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Ann Thorac Surg 2000;70:737
© 2000 The Society of Thoracic Surgeons

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Invited commentary

Invited Commentary

^a Center for Innovative, Cardiovascular Therapy, Heart Institute, Beth Israel Medical Center, First Ave at 16th St, New York, NY, 10003, USA,

e-mail: hshennib{at}bethisraelny.org

Invited commentary

In the year 1927 Sir Russel Brock attempted thrice to use a cardioscope designed for him by Schrantz of the Genitourinary manufacturing company for intraoperative visualization and management of pulmonic valve stenosis in children. All three children died, clearly not related to the use of the cardioscope but to the general conditions in which cardiac surgery was performed during that era. Since then, cardiac surgery evolved to become a safe and effective practice. This primarily is attributed to the development of cardiopulmonary bypass and good myocardial protection.

Then came minimally invasive cardiac surgery. In general, three factors stimulate the adoption of new technology: market needs, threat of distinction whether it be war or take over by other specialty and last but not least; just simply being there (Wright time and Wright place) when technology is developed for other purposes. Minimally invasive cardiac surgery (MICS) is so far the product of all three. Its technology, except for coronary artery stabilizers has yet to be proven of added value to most patients, hospitals or medical industry.

However, the failure to demonstrate benefit from the use of MICS technology may reflect true lack of benefit or simply the lack of sensitive methods to demonstrate an advantage.

In this article, Drs Burke and coworkers at Miami Children’s hospital systematically applied cardioscopy in patients requiring intraventricular repairs. In a series exceeding four hundred children they demonstrated the safety of exposing defects using indirect visualization or magnification with a cardioscope. Even though it was not possible to compare this experience with that of a conventional direct approach it is intuitively likely that better visualization may in fact lead to better quality repair. Only time and careful follow-up will tell. Has this approach led to more cosmetic less lengthy incisions? This does not appear in this article, yet it is likely that better indirect exposure using cardioscopes will reduce the extent of surgical incisions. Totally endoscopic repair however will only happen when other adjunct enabling technology such as closure devices, one shot endoscopic automated patching and others become available. Catheter based technology will most likely challenge surgeons to further evolve their minimally invasive techniques. Dr Burke and his group are to be commended for pushing the frontier and leading the application of innovative minimally invasive cardiac surgery technology in children.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hani Shennib Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Shennib, H. Search for Related Content PubMed Articles by Shennib, H.