Ann Thorac Surg 2008;86:1402-1403. doi:10.1016/j.athoracsur.2008.05.031
© 2008 The Society of Thoracic Surgeons
Correspondence
Reply
Stephen A. Olenchock, Jr, DOa,
C. Michael Gibson, MDb
a Cardiothoracic Surgery Department, Tufts University School of Medicine and Caritas St. Elizabeth's Medical Center, 11 Nevins St, Suite 306, Boston, MA 02135
b Cardiovascular Division, Departments of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA
(Email: stephen.olenchock{at}caritaschristi.org).
To the Editor:
We thank Cikirikcioglu and Duran [1] for responding to our article [2] that reported the results of an observational study of the use of saphenous vein graft radiographic markers in coronary bypass surgery in the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial. Cikirikcioglu and Duran [1] note the importance of proximal anastomotic marker implantation in the setting of re-angiography procedures. They should be congratulated for applying this practice in their own institution (ie, Department of Cardiovascular Surgery, University Hospital of Trakya, Edirne, Turkey) for the past 7 years, and specifically for applying a consistent technique in selecting the style of the marker. As noted by the authors, "We prefer to use ‘home made' markers by sternal steel wire. We use different shapes according to the target coronary arteries; for example circular for right coronary artery and its branches, square for left anterior descending artery and its branches, and hexagonal for circumflex artery branches."
As stated in the "Limitations" section of our article [2], the specific type of marker used by the surgeon was not available in our study (circumferential markers, marker clip, and so forth), and it is possible that the type of marker used could have different effects on patency. Cikirikcioglu and Duran [1] also inquired about the region of infarction for the perioperative myocardial infarctions (MIs) and whether or not the MIs were related to territories that were perfused by a marked saphenous vein graft (SVG). Finally, they request data on the reoperative findings in the patients with markers who underwent repeat coronary bypass surgery. Of the patients with an SVG marker placed, only 7 underwent repeat surgery. We do not have the data that Cikirikcioglu and Duran [1] requested on the reoperative findings (ie, "Did they encounter fibrosis, narrowing or any marker related pathologic changes around the proximal anastomoses?") in these 7 patients. Nor do we have information on the region of infarction for the perioperative MIs. We agree with the authors that such additional data would be valuable in subsequent studies and would further guide the decision process on the use of SVG markers.
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References
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- Cikirikcioglu M, Duran E. New discussion on an old subject: proximal anastomosis markers in coronary bypass surgery (letter) Ann Thorac Surg 2008;86:1401-1402.[Free Full Text]
- Olenchock Jr SA, Karmpaliotis D, Gibson WJ, et al. Impact of saphenous vein graft radiographic markers on clinical events and angiographic parameters Ann Thorac Surg 2008;85:520-524.[Abstract/Free Full Text]
Related Article
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New Discussion on an Old Subject: Proximal Anastomosis Markers in Coronary Bypass Surgery
- Mustafa Cikirikcioglu and Enver Duran
Ann. Thorac. Surg. 2008 86: 1401-1402.
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