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J Thorac Cardiovasc Surg 1999;118:977-978
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Emerging new concepts of myocardial laser revascularization

Marco Zenati, MD

Director, Minimally Invasive Cardiac Surgery Program

Howard A. Cohen, MD

Director, Cardiac Clinical Services
Cardiovascular Institute
Universityof Pittsburgh Medical Center
Pittsburgh, PA 15213

Reply to the Editor:

We enjoyed reading Beranek’s comments and discussion of myocardiallaser revascularization (MLR). Our concept of integrated coronary revascularizationis in constant evolution, as new techniques become available both to the cardiacsurgeon and to the interventional cardiologist. Regarding the combinationof MLR and conventional bypass operations, Allen and associatesGo 1 recently presented favorable results of a multicenterprospective randomized study; therefore we agree that the combination of revascularizationtechniques using minimally invasive off-pump surgery and MLR (percutaneousor surgical) will have a role in the future for selected subsets of patients.This multimodality collaborative approach to myocardial revascularizationis currently being applied increasingly at our institution, and we agree withMack’s recent forecastGo 2that in 10 years 50% of all cardiac operations will be combined with a catheter-basedprocedure. To quote Rihal and Yusuf,Go 3 perhaps the relevant clinical question is not which mode of treatmentis best, but which combinations of treatments, in what sequence, are appropriatefor a specific patient at a specific point in his or her clinical course.

12/8/101410

References

  1. Allen KB, Delrossi AJ, Realyvasquez F,et al. Transmyocardial revascularization combined with coronary artery bypassgrafting versus bypass grafting alone: a prospective randomized multi-centertrial. Program of the Seventy-ninth Annual Meeting of The American Associationfor Thoracic Surgery, New Orleans: April 18-21, 1999. p. 38.
  2. Mack MJ. Era of minimization: definingand reducing surgical trauma for cardiac patients. Program of Symposium "Neurologicinjury during cardiac surgery II," Brussels, Belgium: September 20, 1998. p. 14-18.
  3. Rihal CS, Yusuf S. Chronic coronary arterydisease: Drugs, angioplasty or surgery? Br Med J 1996;312:265-6.[Free Full Text]




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