Gradinariu et al. Vessel Plus 2021;5:22 DOI: 10.20517/2574-1209.2020.86 Vessel Plus © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. www.vpjournal.net Open Access Review Myocardial surgical revascularization as a subspecialty: to be or not to be, that is the question George Gradinariu 1 , Shahzad G. Raja 2 1 Department of Cardiac Surgery, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK. 2 Department of Cardiac Surgery, Harefield Hospital, London UB9 6JH, UK. Correspondence to: Dr. Shahzad G. Raja, BSc, MBBS, MRCS, FRCS(C-Th), Department of Cardiac Surgery, Harefield Hospital, London UB9 6JH, UK. E-mail: drrajashahzad@hotmail.com How to cite this article: Gradinariu G, Raja SG. Myocardial surgical revascularization as a subspecialty: to be or not to be, that is the question. Vessel Plus 2021;5:22. https://dx.doi.org/10.20517/2574-1209.2020.86 Received: 8 Dec 2020 First Decision: 12 Jan 2021 Revised: 17 Jan 2021 Accepted: 28 Jan 2021 Published: 13 May 2021 Academic Editor: Cristiano Spadaccio Copy Editor: Xi-Jun Chen Production Editor: Yue-Yue Zhang Abstract Over the last few decades, a trend for increased specialization has been observed in all surgical domains. This has been driven by the advancement of medical knowledge and technology and by the realization of a clear association between higher volume of cases and better surgical outcomes. The field of cardiothoracic surgery has followed the same trend, but the most commonly performed operation, coronary artery bypass grafting, is still considered a generalist procedure and does not benefit from recognition as a formal subspecialty. There is robust evidence to support that a positive effect on outcomes can be achieved by both increased volume and better quality of surgical techniques and perioperative protocols. We hypothesize that a structured specialized coronary revascularization program can be initiated in every institution through a strong leadership focused on effective mentorship and training that will achieve the benchmark of less than 1% operative mortality following coronary revascularization. This review article makes a case for recognition of myocardial surgical revascularization as a subspecialty and proposes a strategy to overcome the barriers that preclude such a recognition. Keywords: Benchmark, coronary artery bypass grafting, generalist procedure, subspecialization, volume-outcome relationship BACKGROUND: THE INHERENT NEED FOR SUBSPECIALIZATION Adopting a more focused approach to training and delivering clinical care through subspecialization has