| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2004;26:1229
© 2004 Elsevier Science NL
Letter to the Editor |
Department of Cardiac Surgery, Royal Hospital for Sick Children, Yorkhill NHS Trust, Dalnair Street, Glasgow G3 8SJ, Scotland, UK
Received 23 August 2004; accepted 1 September 2004.
* Tel.: +44 141 201 0269; fax:+44 141 201 9204. (E-mail: drrajashahzad{at}hotmail.com).
Stamou and colleagues [1], and the editorial staff of EJCTS, deserve credit for carrying out and publishing results of the first-ever propensity matched score analysis comparing solely the operative mortality rate after off-pump coronary artery bypass (OPCAB) and conventional coronary artery bypass grafting. Their results suggest that in unselected patients with multivessel disease a lower operative mortality rate can be achieved with the OPCAB technique compared with the conventional on-pump approach. This finding is without doubt the last nail in the coffin of skeptics who for almost a decade have regarded OPCAB as a technique with the potential for intra-operative myocardial ischemia, suboptimal anastomoses, and a protracted learning curve.
Presently, abundant evidence is available to suggest that excellent results can be achieved when cardiopulmonary bypass is avoided [2–5]. Comparison between the costs of both procedures also tilts the balance in favour of OPCAB. From the material costs per patient needed to perform a routine operation to the other economical aspects, such as bed occupancy, postoperative complications, and transfusion requirements, OPCAB has been shown to be at least equivalent if not superior to CPB [2,5]. Objective analysis through randomized controlled trials has also proved that incomplete myocardial revascularization and early anastomotic dysfunction, previously thought as severely compromising this technique, are merely unfounded fears and probably an accompaniment of the learning curve as is seen with any new technique [2–5].
With increasing experience OPCAB can be safely performed in unselected patients [2]. In fact, more than patient condition, an individual surgeon's competence and common sense are probably the most important determinants of selection criteria for OPCAB surgery. Hence, the argument that a select few can possibly benefit from OPCAB also no longer holds true. In the last decade or so, OPCAB has been tested through an increasingly rigorous process of scientific validation. From a large number of observational, case-matched, retrospective analyses to randomized controlled trials, there is plenty of evidence to validate that OPCAB surgery is now a proven, safe, cost effective and reproducible surgical technique. The study of Stamou et al. [1] by statistically proving the safety of OPCAB finally marks once and for all ‘the triumph of technical skill’ over ‘fears and ego of the skeptics’.
Footnotes
☆ The authors of the original paper [1] were invited to comment on this Letter to the Editor but declined the offer.
References
This article has been cited by other articles:
|
|
 |
|
  S. G Raja and G. D Dreyfus Current Status of Off-pump Coronary Artery Bypass Surgery Asian Cardiovasc Thorac Ann, April 1, 2008; 16(2): 164 - 178. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
