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Rhythm surgery, which was initiated many years ago, has fundamentally changed by the development of sparing interventional treatment procedures and the successful introduction of the implantable defibrillator.A cornerstone in the history was the first successful treatment of a patient with Wolff-Parkinson-White-Syndrome separating accessory conduction lines between atrium and ventricle in 1968. The experience and knowledge of the surgical therapy of the 70ies has promoted the implementation of successful interventional ablation procedures in the early 80ies.Further steps in the rapidly developing area of rhythm surgery were the left and right atrial isolation procedures for the treatment of automatically atrial tachycardia's, the use of cryo-surgery for AV-node ablation in patients with AV-re-entry tachycardia's in the 80ies and finally the procedures for the treatment of atrial fibrillation like the transsection procedure, the corridor operation and the Maze procedure. Special methods for the therapy of ventricular arrhythmias should be mentioned for the sake of completeness, but are not extensively discussed. These are the right ventricular disconnection procedure, endocardial and subendocardial resections, endocardial cryo-ablation, the Jatene- and Dor-operation for the treatment of ischemic ventricular arrhythmias. Out of the original indications, today the therapy of atrial fibrillation has become more and more important and represents a booming part of rhythm surgery in the last decade. The unsatisfactory results of medical treatment, new understanding of the pathophysiology of atrial fibrillation and the introduction of simplified ablation procedures have led to a markable increase of rhythm surgery procedures. One reason is the increasing life expectancy of the population leading to a higher incidence of atrial fibrillation, which makes this arrhythmia to the most common rhythm disturbance. This growing number of patients is a challenge for cardiac surgery today and leads the focus on this special part.

Background: The number of surgical coronary revascularization procedures is static and even declining. Since the introduction of drug eluting stents the question arose whether this will have an impact on the spectrum of surgical coronary revascularization procedures., Bypass Surgery: Bypass surgery is a routine procedure for the treatment of coronary artery disease with good results. Studies have shown that there is a benefit in favor of surgery compared to interventional cardiologic procedures. DRUG-ELUTING STENTS: In recent studies a new generation of stents, drug-eluting stents, have proven to have a significant better patency rate than common stents. However, to date there are no studies which show a benefit compared to surgery given the same indication for treatment., Conclusion: Therefore, the question whether drug-eluting stents have an impact on the spectrum of bypass surgery cannot be fully answered at present.

Coronary perforation and entrapment of catheter materials are rare, but life-threatening complications, which often require emergency cardiosurgical treatment. Surgical options include tamponade drainage, coronary artery bypass grafting, perforation suturing, and removal of catheter materials. Surgical strategies are not standardized but mainly depend on the surgical anatomy. This is in particular true for the removal of the catheter remnants (stent, guidewire). Keeping this in mind, these patients can be treated with good clinical results.

Bypass surgery has become a routine procedure for the treatment of coronary artery disease. Due to increase numbers of high-risk patients minimally invasive techniques were introduced in cardiac surgery with excellent clinical results. In addition molecular methods have been applied for primary and secondary treatment of coronary artery disease.

To reduce surgical trauma and median sternotomy related complications in cardiac surgery, a new minimally invasive surgical technique has been developed for the treatment of coronary artery multivessel disease using a small left lateral chest incision in the 3rd intercostal space. This technique enables direct LIMA harvesting and performance of bypass surgery upon all coronary vessels with cardiopulmonary bypass and cardioplegic arrest. So far, 123 patients have been treated with this procedure and survived with fewer complications, and we believe that routine application of this procedure will lead to reduced morbidity in patients receiving coronary artery bypass surgery, short hospital stay and early convalescence, combined with good cosmetic results.