Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Reply to Ngaage

Reply to Ngaage Downloaded from https://academic.oup.com/ejcts/article-abstract/20/3/657/367839 by DeepDyve user on 04 July 2020 European Journal of Cardio-thoracic Surgery 20 (2001) 657 www.elsevier.com/locate/ejcts Reply to the Letter to the Editor M. Amrani Department of Cardiac Surgery, Hare®eld Hospital, Hill End Road, Hare®eld, Middlesex UB9 6JH, UK Received 31 May 2001; accepted 1 June 2001 We read with great interest the paper from D.L. Ngaage exposure technique we managed to avoid any conversion and thank him for his nice comments. We completely agree in the last 250 cases. with the fact that complete myocardial revascularisation OPCAB surgery has somehow suffered from early and (CMR) should never be traded against an unsatisfactory hasty criticism which we believe is unfair and unjusti®ed `fashionable' procedure. Off-pump coronary artery bypass for several reasons. Firstly, the issue of the learning curve is (OPCAB) surgery will only be accepted if, at the very least, very rarely taken into consideration when OPCAB is the outcome is comparable to cardiopulmonary bypass compared to CPB. Secondly, whilst there are some broad (CPB). We also believe that similar practice should be guidelines about how coronary surgery should be performed maintained. This is particularly true as far as the type of with CPB, there are still no consensus regarding many conduit and number of grafts is concerned. The patient aspects of OPCAB including the level of anticoagulation, who died in this cohort of patients had critical left main the methods of hemodynamic assessment, the sequence of stem and a blocked right coronary artery. He also had a grafting, the indication for intracoronary shunt, the method large posterior scar. As he received four grafts, incomplete of the vessels exposure etc. The lack of uniformity in the myocardial revascularisation can be ruled out as a cause of practice could explain some of the discrepancies reported as death. well as the difference of perception. In our institution we have now performed over 300 conse- Finally, in a very short period there has been tremendous cutive OPCAB for multivessel disease with a morbidity, progress in the quality of stabilisation devices and other mortality, type and number of graft at least similar to tools. The surgical comfort provided by the recent technol- what we used to achieve with CPB. ogy is by no means comparable to what was available only a In our initial experience (®rst 50 patients) we converted year ago! Therefore some of the negative conclusions eight patients to CPB because of unsatisfactory exposure of published in the mid nineties do not re¯ect what could be the lateral wall. With growing anaesthetic and surgical achieved nowadays. OPCAB surgery should be given the experience as well as additional personal modi®cation of chance to mature. It is only the end of the beginning. E-mail address: mr.amrani@rbh.nthames.nhs.uk (M. Amrani). 1010-7940/01/$ - see front matter q 2001 Elsevier Science B.V. All rights reserved. PII: S 1010-794 0(01)00843-0 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Reply to Ngaage

Download PDF
1 page

Loading next page...
 
/lp/oxford-university-press/reply-to-ngaage-5Qzqwmkys8

References (0)

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
Oxford University Press
Copyright
© 2001 Elsevier Science B.V. All rights reserved.
Subject
Letter to the Editor
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1016/S1010-7940(01)00843-0
Publisher site
See Article on Publisher Site

Abstract

Downloaded from https://academic.oup.com/ejcts/article-abstract/20/3/657/367839 by DeepDyve user on 04 July 2020 European Journal of Cardio-thoracic Surgery 20 (2001) 657 www.elsevier.com/locate/ejcts Reply to the Letter to the Editor M. Amrani Department of Cardiac Surgery, Hare®eld Hospital, Hill End Road, Hare®eld, Middlesex UB9 6JH, UK Received 31 May 2001; accepted 1 June 2001 We read with great interest the paper from D.L. Ngaage exposure technique we managed to avoid any conversion and thank him for his nice comments. We completely agree in the last 250 cases. with the fact that complete myocardial revascularisation OPCAB surgery has somehow suffered from early and (CMR) should never be traded against an unsatisfactory hasty criticism which we believe is unfair and unjusti®ed `fashionable' procedure. Off-pump coronary artery bypass for several reasons. Firstly, the issue of the learning curve is (OPCAB) surgery will only be accepted if, at the very least, very rarely taken into consideration when OPCAB is the outcome is comparable to cardiopulmonary bypass compared to CPB. Secondly, whilst there are some broad (CPB). We also believe that similar practice should be guidelines about how coronary surgery should be performed maintained. This is particularly true as far as the type of with CPB, there are still no consensus regarding many conduit and number of grafts is concerned. The patient aspects of OPCAB including the level of anticoagulation, who died in this cohort of patients had critical left main the methods of hemodynamic assessment, the sequence of stem and a blocked right coronary artery. He also had a grafting, the indication for intracoronary shunt, the method large posterior scar. As he received four grafts, incomplete of the vessels exposure etc. The lack of uniformity in the myocardial revascularisation can be ruled out as a cause of practice could explain some of the discrepancies reported as death. well as the difference of perception. In our institution we have now performed over 300 conse- Finally, in a very short period there has been tremendous cutive OPCAB for multivessel disease with a morbidity, progress in the quality of stabilisation devices and other mortality, type and number of graft at least similar to tools. The surgical comfort provided by the recent technol- what we used to achieve with CPB. ogy is by no means comparable to what was available only a In our initial experience (®rst 50 patients) we converted year ago! Therefore some of the negative conclusions eight patients to CPB because of unsatisfactory exposure of published in the mid nineties do not re¯ect what could be the lateral wall. With growing anaesthetic and surgical achieved nowadays. OPCAB surgery should be given the experience as well as additional personal modi®cation of chance to mature. It is only the end of the beginning. E-mail address: mr.amrani@rbh.nthames.nhs.uk (M. Amrani). 1010-7940/01/$ - see front matter q 2001 Elsevier Science B.V. All rights reserved. PII: S 1010-794 0(01)00843-0

Journal

European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: Sep 1, 2001

There are no references for this article.