Circulation. 1998;98:495-497
(Circulation. 1998;98:495-497.)
© 1998 American Heart Association, Inc.
Minimally Invasive Coronary Bypass
A Dissenting Opinion
Lawrence I. Bonchek, MD;
; Daniel J. Ullyot, MD
From the Mid-Atlantic Heart Institute at Lancaster General Hospital,
Lancaster, Pa (L.I.B.), and Mills-Peninsula Hospitals, Burlingame, Calif
(D.J.U.).
Correspondence to Lawrence I. Bonchek, MD, Surgical Director, Mid-Atlantic Heart Institute at Lancaster General Hospital, 555 N Duke St, PO Box 3555, Lancaster, PA 17604-3555. E-mail ctsl@redrose.net
Key Words: Editorials • bypass • surgery
Minimally
invasive techniques for coronary surgery are gaining increased
attention, but not without debate. We recognize that in criticizing a
new technique, it is necessary to have not only a firm opinion but also
a willingness to be wrong; our purpose is to stimulate discussion and
debate. Of course, it is difficult to argue against attempts to
minimize the invasiveness of any procedure, but it is well to recall
that the most obvious successes of minimally invasive surgery have
involved technically simple operations, such as arthroscopy or
cholecystectomy, which involve a minimum of precision and almost no
sewing. The circumstances are different, however, when one attempts to
apply the same theory and strategy to
physiologically and technically complex cardiac
operations.
Advantages of Conventional CABG
The remarkable success of conventional CABG is due to the
application of a standardized operation in a wide variety of settings
to large numbers of patients with advanced disease by a vast cadre of
trained, experienced surgeons who can offer the public an operation
that is safe, effective, durable, reproducible, complete, versatile,
and teachable and that, over time, offers cost savings because of the
low incidence of complications and repeat
revascularizations. (Randomized studies such as the
RITA trial,1 which compare CABG with angioplasty,
show higher initial costs for surgery but convergence of costs within 2
to 3 years because of the infrequency of repeat
revascularizations in the surgical cohort.) These
excellent outcomes after surgery depend on a number of critical
components: uncompromising selection of the best sites for
coronary anastomoses; . . . [Full Text of this Article]
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