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Ann Thorac Surg 1999;68:436
© 1999 The Society of Thoracic Surgeons

Invited Commentary

Hisayoshi Suma, MDa

a Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, Kamakura 247, Japan

e-mail: hisasuma{at}netlaputa.ne.jp

Invited commentary

Doctor Fonger and colleagues challenged the use of the right gastroepiploic artery (GEA) graft on 66 right coronaries and 8 anterior descending arteries under beating heart without cardiopulmonary bypass through a small epigastric incision and obtained suboptimal result in terms of mortality, morbidity and graft patency.

On the other hand, we already know that the GEA graft is a safe, effective and reliable conduit with its history of clinical application of over ten years. Our experience with 800 consecutive GEA grafting has shown that its operative mortality is 2%, and early (2 months), midterm (2 years) and late (8 years) patency rates are 94% (n = 583), 88% (n = 86) and 84% (n = 32), respectively. Off pump MIDCAB has also been recognized recently to be a safe and effective procedure if handled with adequately mature technical skill and stabilizing devices. These two particular procedures, however, definitely require special sense, technical skill and learning period before achieving satisfactory result.

Since the authors have not stated how much experience they had on GEA grafting in conventional CABG and MIDCAB with internal thoracic artery before initiating this study, it is hard to presume how this difficult combination, GEA plus MIDCAB, was handled in a mature way. However, the authors’ message is clear that this procedure was not easy in their courageous challenge and honest presentation.

One thing is certain, that off-pump MIDCAB is maximally invasive for cardiac surgeons at first but then MIDCAB could turn out to be a mad CAB if the graft becomes occluded.


Related Article

Initial experience with MIDCAB grafting using the gastroepiploic artery
James D. Fonger, John R. Doty, Jorge D. Salazar, Peter L. Walinsky, and Neal W. Salomon
Ann. Thorac. Surg. 1999 68: 431-436. [Abstract] [Full Text] [PDF]




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