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J Thorac Cardiovasc Surg 1998;115:487
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Minimally invasive coronary artery surgery

Michael J. Reardon, MD

Reply to the Editor:

I appreciate Dr. Coulson's comments and suggestions. I agree that redo coronary surgery is an optimal case on which to start learning the technique, provided a redo operation requiring only a single vessel bypass is available, which is unusual in my experience. We have used coronary artery perfusion cannulus when necessary, particularly for the right coronary artery. We have not found this necessary in the left coronary artery if the artery is snared beyond its middle position, but we will keep this technique in mind for the left side also.

I have read the Coulson and Bakhshay's article describing the use of the subclavian artery as an origin for coronary artery bypass and find it an interesting variant indeed. I also agree that the saphenous vein is an easier conduit to use in the minimally invasive setting. However, because the left internal thoracic artery has been shown to have superior results, in both the short and long terms, I would hesitate to justify a vein bypass to the anterior descending under most circumstances. Again, it would be a useful technique to bear in mind. We have also used the thoracoscopy camera for coronary artery bypasses and for valve operations to improve visualization for our residents and students.

Department of SurgeryBaylor College of Medicine6550 Fannin, No. 2435, Houston, TX 77030



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