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Ann Thorac Surg 1998;65:1196
© 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 Krause’s comments.

No economic studies have been published concerning the cost of minimally invasive direct coronary artery bypass grafting procedures. Therefore, no comparison can be made with standard coronary artery bypass grafting for single-vessel disease. It appears that the extended operating time, anesthesia, and new equipment plus the revision of failed procedures will eventually negate the savings, which are not important with minimally invasive direct coronary artery bypass grafting.

Performing the distal anastomosis off bypass on a beating heart with an open chest is an old procedure. The advantages are still unclear to us because a learning curve as mentioned by Dr Krause will again jeopardize good results and the well-being of the patient.

Neurologic events such as strokes or the use of blood during single-vessel coronary bypass have not occurred in our experience, nor have they been reported in the literature. It is important not to confuse this procedure with the standard coronary artery bypass grafting for multiple vessels in sick patients.

Minimally invasive direct coronary artery bypass grafting is an unproven surgical technique that needs careful study before it is offered openly to our patients.





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