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Ann Thorac Surg 2004;78:1516-1517
© 2004 The Society of Thoracic Surgeons

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Correspondence

Reply

Klinik für Thorax und Kardiovaskularchirurgic, Herzzentrum Nordrhein-Westfalen, Universitätsklinik Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany

gkleikamp{at}hdz-nrw.de

To the Editor:

We appreciate the interest of Drs Rasul and Sim in our work. Our grading system for the overall quality of the coronary arteries was designed to be used in patients with ischemic cardiomyopathy [1]. In this group of patients, we are dealing almost exclusively with triple-vessel coronary artery disease. Many vessels, even major ones, are destroyed; often only one or two arteries are left. In this situation, our score seems adequate. The score is not a universal tool as are some other scoring systems for the coronary arteries that have been proposed. However, the score has been used in another large series of patients with ischemic cardiomyopathy at the German Heart Center in Berlin with very similar results (Harald Hausmann, MD, Roland Hetzer, MD, PhD: personal communication, 2003).

We usually graft vessels with more than 70% stenosis and stenoses of the left main stem that are greater than 50%. In large vessels and vessels that provide collaterals to other coronary arteries, stenoses of more than 50% are bypassed. We are in agreement with the revised Guidelines for Coronary Artery Bypass Graft Surgery [2] published jointly by the American Heart Association and the American College of Cardiology in 1999.

Informed consent is the proper basis for decision making, especially in patients with ischemic cardiomyopathy and severe heart failure. However, informed consent should include all the individual risk factors and the prognosis after a treatment option. Surgical revascularization is not the only possibility for these patients. Some will benefit more from heart transplantation, a Dors procedure, biventricular pacemaker implantation, or mechanical circulatory support, and we believe we are obliged to offer the best option to each patient.

References

1. Kleikamp G, Maleszka A, Reiss N, Stüttgen B, Körfer R. Determinants of mid- and long-term results in patients after surgical revascularization for ischemic cardiomyopathy. Ann Thorac Surg. 2003;75:1406–1413[Abstract/Free Full Text]
2. Eagle KA, Guyton RA, Davidoff R, et al. ALL/AHA guidelines in coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol. 1999;34:1262–1347[Free Full Text]

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 Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kleikamp, G. Articles by Körfer, R. Search for Related Content PubMed Articles by Kleikamp, G. Articles by Körfer, R. Related Collections Coronary disease Related Article