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Ann Thorac Surg 1996;61:1664-1665
© 1996 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 300 words of the full text of this article appear below.

See also page 1658.

DR ROBERT W. EMERY (Minneapolis, MN): Doctor Calafiore, I congratulate you, your co-investigators, and your colleagues who are bringing us back to the future. We, at the Minneapolis Hearts Institute, began a program of minimally invasive bypass operations 6 months ago and have completed single- or double-vessel procedures in 25 patients via left anterior thoracotomy, right anterior thoracotomy, or a ministernotomy with results comparable with yours. I have found the operation to be easier on the patients but more difficult for the surgeon.

Because of some concern around construction of the anastomosis, we have documented anastomotic patency in the operative field using a thermal imaging camera (OPGAL, Jerusalem, Israel). The camera is directed to the anterior surface of the heart, a large black area gently cooled with topical iced saline solution around the distribution of the LAD after removal of the distal occluding clip on the LAD. The serrafine clip on the mammary artery, and the proximal LAD occluder are in place.

After release of the LIMA occluder, a white streak in the middle of the field demonstrates warm blood flowing from the internal mammary artery into the cooled heart, assuring intraoperatively the patency of the anastomosis. This has offered us confidence in an aggressive approach to continue this program.

Your pioneering efforts are greatly appreciated.

DR CALAFIORE: Thank you very much.

DR LAWRENCE I. BONCHEK (Lancaster, PA): I too congratulate Dr Calafiore and associates on their innovative and superior results. My colleagues and I have been interested in this procedure, but before initiating an approach that inevitably involves certain compromises, we thought it important to review our experience with conventional isolated internal mammary artery grafting of the LAD.

Since 1983 we have had experience with 168 patients. Importantly, 16% were operated on emergently for percutaneous . . . [Full Text of this Article]

Related Article

Left Anterior Descending Coronary Artery Grafting via Left Anterior Small Thoracotomy Without Cardiopulmonary Bypass

Antonio M. Calafiore, Gabriele Di Giammarco, Giovanni Teodori, Giovanni Bosco, Erminio D'Annunzio, Antonio Barsotti, Nicola Maddestra, Leonardo Paloscia, Giuseppe Vitolla, Antonio Sciarra, Carlo Fino, and Marco Contini
Ann. Thorac. Surg. 1996 61: 1658-1663. [Abstract] [Full Text]

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