Ann Thorac Surg 1997;64:1842
© 1997 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Kit V. Arom, MD,PhD
Department of Cardiothoracic Surgery, Minneapolis Heart Institute, 920 E 28th St, Suite 420, Minneapolis, MN 55407
See also page 1840.
The growing number of MIDCABGs using the LIMA to the LAD on a beating heart via left anterior thoracotomy incision has reached a plateau since last year. Few centers claim a patency rate of 95% or better. Some centers are suffering from a low success rate and thus losing their support from the cardiologists. However, MIDCABG will continue to develop at a slower pace. It will be done according to the set goal, not because of peer pressure, cosmesis, or marketing. The small and inexperienced centers will be trained with close supervision. In the meantime, we need to show that the LIMA graft to the LAD on a beating heart can provide an immediate patency rate as satisfactory as the conventional LIMA-to-LAD graft using cardiopulmonary bypass. Many noninvasive hemodynamic measurements have been used to evaluate flow, but none of them will satisfy the surgeons or cardiologists unless the angiographic study shows a widely patent anastomosis and no deformity in the LIMA graft itself.
This timely article describes another technique to perform a postoperative angiogram before the chest is closed. It appears to be simple and user friendly, and can be performed in the operating room by the surgeon or with the assistance of the cardiologist. Any defects seen on this angiogram can be corrected and rechecked before the chest is closed. Elbeery and Chitwood should conduct a comparative study of the early patency rate between MIDCABG and conventional LIMA-to-LAD grafting on cardiopulmonary bypass because there is no such information available at the present time. Early angiographic study of LIMA-to-LAD grafts performed with cardiopulmonary bypass should provide more information regarding the hazy areas seen on angiograms at the site of anastomosis in MIDCABG patients. Cardiologists believe this haziness to represent a permanent defect, but this is disputed by the cardiac surgeons, who see it as a temporary issue that will disappear in later angiographic study.
Related Article
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Intraoperative Catheterization of the Left Internal Mammary Artery via the Left Radial Artery
- Joseph R. Elbeery and W. Randolph Chitwood, Jr
Ann. Thorac. Surg. 1997 64: 1840-1842.
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[Full Text]
