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Ann Thorac Surg 2000;70:339-340
© 2000 The Society of Thoracic Surgeons

Correspondence

Reply

Erdesir Naseri, MDa, Sinan Arsan, MDa

a Department of Cardiovascular Surgery, Academic Hospital, Nuhkuyusu Cad. No: 88, Altunizade Istanbul 81190, Turkey

e-mail: arsansim.net.tr

To the Editor

We read Bedi and Kalkat’s letter with pleasure. Knowing that other centers are also performing coronary endarterectomy on a beating heart can be considered as a sign as more widespread use of the beating heart technique even in those vessels previously considered to be inappropriate for off-pump method. Deciding to carry out the coronary bypass operation on a beating heart is based mainly on the presence of the risk factors prohibiting the use of cardiopulmonary bypass. In these cases intraoperative presence of diffuse coronary artery disease and absence of the appropriate intraluminal diameter must not preclude the use of the off-pump technique.

Our experience and that of Bedi and Kalkat show that coronary artery endarterectomy can be performed safely on a beating heart. Although in our study endarterectomy had been carried out only on right coronary artery, we have used this technique satisfactorily in left anterior descending artery and its diagonal branches.

Since the publication of our letter in The Annals [1] we have performed a total of 17 endarterectomies in 13 cases of coronary bypass operations on beating hearts (7 left anterior descending artery, 2 diagonal, 8 right coronary artery). There has been no operative mortality and only 1 perioperative myocardial infarction in the diagonal domain. This was a case in which despite all our efforts a smooth distal tip could not be attained in the diagonal artery.

Control angiography in 2 of the cases included in our previous letter showed three widely open anastomoses and no graft occlusion.

In conclusion, coronary endarterectomy on a beating heart is a safe method of coronary revascularization in most of the cases and can be reverted to cardiopulmonary bypass if it fails.

References

  1. Naseri E, Arsan S. Coronary endarterectomy on beating heart [Letter]. Ann Thorac Surg 1999;68:63–1.

Related Article

Endarterectomy on a beating heart
Harinder Singh Bedi and Maninder Singh Kalkat
Ann. Thorac. Surg. 2000 70: 338-339. [Extract] [Full Text] [PDF]




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