(Circulation. 1999;99:1400-1403.)
© 1999 American Heart Association, Inc.
Editorials |
Minimally Invasive Coronary Artery Bypass Grafting
An Experimental Perspective
From the Department of Cardiology, Heart Lung Institute, Utrecht University Hospital, Utrecht, Netherlands.
Correspondence to Cornelius Borst, MD, PhD, Professor of Experimental Cardiology, Heart Lung Institute, Utrecht University Hospital (Room G02.523), PO Box 85500, 3508 GA Utrecht, Netherlands. E-mail c.borst@hli.azu.nl
Key Words: Editorials • bypass • surgery • coronary
In their recent editorial "Minimally Invasive Coronary Bypass: A Dissenting Opinion," Bonchek and Ullyot1 express concerns about ill-guided attempts to deviate from the conventional revascularization procedure that is "safe, effective, durable, reproducible, complete, versatile, and teachable." In the present editorial, an experimental perspective on the search for less invasive surgical strategies is provided that will convey an opposite opinion. First, a brief reappraisal is warranted of the safety of coronary artery bypass graft surgery (CABG) during cardiac arrest supported by cardiopulmonary bypass (CPB).
Safety of Conventional CABG
The great majority of CABG patients benefit greatly from
coronary revascularization, but the
surgical procedure is not without adverse effects. The Society of
Thoracic Surgeons (STS) National Cardiac Surgery Database (January
1998) lists complications of 170 895 CABG-only operations, including
13 736 reoperations, performed in the United States in 1996. Operative
mortality was 2.9% (2.5% in men, 4.0% in women). Operative mortality
increases with age, from 1.1% at age 20 to 50 years to 7.2% at 81 to
90 years. In only 65.4% of procedures were no complications reported.
Most complications are listed in the
Table
.
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Another way to assess the clinical outcome of conventional CABG is to
analyze hospital discharge data from health insurance
records.2 Of 101 812 patients 
65 years old operated
on in January through October 1993 in the United States, 4.3% died in
hospital. Of particular concern are patients (3.6%) who were
discharged to a non–acute-care facility.3 Owing to
complications, 10.2% were
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