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(Circulation. 1999;99:2967.)
© 1999 American Heart Association, Inc.

Correspondence

Minimally Invasive Coronary Bypass Surgery: An Example for Optimal Teamwork Between Cardiologists and Cardiac Surgeons?

Guy J. Friedrich, MD; Johannes Bonatti, MD; Otmar Pachinger, MD

Cardiology and Cardiac Surgery Departments, University Hospital Innsbruck, Innsbruck, Austria

To the Editor:

At our institution, where we offer minimally invasive coronary bypass surgery alone or in combination with balloon angioplasty (hybrid revascularization), we also experienced powerful public demand for minimally invasive procedures. Much time was and will be spent to inform patients with single or multiple coronary vessel disease about the different revascularization options actually available. In accordance with Bonchek and Ullyot,¹ we also are waiting for study results comparing minimally invasive coronary surgery with standard CABG in similar clinical settings. However, during our preliminary experiences with minimally invasive coronary surgery combined with coronary angioplasty,² the most striking step toward optimal therapeutic approach was achieved through intensive and critical patient selection between cardiac surgeons and interventional cardiologists. In the absence of comparative studies, we do not consider minimally invasive approaches as an alternative to well-documented standard operation strategies in multiple-vessel disease, but on the basis of our experience, we see a "niche" for critically selected patients profiting from minimally invasive revascularization procedures.

In our opinion, only ameliorated teamwork between cardiologists and cardiac surgeons, evaluating the individual patient's clinical situation and procedure-related risk, will provide the best revascularization strategy.

References

1. Bonchek LI, Ullyot DJ. Minimally invasive coronary bypass: a dissenting opinion. Circulation. 1998;98:495–497.[Free Full Text]

2. Friedrich GJ, Bonatti J, Dapunt OE. Preliminary experience with minimally invasive coronary-artery bypass surgery combined with coronary angioplasty. N Engl J Med. 1997;336:1454–1455.[Free Full Text]

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