HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joseph C. Cleveland, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cleveland, J. C. Search for Related Content PubMed PubMed Citation Articles by Cleveland, J. C., Jr Related Collections Coronary disease Minimally invasive surgery Related Article

---

Original Articles: Adult Cardiac

Invited Commentary

Division of Cardiothoracic Surgery, University of Colorado at Denver, Academic Office 1, L15, 12631 East 17th Ave, C310, PO Box 6511, Aurora, CO 80045

(Email: joseph.cleveland{at}uchsc.edu).

This single center observational study by Navia and colleagues [1] describes their experience with off-pump total arterial coronary artery revascularization. The results presented are indeed impressive. These surgeons report a perioperative mortality of less than 1%, with similarly low rates of major complications and graft patency that exceeds 90%. Medium-term survival of this 569 patient cohort was also greater than 90%. Most noteworthy, likely representing their institutional commitment to adopting and implementing an off-pump strategy for all patients is that only 4 of 569 patients (< 1%) required conversion to cardiopulmonary bypass to accomplish complete arterial revascularization. I must confess that even as an early off-pump enthusiast, I often conceded the off-pump approach when the going got tough, particularly on the lateral wall grafts.

Based on these outstanding results, one must entertain the following question: Should off-pump bilateral internal thoracic arterial grafting become the accepted standard for coronary revascularization? One could make a very strong argument for this approach based on these outstanding outcomes, the theoretical advantages of avoiding the deleterious effects of cardiopulmonary bypass, and the seemingly strong biological appeal of using internal thoracic arterial conduits.

However, I believe that as a surgical community we owe our patients the responsible adoption of new technology and techniques. As such, these impressive short-term and medium-term results must be replicated by other centers, and we must collectively demonstrate good long-term graft patency and patient outcomes for this technique to gain widespread acceptance. Navia and colleagues [1] are to be commended for taking the first steps in what may prove to be a significant advance in the techniques of surgical revascularization for coronary artery disease.

	References

Top References

 

1. Navia D, Vrancic M, Vaccarino G, et al. Total arterial off-pump coronary revascularization using bilateral internal thoracic arteries in triple-vessel disease: surgical technique and clinical outcomes Ann Thorac Surg 2008;86:524-531.[Abstract/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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joseph C. Cleveland, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cleveland, J. C. Search for Related Content PubMed PubMed Citation Articles by Cleveland, J. C., Jr Related Collections Coronary disease Minimally invasive surgery Related Article