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Ann Thorac Surg 2004;77:380
© 2004 The Society of Thoracic Surgeons

Correspondence

Reply

Rinaldo Bellomo, MDa, Michael Haase, MDa, Anamika Sharma, BMedScia, Anja Fielitz, BPharma, Shigehiko Uchino, MDa, Jens Rocktaeschel, MDa, Laurie Doolan, MDa, George Matalanis, FRACSa, Alexander Rosalion, FRACSa, Brian F. Buxton, FRACSa, Jai S. Raman, FRACSa

a Department of Intensive Care, Austin and Repatriation Medical Centre, Studley Rd, Heidelberg 3084 Victoria, Australia

e-mail: rinaldo.bellomo{at}armc.org.au

To the Editor:

We thank Dr Chavanon and colleagues for their comments. We are currently conducting a randomized, controlled trial comparing venous with arterial grafting. Thus, we continue to use some venous grafts. In the on-pump group from our study [1], 31 venous grafts were performed in 25 patients.

We fully support the view that avoidance of aortic manipulation is highly desirable. Although decisions are often individualized on the basis of clinical observations, anatomy, age, chest roentgenographic findings of calcification, and preoperative transesophageal echocardiographic imaging of the aorta, we generally support the use of a no-touch aortic technique. In fact, in our study of off-pump patients, 55 grafts were T or Y grafts from the left or right internal mammary artery. It seems clear from the data of Dr Chavanon's group and ours that, in the short term, this approach is safe.

The ability to demonstrate a significant decrease in embolic strokes will require large patient cohorts because of issues of statistical power. We also need long-term patency data as well as long-term clinical morbidity and mortality information. Although such data will be a long time coming, we agree that all available preliminary findings lend support to the safety or arterial grafting under variable circumstances and to the desirability of minimizing or eliminating aortic manipulation whenever technically feasible.

References

  1. Haase M., Sharma A., Fielitz A., et al. On-pump coronary artery surgery versus off-pump exclusive arterial coronary grafting: a matched cohort comparison. Ann Thorac Surg 2003;75:62-67.[Abstract/Free Full Text]




This Article
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