Ann Thorac Surg 1997;64:1839
© 1997 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Paul A. Spence, MD
Department of Thoracic Surgery, University of Louisville School of Medicine, 201 Abraham Flexner, Suite 1200, Louisville, KY 40202
See also page 1835.
Although coronary bypass is a routine procedure, converting it to a minimally invasive procedure is not simply a problem of scale. The surgeon has considerably less certainty in harvesting of conduits and in performance of the anastomosis. Barstad and associates are to be congratulated for the clear recognition of this problem. They have developed an operating theater that includes conventional surgical equipment, as well as radiologic and cardiologic facilities so that quality can be verified at the time of operation. In addition, they have facilitated the performance of hybrid (surgical and endovascular) revascularization.
The concept of quality assurance is absolutely necessary in the development of less invasive bypass procedures. Four of 11 anastomoses were revised based on intraoperative measurements. (It is interesting that the transit time flow measurements did not adequately predict errors in at least two of the four episodes.) Unexpected problems were identified, including a dissection in a graft. One might wonder whether the results could have been better if a stabilizer or a suction device had been used to immobilize the area of the anastomosis. Another concern in this study relates to the anastomotic stenosis that occurred in a patient at 3 months. Perhaps this will resolve spontaneously, but it may result in early graft failure. Patients tolerate cardiac surgeons but prefer cardiologists for revascularization of diseased coronary arteries. The goal for the current generation of cardiac surgeons is to develop a bypass procedure with a level of invasiveness similar to a cardiologist's. There are many steps in the process, and the one reported here by Barstad and associates is almost certainly one of them.
Related Article
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Intraoperative Angiography in Minimally Invasive Direct Coronary Artery Bypass Grafting
- R. Marius Barstad, Erik Fosse, Karleif Vatne, Kai Andersen, Tor-Inge Tønnessen, Jan L. Svennevig, and Odd R. Geiran
Ann. Thorac. Surg. 1997 64: 1835-1839.
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