, Manganiello S, Pirola S, et al. Very long-term outcome of minimally invasive direct coronary artery bypass. The Annals of Thoracic Surgery 2021; 111(3): 845–52.
https://doi.org/10.1016/j.athoracsur.2020.06.025 DOI: https://doi.org/10.1016/j.athoracsur.2020.06.025
38. Ilcheva L, Häussler A, Cholubek M, et al. Thirteen Years of Impactful, Minimally Invasive Coronary Surgery: Short-and Long-Term Results for Single and Multi-Vessel Disease. Journal of Clinical Medicine 2024; 13(3): 761.
https://doi.org/10.3390/jcm13030761 DOI: https://doi.org/10.3390/jcm13030761
39. Fortunato GA, Davierwala PM. The current role and future perspectives of minimally invasive coronary artery bypass grafting. Journal of Visualized Surgery 2023; 9.
https://doi.org/10.21037/jovs-22-41 DOI: https://doi.org/10.21037/jovs-22-41
40. Guo MH, Toubar O, Issa H, et al. Long-term survival, cardiovascular, and functional outcomes after minimally invasive coronary artery bypass grafting in 566 patients. The Journal of Thoracic and Cardiovascular Surgery 2024; 168(4): 1080–8. e2.
https://doi.org/10.1016/j.jtcvs.2023.07.047 DOI: https://doi.org/10.1016/j.jtcvs.2023.07.047
41. Ilcheva L, Risteski P, Tudorache I, et al. Beyond conventional operations: embracing the era of contemporary minimally invasive cardiac surgery. Journal of Clinical Medicine 2023; 12(23): 7210.
https://doi.org/10.3390/jcm12237210 DOI: https://doi.org/10.3390/jcm12237210
42. van der Merwe J, Casselman F. Minimally invasive surgical coronary artery revascularization—Current status and future perspectives in an era of interventional advances. Journal of Visualized Surgery 2023; 9.
https://doi.org/10.21037/jovs-22-40 DOI: https://doi.org/10.21037/jovs-22-40
43. Oishi K, Nagaoka E, Kawabata T, et al. Coronary Artery Bypass Grafting in the Era of Evidence-Based Medicine Advancing Techniques and Their Integration into Future Guidelines. Journal of Coronary Artery Disease 2025; 31(2): 52–8.
https://doi.org/10.7793/jcad.31.25-00010 DOI: https://doi.org/10.7793/jcad.31.25-00010
44. Hou H-T, Chen H-X, Wang Z-Q, et al. Integrative Multi-omics Approach Reveals the Molecular Characterization and Differences of ECM-PI3K-Akt Pathway among Coronary Artery Bypass Grafting Conduits with Clinical Implications. medRxiv 2024: 2024.08. 11.24311581.
https://doi.org/10.1101/2024.08.11.24311581 DOI: https://doi.org/10.1101/2024.08.11.24311581
45. Hou H-T, Chen H-X, Wang Z-Q, et al. Arterial and venous grafting biomaterials in coronary Surgery: Integrative multi-omics approach reveals ECM-PI3K-Akt pathway as Key Regulator of different patency. Chemical Engineering Journal 2025; 511: 161829.
https://doi.org/10.1016/j.cej.2025.161829 DOI: https://doi.org/10.1016/j.cej.2025.161829
46. Khan MA. Ethical implications of AI (artificial intelligence) in healthcare mainly focus on surgical procedures: identification of ethical issues of AI in surgical procedures and ranking of ethical issues based on criticality. 2024.
47. Jayabal R. Nanomaterials in Regenerative Medicine: Advancing the Future of Tissue Engineering. Regenerative Engineering and Translational Medicine 2025: 1–19.
https://doi.org/10.1007/s40883-025-00416-x DOI: https://doi.org/10.1007/s40883-025-00416-x