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J Thorac Cardiovasc Surg 2008;135:306-307
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

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

Dr Brian F. Buxton (Melbourne, Australia). This paper has some fascinating aspects to it. One is the sequential rate of angiography and the second is the excellent results obtained by off-pump surgery. Let me just run through some of the aspects of this study. This is a single-center, in fact almost a single-surgeon, retrospective observational study of 240 out of 402 patients who had off-pump surgery, 60% of whom had repeat angiography unrelated to symptoms. The sequential angiograms were obtained the day after surgery and at 1 year and 5 years. I will confine most of my comments to the main groups rather than the subset analyses presented toward the end.

First, the 5-year angiographic patency studies of the ITA grafts were absolutely excellent, with 92% and 93% 5-year patency for the OPCAB series. In particular, I noted that most or many of the right ITA grafts were in situ. In contrast, the RGEA had 83% and saphenous vein 74% 5-year patency results. There were insufficient radial arteries in this small series to comment on the patency rates. However, these results overall do confirm the excellent results in the hands of the Korean surgeons in terms of their OPCAB series.

The second point is that the overall patency in relation to target arteries provides no real new information. We know that the right ITA patency is superior to the LCX and RCA, and that was confirmed by these studies.

I think of special interest in this paper are the data provided by the progression of disease in the FitzGibbon 50% stenosis or FitzGibbon B group. This showed several interesting facts. In some of the patients the lesions recovered and in other patients new type B lesions appeared.

Let me run through the progression of disease. The ITA grafts showed very . . . [Full Text of this Article]






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