J Thorac Cardiovasc Surg 1998;115:1392-1393
© 1998 Mosby, Inc.
Minimally invasive coronary artery surgery—A word of caution
Raymond L. Singer, MD
To the Editor:
Reardon and colleagues
1 succinctly outlined a variety of concerns relating to minimally invasive coronary artery bypass surgery. Along with recognizing the pressure of the media and company sales representatives, the authors listed four specific concerns: (1) the accuracy and patency of the anastomosis; (2) issues of incomplete revascularization; (3) ability to teach the procedure to residents; and (4) long-term outcome.
The authors concluded, however, that "on the basis of our experience, the procedure does not seem to allow comparable accuracy and anastomotic patency for the community cardiac surgeon." Indeed, it is an excellent essay. However, to imply that "community cardiac surgeons" should not perform minimally invasive cardiac procedures is an unfortunate choice of words, which has both professional and medical-legal implications.
For example, Lehigh Valley Hospital in Allentown, Pennsylvania, is a tertiary community hospital in which 1200 cardiac operations are performed per year. Our program was one of the first to perform minimally invasive directed coronary artery bypass (MIDCAB), Heartport procedures (Heartport, Inc., Redwood City, Calif.), thoracoscopic harvesting of the internal thoracic artery, endoscopic harvesting of the saphenous vein, and robotic assisted surgery. For each procedure, our surgeons worked on animal models in our own laboratories, as well as attending appropriate continuing medical education accredited courses. We have complete follow-up on outcomes and participate in several databases. In addition, Pennsylvania is a "report card state," in which all of the cardiac surgeons' data are publicly scrutinized.
The Baylor group's conclusion not only may be interpreted as academic snobbery divisive to our profession, but also could open the door for malpractice attorneys to use this inaccurate conclusion against "community surgeons" who are, in fact, well trained and suited to perform these minimally invasive procedures.
I believe their conclusion should have been that surgeons and institutions lacking an adequate volume of experience, laboratory facilities for training, or a system of appropriate follow-up and clinical analysis should not perform these types of procedures.
My father always told me that I should choose my words carefully so that they could not come back and bite me. The Baylor group could learn from this advice, since it is my understanding that the Methodist Hospital in Houston is, indeed, a "community hospital."
Associate ChiefDivision of Cardiothoracic SurgeryLehigh Valley Hospital1240 S. Cedar Crest Blvd., Suite 308,
Allentown, PA 1810312/8/89288
[Response declined]
References
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Reardon MJ, Espada R, Letsou GV, Safi HJ, McCollum CH, Baldwin JC. Editorial: Minimally invasive coronary artery surgery—a word of caution. J Thorac Cardiovasc Surg 1997;114:419-20.[Free Full Text]
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