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J Thorac Cardiovasc Surg 2002;124:655-659
© 2002 The American Association for Thoracic Surgery

Editorial

Through the open door! Where has the ride taken us?

From Medical City Dallas Hospital, Dallas, Tex.

Received for publication Jan 15, 2002. Accepted for publication Feb 8, 2002. Address for reprints: Michael J. Mack, MD, 7777 Forest Ln, Suite A323, Dallas, TX 75230 (E-mail: mjmack@earthlink.net).

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

See related article on page 698.

There is no operation as complex, yet as fundamentally unchanged over time, as conventional coronary artery bypass grafting (CABG). This remarkable achievement is credited to the operation's adaptability to a wide variety of clinical settings; its reproducibility and durability while performed by a vast cadre of surgeons all across the world; and its proven track record for safety and effectiveness. A momentous effort, however, is evolving to redefine CABG. This paradigm shift has received a groundswell of support as advances in minimally invasive surgery in other areas, such as arthroscopy, laparoscopic cholecystectomy, and thoracoscopy, combined with an increasing focus on cost containment, have forever changed the milieu of the cardiac surgeon.

The clinical effectiveness of the left internal thoracic artery-to-left anterior descending coronary artery anastomosis combined with the considerable morbidity associated with conventional CABG provided the impetus for exploring alternative approaches to surgical revascularization. These approaches have all fallen under the general rubric of minimally invasive CABG. The clinical goals of minimally invasive CABG are interrelated and include (in order of importance): (1) achieving graft patency rates equal or superior to those of conventional CABG (avoid repeated revascularization); (2) decreasing incisional pain and discomfort (reduce invasiveness); (3) facilitating a more rapid return to normal activity levels (reduce invasiveness); (4) reducing the length of hospital stay (decrease complications); and (5) decreasing cost. Currently, the most widely practiced minimally invasive approach involves surgical revascularization on the beating heart through a median sternotomy incision, or off-pump coronary artery bypass grafting (OPCAB). Best industry estimates are that OPCAB, and other beating heart techniques, constituted approximately 24.7% of the 350,000 isolated CABG operations performed in 2001 (personal communication from Medtronic, Inc, Minneapolis, Minn, December 2001). Despite tremendous enthusiasm on the part of patients, industry, and the media, however, . . . [Full Text of this Article]

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