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J Thorac Cardiovasc Surg 1998;115:964
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Minimally invasive coronary artery surgery

To the Editor:

We read with great interest the editorial by Reardon and associates ¹ regarding minimally invasive coronary artery surgery. We share their concerns about the safety of minimally invasive coronary artery bypass, particularly when the left internal thoracic artery is used to bypass the left anterior descending artery, our "gold standard." The operation with the best track record may have been converted into an extremely dangerous surgical tool.

Many surgeons attended meetings dealing with minimally invasive coronary artery surgery and returned with great enthusiasm. From the outset, however, we were very concerned that small thoracic incisions were not the ideal approach from the technical and safety standpoints in patients who could become unstable, regardless of whether the surgeon had access to the femoral vessels.

We have adopted the surgical exposure described by Arom, Emery, and Nicoloff. ² We modified their techniques to use a complete sternotomy approach via a small skin incision, usually 5 inches (12.5 cm) in length. Because of the skin's great elasticity, we can perform a complete median sternotomy using the standard sternal saw. In this way, we have complete access to the heart via a small skin incision that is cosmetically appealing.

Through this approach we can mobilize both internal thoracic arteries and use the radial artery as a free graft to reach diagnonal branches, the ramus marginalis, or proximal circumflex branches. Because we use cardiopulmonary bypass and the standard antegrade/retrograde cardioplegia with the heart still, we can construct perfect anastomoses. So much has been written about the deleterious effects of cardiopulmonary bypass that the safety of a 5- to 15-minute pump run with cardioplegic arrest has been forgotten.

We have used this strategy and have not had a single instance of symptoms or signs of coronary insufficiency from the operations performed. We wonder whether the surgeons who have commercial interests in the companies promoting minimally invasive surgery can claim this completeness of revascularization and excellence of results. We congratulate Dr. Reardon and his group for putting a word of caution to the enthusiasm that minimally invasive coronary surgery has generated.

Pavía Heart InstituteSan Juan, Puerto Rico12/8/87794

References

1. Reardon MJ, Espada R, Letsou GV, et al. Editorial: minimally invasive coronary artery surgery—a word of caution. J  Thorac Cardiovasc Surg 1997;14:419-20.
   
2. Arom KV, Emery RW, Nicoloff DM. Mini-sternotomy for coronary artery bypass grafting. Ann Thorac Surg 1996;61:1271-2.[Abstract/Free Full Text]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ernesto R. Soltero Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rinaldi, R. G. Articles by Carballido, J. Search for Related Content PubMed PubMed Citation Articles by Rinaldi, R. G. Articles by Carballido, J.