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Ann Thorac Surg 2000;70:1774-1778
© 2000 The Society of Thoracic Surgeons
a Cardiopulmonary Research Science Technology Institute, Dallas, Texas, USA
Address reprint requests to Dr Mack, COR Specialty Associates of North Texas, P.A., 7777 Forest Lane, Suite A-323, Dallas, TX 76230
e-mail: mmack@cristi.org
Presented at Outcomes 2000, "The Key West Meeting," Key West, FL, May 24–28, 2000.
It is an honor and a privilege to share the podium with Dr Cooley. Since my years in college in the late 1960s, he has served as a role model and an icon for me and I am humbled by the task of debating him on the merits of a procedure that he pioneered. Nonetheless, I will attempt to make the case that beating-heart surgery is a significant incremental improvement in the performance of coronary artery bypass surgery.
I will concede the debate to Dr Cooley that beating heart surgery is not the most significant advance in coronary revascularization since the heart lung machine! First, it should be noted that beating-heart surgery historically preceded cardiopulmonary bypass (CPB), making CPB the most important advance since beating-heart surgical revascularization [1, 2]! Second, if in fact we evaluate post-CPB, the significance of "new era" minimally invasive (MICS) beating-heart surgery for sake of debate, it ranks only third in my opinion! The introduction of catheter-based therapy by Greuntzig in 1979 and the broader use of arterial grafts as the preferred conduit have had a greater impact on coronary revascularization than beating-heart surgery has yet to date.
Catheter-based coronary revascularization
Catheter-based interventions were introduced in 1979. Within 10 years, due to significant incremental improvements of the original core technology and technique of balloon angioplasty, annual procedural volume eclipsed that of coronary bypass surgery in the United States. Further technological enhancements including low-profile, steerable catheters, stents, closure devices, and pharmacologic adjuncts have minimized procedural morbidity and expanded the applicability so that currently annual case volumes of angioplasty outnumber surgery by a 2:1 ratio and in many centers by 4:1.
Arterial grafting in coronary artery bypass surgery
With regard to arterial grafting, it has been clearly demonstrated by Loop that "use of the left internal thoracic artery is the single most important determinant of
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