Ann Thorac Surg 1997;63:1117
© 1997 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Daniel J. Ullyot, MD
1828 El Camino Real, Suite 802, Burlingame, CA 94010
See also page 1113.
This report by Lin and coauthors is another contribution to the current discussion about modifications in the surgical technique of coronary artery bypass grafting. The thrust of these modifications is to accomplish coronary bypass grafting without the exposure afforded by median sternotomy and thereby hasten the recovery and make the operation more attractive for patients and payers.
Lin and associates describe a technique, intermediate between "minimally invasive" coronary artery bypass grafting and the standard operation, in which sternotomy is avoided in favor of a left anterior thoracotomy, and cardiopulmonary bypass is used by way of peripheral cannulation. Exposure is enhanced by thoracoscopic instrumentation. The coronary circulation is not interrupted and visualization for anastomoses is accomplished by applying air pressure to the opened artery during hypothermic fibrillatory arrest.
It should be observed that the anastomoses were done under direct vision using conventional instruments and suture technique and aided by fiberoptic illumination and, for the posterior descending branch--right gastroepiploic artery anastomosis, perhaps by endoscopic visualization. I am not convinced that a left anterior thoracotomy, resection of the fourth rib cartilage, counterincisions for thoracoscopic instruments, and a left groin incision in their totality are any "less invasive," less painful, or more cosmetically acceptable than a median sternotomy. Nor am I persuaded that mean operative, cardiopulmonary bypass duration, and postoperative length of stay times of 5.3 hours, 92 minutes, and 5.5 days, respectively, in young patients with one- or two-vessel disease and good left ventricular function represent a simplification in intraoperative and postoperative care compared with conventional management.
Let us welcome innovation and the contributions exemplified by the report by Lin and colleagues. At the same time, we must demand studies directly comparing the new operations with the standard operation before we give our patients and the public the impression that something new and perhaps "less invasive" is as safe as standard coronary artery bypass grafting as performed today and is associated with the same well-documented excellent long-term benefits.
Related Article
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Video-Assisted Coronary Artery Bypass Grafting During Hypothermic Fibrillatory Arrest
- Pyng Jing Lin, Chau-Hsiung Chang, Jaw-Ji Chu, Hui-Ping Liu, Feng-Chun Tsai, Fen-Chiung Lin, Cheng-Wen Chiang, Min-Wen Yang, and Peter P. C. Tan
Ann. Thorac. Surg. 1997 63: 1113-1117.
[Abstract]
[Full Text]
