JTCS KCI
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Raimondo Ascione
Gianni D. Angelini
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ascione, R.
Right arrow Articles by Angelini, G. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ascione, R.
Right arrow Articles by Angelini, G. D.
Related Collections
Right arrow Coronary disease
Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2003;125:779-781
© 2003 The American Association for Thoracic Surgery

Editorials

Off-pump coronary artery bypass surgery: The implications of the evidence

Raimondo Ascione, MD, Gianni D. Angelini, FRCS

From the Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.

Received for publication June 30, 2002. Revisions requested July 1, 2002; revisions received July 30, 2002. Accepted for publication Aug 6, 2002. Address for reprints: Gianni D. Angelini, MD, Professor of Cardiac Surgery, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom (E-mail: R.Ascione@bristol.ac.uk).

The first 20% of the full text of this article appears below.


   Introduction
 


Figure Removed (Available Only in the Full Text)
View larger version (100K):
[in this window]
[in a new window]
  		Dr Ascione

 


Figure Removed (Available Only in the Full Text)
View larger version (97K):
[in this window]
[in a new window]
  		Dr Angelini

 
Off-pump coronary artery bypass surgery (OPCAB) has experienced a revival since the early 1990s, with the emergence of two schools of thought. The school in favor of OPCAB emphasizes the potential of reducing morbidity while allowing undeveloped countries to access a program of coronary surgery at reduced cost. The other school expresses concern because of the potential for intraoperative myocardial ischemia, suboptimal anastomoses, and a protracted learning curve. Progressively, a variety of innovative techniques and enabling instruments have made OPCAB a standard procedure. Concomitantly, a large number of observational, case-matched, and, not least, prospective randomized studies have been published. In the absence of recognized guidelines, the decision whether to use on-pump or off-pump techniques is often left to individual surgeons. Many are enthusiastically jumping on the OPCAB bandwagon, whereas others are adopting an even more conservative approach. The result is a significant divergence in the treatment of patients, often even within the same unit, the impact of which remains uncertain. There is an urgent need to evaluate the available evidence in a measured and scientific fashion to prevent this gut feeling-based disparity of treatment.


   The evidence
 
The ancient Romans aiming to please the people used to say, "Vox populi, vox dei!" when deciding in the arena whether to put their thumbs up or (mostly) down. In the same way, when auditing the efficacy of a new technique, the surgical scientific community has shown lack of methodology and consistency, in most cases leaving events to sort themselves out. This has been fortunate with the advent in coronary surgery of the left internal thoracic artery graftGo 1 but rather disappointing in other cases, such as . . . [Full Text of this Article]




This article has been cited by other articles:


Home page
 StrokeHome page
A. Sedrakyan, A. W. Wu, A. Parashar, E. B. Bass, and T. Treasure
Off-Pump Surgery Is Associated With Reduced Occurrence of Stroke and Other Morbidity as Compared With Traditional Coronary Artery Bypass Grafting: A Meta-Analysis of Systematically Reviewed Trials * Supplemental Appendix I
Stroke, November 1, 2006; 37(11): 2759 - 2769.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. C. Guida, G. Pecora, A. Bacalao, G. Munoz, P. Mendoza, and L. Rodriguez
Multivessel Revascularization on the Beating Heart by Anterolateral Left Thoracotomy
Ann. Thorac. Surg., June 1, 2006; 81(6): 2142 - 2146.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
D. N. Wijeysundera, W. S. Beattie, G. Djaiani, V. Rao, M. A. Borger, K. Karkouti, and R. J. Cusimano
Off-Pump Coronary Artery Surgery for Reducing Mortality and Morbidity: Meta-Analysis of Randomized and Observational Studies
J. Am. Coll. Cardiol., September 6, 2005; 46(5): 872 - 882.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
T. D.L. Keenan, Y. Abu-Omar, and D. P. Taggart
Bypassing the Pump: Changing Practices in Coronary Artery Surgery
Chest, July 1, 2005; 128(1): 363 - 369.
[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
Copyright © 2003 by The American Association for Thoracic Surgery.