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Ann Thorac Surg 2003;76:661-662
© 2003 The Society of Thoracic Surgeons

Correspondence

Reply

Lucia Raco, MDa

a Department of Cardiac Surgery, Blackpool Victoria Hospital, Whinney Heys Rd, Blackpool, FY3 8NR, UK

e-mail: lucia{at}duke.force9.co.uk

To the Editor:

We welcome the comments to our article published in The Annals[1].

Doctor Bonchek and his colleagues in Lancaster certainly have extensive experience with the technique and it is encouraging to see the same gratifying results reproduced on an even larger scale. At our institution we have another surgeon who has been using intermittent cross-clamping and about 2 years ago started to perform off-pump CABG. We think the transition between the two techniques has been much easier because of his previous experience with intermittent cross-clamping. As for the need to clamp both the aorta and controlling the target coronary artery with sutures, this merely reflects the surgeon’s training with this particular method. We found 2-0 vicryl sutures very safe, provided a big bite of tissue is included to spread the forces over a wide area thus mimicking the effect of the coronary clamps described in Dr Bonchek’s technique[1].

We thank Professor Antunes from Coimbra, Portugal, for his comments. He quite rightly points out that this technique does not result in poorer myocardial protection. It is interesting that at his institution they decided to switch from cardioplegia to noncardioplegic techniques and produced excellent results. Certainly avoiding aortic occlusion seems to be a natural step forward but although we occasionally use this technique we do not use it routinely at present. In our institution the incidence of postoperative cerebrovascular accidents is low and mainly confined to the emergency group of patients who are often not only clinically very unstable but also more likely to be in a low cardiac output status before surgery.

We thank our distinguished colleagues for their comments.

References

  1. Raco L., Mills E., Millner R.J. Isolated myocardial revascularization with intermittent aortic cross-clamping: experience with 800 cases. Ann Thorac Surg 2002;73:1436-1440.[Abstract/Free Full Text]




This Article
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PubMed
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Right arrow Myocardial protection

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