HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

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): Erik W. L. Jansen Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jansen, E. W. L. Articles by Grobbee, R. E. Search for Related Content PubMed PubMed Citation Articles by Jansen, E. W. L. Articles by Grobbee, R. E.

J Thorac Cardiovasc Surg 1999;117:1226
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Off-pump internal thoracic artery–left anterior descendingcoronary artery grafting via small anterior thoracotomy: When and comparedto what?

Department of Cardiopulmonary Surgery
Heart Lung Institute
UtechtUniversity Hospital (Rm E03.406)
PO Box 85500
Utrecht, 3508 GA, TheNetherlands

To the Editor:

We read with interest the article by Calafiore and associates on themidterm results after minimally invasive coronary surgery (J Thorac CardiovascSurg 1998;115:763-71).

The authors deserve credit for having popularized grafting of the leftinternal thoracic artery (ITA) to the left anterior descending coronary artery(LAD). There is some concern, however, about patient selection and patientmix in the study population, on which the analyses in the paper are based.It is uncommon to find an indication for single LAD grafting in patients withmultiple-vessel disease. Indeed, on page 764 the authors state that patientswho are eligible for such an operation form a "very select" groupof all patients having multiple-vessel disease. It is therefore surprisingthat the authors managed to find 220 patients of this rare category selectedfor their study, an even larger group than the single-LAD group (214 patients).The total number of patients who underwent coronary artery bypass graftingin that period was not mentioned. Also, there may have been some special referrals.More important, in the presentation of the results the two groups are largelycombined.

This makes generalization of the results questionable. The extraordinarynature of this large group of patients with multiple-vessel disease, treatedwith single-LAD grafting, is illustrated by the apparent absence of a materialdifference in functional outcome. It should be noted, however, that this pertainsto midterm outcome only. Differences in outcome may well become visible onlong-term follow-up.

The authors should consider presenting their data strictly separatelyfor single- and multiple-vessel groups. The multiple-vessel group in the presentstudy should be regarded with caution, because this necessarily is a highlyatypical group of patients. If not, the findings challenge the basic conceptof surgical myocardial revascularization, that is, complete revascularization.Still, the long-term follow-up of this atypical group is of clear interest.In its present form the results of the report are difficult to interpret andmay lead to confusion.

12/8/97383

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): Erik W. L. Jansen Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jansen, E. W. L. Articles by Grobbee, R. E. Search for Related Content PubMed PubMed Citation Articles by Jansen, E. W. L. Articles by Grobbee, R. E.