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Ann Thorac Surg 1998;65:1195
© 1998 The Society of Thoracic Surgeons

Correspondence

Reply

Nelson Ancalmo, MDa, John R. Busby, MDa

a Cardiovascular Surgery Center of South Arkansas, PA, 1609 W 40th Ave, Suite 202, Pine Bluff, AR 71603, USA

To the Editor

We appreciate Dr Pfister and Dr Resano’s comments. A few remarks need to be clarified:

The "learning curve" to which they refer as "substantial" needs to be defined. What is an acceptable learning curve for the harvesting of the internal mammary artery and for the arterial anastomosis? Because the gold standard to be compared with approaches 100%, it is difficult to accept anything less.

The study called POEM (Patency, Outcome and Economics of MIDCAB) compares angiographic patency of left internal mammary artery-to-left anterior descending artery grafts at 6 months. Again, when the patency rate of standard left internal mammary artery-to-left anterior descending artery bypass grafts approaches 95% at 10 years, a study of 6 months is meaningless except as an evaluation of the surgeon’s technical abilities which, from our point of view, should not be the problem.

Total myocardial revascularization has been the ultimate goal of standard coronary artery bypass grafting. To imply that is not optimal for certain patients and to suggest that hybrid procedures (some bypass, some percutaneous transluminal coronary angioplasty/stent) should be contemplated is to relinquish our major role in the treatment of coronary disease.

We strongly believe that minimally invasive direct coronary artery bypass grafting is still an unproven surgical procedure with unpredictable long-term results, and we firmly believe that it should not be offered to our patients until we can assure them, without a doubt in our minds, that it is the best operation for coronary artery disease.





This Article
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