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As originally published in 1992: Updated in 1999 by
UPDATE
As Originally Published in 1992:
Updated in 1999 by Albert J. Pfister, MD Washington Heart at Washington Hospital Center, Washington, DC and Washington Adventist Hospital, Takoma Park, Maryland
S
ince publication of our paper in 1992, my colleagues and I continued to perform beating heart coronary operations on selected patients. We were, and still are, convinced that avoidance of cardiopulmonary bypass is a good thing, provided quality anastamoses and complete revascularization are possible. Given those constraints, off-bypass cases represented less than 5% of our patients until recently. In June 1996 the minimally invasive direct coronary artery bypass (MIDCAB) technique and a variety of mechanical stabilization devices became available at our institutions. Although initially used through an anterior thoracotomy, we were so impressed with the stabilizers’ performance, that we began using them for all beating heart cases, regardless of incision (sternotomy, anterior thoracotomy, posterolateral thoracotomy, subxyphoid midline). Although off-pump coronary surgical procedures remain more technically demanding than standard on-pump coronary artery bypass grafting, these new instruments have made it
Address reprint requests to Dr Pfister, 106 Irving St, NW, Suite 308 South Tower, Washington, DC 20010.
© 1999 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
feasible for most surgeons and most coronaries in the left anterior descending and right coronary artery distributions. The circumflex system can still be difficult to expose, though new techniques and instruments are evolving to help in that regard. Since 1992 (up to September 1, 1998), we have performed off-pump coronary artery bypass grafting on 663 patients for a total of 910 grafts and a mortality of 1.5%. Of that number, 411 cases have been performed since June 1996, with 245 of those being MIDCABs (left internal mammary artery to left anterior descending coronary artery through anterior thoracotomy). The mortality in that cohort of 411 patients was 0.7% with a perioperative myocardial infarction rate of 0.5% and a stroke rate of 0.2% (1 patient). One only needs to look at the table of contents in any cardiac surgical journal to realize that beating heart and minimally invasive coronary surgical procedures have become tremendously popular. We are very encouraged and enthusiastic about this. We are also excited at the prospect of multiple studies to look at the patency and outcome of off-pump versus on-pump coronary operations.
Ann Thorac Surg 1999;67:1525 • 0003-4975/99/$20.00 PII S0003-4975(99)00121-6
As Originally Published in 1992:
Updated in 1999 by Albert J. Pfister, MD Washington Heart at Washington Hospital Center, Washington, DC and Washington Adventist Hospital, Takoma Park, Maryland
S
ince publication of our paper in 1992, my colleagues and I continued to perform beating heart coronary operations on selected patients. We were, and still are, convinced that avoidance of cardiopulmonary bypass is a good thing, provided quality anastamoses and complete revascularization are possible. Given those constraints, off-bypass cases represented less than 5% of our patients until recently. In June 1996 the minimally invasive direct coronary artery bypass (MIDCAB) technique and a variety of mechanical stabilization devices became available at our institutions. Although initially used through an anterior thoracotomy, we were so impressed with the stabilizers’ performance, that we began using them for all beating heart cases, regardless of incision (sternotomy, anterior thoracotomy, posterolateral thoracotomy, subxyphoid midline). Although off-pump coronary surgical procedures remain more technically demanding than standard on-pump coronary artery bypass grafting, these new instruments have made it
Address reprint requests to Dr Pfister, 106 Irving St, NW, Suite 308 South Tower, Washington, DC 20010.
© 1999 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
feasible for most surgeons and most coronaries in the left anterior descending and right coronary artery distributions. The circumflex system can still be difficult to expose, though new techniques and instruments are evolving to help in that regard. Since 1992 (up to September 1, 1998), we have performed off-pump coronary artery bypass grafting on 663 patients for a total of 910 grafts and a mortality of 1.5%. Of that number, 411 cases have been performed since June 1996, with 245 of those being MIDCABs (left internal mammary artery to left anterior descending coronary artery through anterior thoracotomy). The mortality in that cohort of 411 patients was 0.7% with a perioperative myocardial infarction rate of 0.5% and a stroke rate of 0.2% (1 patient). One only needs to look at the table of contents in any cardiac surgical journal to realize that beating heart and minimally invasive coronary surgical procedures have become tremendously popular. We are very encouraged and enthusiastic about this. We are also excited at the prospect of multiple studies to look at the patency and outcome of off-pump versus on-pump coronary operations.
Ann Thorac Surg 1999;67:1525 • 0003-4975/99/$20.00 PII S0003-4975(99)00121-6