Coronary artery bypass graft (CABG) surgery remains a pivotal cornerstone, offering established symptomatic alleviation and prognostic advantages for patients grappling with complex multivessel and left main coronary artery diseases. Despite the lucid guidance laid out by contemporary guidelines regarding the choice between CABG and percutaneous coronary intervention (PCI), a notable hesitation persists among certain patients, characterized by psychological reservations, knowledge gaps, or individual beliefs that sway their inclination toward surgical intervention. This comprehensive review critically synthesizes the prevailing guidelines, modern practices, and outcomes pertaining to CABG surgery, delving into an array of techniques and advancements poised to enhance both short-term and enduring surgical outcomes. The exploration encompasses advances in on-pump and off-pump procedures, conduit selection strategies encompassing the bilateral utilization of internal mammary artery and radial artery conduits, meticulous graft evaluation methodologies, and the panorama of minimally invasive approaches, including those assisted by robotic technology. Furthermore, the review navigates the terrain of hybrid coronary revascularization, shedding light on the pivotal roles of shared decision-making and the heart team in shaping treatment pathways. As a comprehensive compendium, this review not only navigates the intricate landscape of CABG surgery but also aligns it with contemporary practices, envisioning its trajectory within the evolving currents of healthcare dynamics.

中文翻译：

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冠状动脉搭桥手术：循证实践。

冠状动脉旁路移植术 (CABG) 手术仍然是关键的基石，为患有复杂的多支血管和左主干冠状动脉疾病的患者提供既定的症状缓解和预后优势。尽管当代指南对 CABG 和经皮冠状动脉介入治疗 (PCI) 之间的选择提出了明确的指导，但某些患者仍然存在明显的犹豫，其特点是心理保留、知识差距或个人信念影响了他们对手术干预的倾向。这篇全面的综述批判性地综合了与 CABG 手术相关的现行指南、现代实践和结果，深入研究了一系列旨在提高短期和持久手术结果的技术和进步。该探索包括体外循环和非体外循环手术的进展、导管选择策略（包括乳内动脉和桡动脉导管的双边利用）、细致的移植物评估方法以及微创方法的全景，包括机器人技术辅助的方法。此外，该综述还探讨了混合冠状动脉血运重建的领域，揭示了共同决策和心脏团队在塑造治疗途径中的关键作用。作为一部综合性纲要，这篇综述不仅阐述了 CABG 手术的复杂情况，而且还使其与当代实践保持一致，在不断变化的医疗动态中设想了其发展轨迹。