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J Thorac Cardiovasc Surg 2003;125:1204-1207
© 2003 The American Association for Thoracic Surgery

Editorials

Risky business

Christina T. Mora Mangano, MD

From the Department of Anesthesia, Stanford University School of Medicine, Stanford, Calif.

Received for publication Jan 17, 2003. Accepted for publication Jan 22, 2003. Address for reprints: Christina Mora Mangano, MD, Stanford University Hospital, Department of Anesthesia, 300 Pasteur Dr, H3577, Stanford, CA 94305 (E-mail: cmoraman@stanford.edu).

The first 300 words of the full text of this article appear below.


   Introduction
 


See related articles on pages 1394, 1401, and 1526.

The ubiquitous media coverage of health care issues provides the patient, as consumer, with a plethora of information (and disinformation) for consideration. For example, casual investigation by a nonphysician will identify a variety of fundamentally different treatment options for ischemic heart disease. Strategies centered on pharmacologic therapy, angioplasty, coronary stents, or drug-eluting stents all have advocates and detractors. And although the prevalence of surgical coronary revascularization declined approximately 15% from 2000 to 2002, the proliferation of "new and improved" operative techniques—warm heart, minimally invasive, beating heart surgery—continues unfettered by rigorous scientific study. In contrast to new drugs, surgical innovation is adopted without peer or patient advocate review. Market forces persuade hospital administrators and push clinicians to adopt the latest surgical fashion to appease ever more "informed" patients. Marketing is increasingly more important than outcomes research.

In this issue of the Journal, two institutions share their individual experiences with another permutation of surgical revascularization techniques, and thus expose the patient to a new seduction or marketing tool: awake heart surgery.Go Go 1,2 The patient may be persuaded that heart surgery is now so safe, so noninvasive, so trivial a challenge, that general anesthesia is no longer required. Referring physicians may conclude that the stress and recovery profiles associated with surgical coronary revascularization are similar to that of angioplasty, but now their patients can enjoy brand new conduits!

Aybek and associates,Go 1 and Karagoz and colleagues,Go 2 separately argue that their successful series of 34 and 137 awake CABG procedures, respectively, combine the "obvious" advantages of beating-heart surgery, and an anesthetic technique that provides analgesia in an awake, spontaneously breathing patient. In a previous Journal editorial ("Off-Pump Coronary Bypass: Is It for Everybody?"), BonchekGo 3 successfully debunked the notion that beating-heart surgery is obviously . . . [Full Text of this Article]


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Operative techniques in awake coronary artery bypass grafting
Tayfun Aybek, P. Kessler, M. F. Khan, S. Dogan, G. Neidhart, A. Moritz, and G. Wimmer-Greinecker
J. Thorac. Cardiovasc. Surg. 2003 125: 1394-1400. [Abstract] [Full Text] [PDF]

Coronary artery bypass grafting in the awake patient: Three years' experience in 137 patients
Haldun Y. Karagoz, Murat Kurtoglu, Beyhan Bakkaloglu, Beril Sonmez, Taner Cetintas, and Kemal Bayazit
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