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Ann Thorac Surg 2000;70:96
© 2000 The Society of Thoracic Surgeons

Invited commentary

Invited commentary

David A. Fullerton, MDa

a Cardiothoracic Surgery, Northwestern University Medical School, Suite 1030 Wesley Pavilion, 251 East Chicago Ave, Chicago, IL 60611, USA

e-mail: dfullert{at}nmh.org

The conventional surgical approach used for coronary artery bypass grafting (sternotomy, use of cardiopulmonary bypass, etc) has well–defined, low operative risks and predictable long-term results. Hence, refinements in the surgical technique must achieve the same excellent results without compromising the safety of the procedure. Doctor Karagoz and colleagues must be complimented for their efforts to advance our surgical discipline. In my opinion, however, their suggested technique does not offer an advantage that may be widely applied.

The operative technique used in the present series employed a small anterior thoracotomy incision and regional anesthesia. The use of small anterior thoracotomy incisions for coronary bypass grafting enjoyed short-lived popularity and was largely abandoned because of its technical limitations. General anesthesia for cardiac surgical procedures is virtually risk-free. Patient comfort is maximized and the operating team has optimal control of the patient’s cardiopulmonary status. With the patient under general anesthesia, the surgeon and anesthesiologist are best able to successfully handle unexpected events during the course of the operation. Some operating teams regularly extubate patients at the end of cardiac surgical procedures following general anesthesia. The use of thoracic epidural anesthesia for the procedure carries risks which would not otherwise be incurred (epidural hematoma, pneumothorax in a spontaneously breathing patient, etc). Hence, avoidance of general anesthesia for coronary bypass surgery seems to offer more risk with little advantage.


Related Article

Coronary artery bypass grafting in the conscious patient without endotracheal general anesthesia
Haldun Y. Karagoz, Beril Sönmez, Beyhan Bakkaloglu, Murat Kurtoglu, Melih Erdinç, Aylin Türkeli, and Kemal Bayazit
Ann. Thorac. Surg. 2000 70: 91-96. [Abstract] [Full Text] [PDF]




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