(Circulation. 1999;99:2967A-2967.)
© 1999 American Heart Association, Inc.
Correspondence |
Minimally Invasive Heart Surgery
Southwest Cardiology Associates, Albuquerque, NM
To the Editor:
We fully agree with the recent editorial by Drs Bonchek and Ullyot concerning minimally invasive heart surgery.1 Published comparisons between minimally invasive surgery and "standard" operations can be misleading and inappropriate.2 3 4 Indeed, the purported benefits of earlier discharge and cost savings can be similarly achieved with conventional cardiac surgical techniques, as was reported at the Society of Thoracic Surgeons meeting in January 1998 in New Orleans, La.5 Since 1995, we have applied our ultra–fast-track methods to all open heart surgical patients and have observed excellent outcomes, with most discharges occurring between postoperative days1 and 4. Currently, >70% of our surgical cases are safely discharged within this time frame. These cases comprise the full spectrum of an active, adult cardiac surgical practice, including a high percentage of emergency cases as well as high-complexity/high-risk operations (eg, acute aortic dissection, Ross procedure, Bentall, redo CABG, and multiple comorbidities).
In our opinion, the standard operation using conventional techniques endorsed by Drs Bonchek and Ullyot remains the operation of choice in almost all cases owing to its superior exposure, broad applicability, and time-tested results. We believe recent developments in ultra–fast-track protocols only reinforce its superiority.
References
1.
Bonchek LI, Ullyot DJ. Minimally invasive
coronary bypass: a dissenting opinion. Circulation. 1998;98:495–497.
2.
Stevens JH, Burdon TA, Peters WS, Siegel LC, Pompili
MF, Vierra MA, St Goar FG, Ribakove GH, Mitchell RS, Reitz BA.
Port-access coronary artery bypass grafting: a proposed
surgical method. J Thorac Cardiovasc Surg. 1996;111:567–573.
3.
Westaby S, Benetti FJ. Less invasive coronary
surgery: consensus from the Oxford meeting. Ann Thorac Surg. 1996;62:924–931.
4.
Ullyot DJ. Look, Ma, no hands! Ann Thorac
Surg.. 1996;61:10–11.
5.
Walji S, Peterson RJ, Neis P, DuBroff R, Gray WA,
Benge W. Ultra-fast track hospital discharge using conventional cardiac
surgical techniques. Ann Thorac Surg. 1999;67:363–371.
Response
Surgical Director Mid-Atlantic Heart Institute at Lancaster General Hospital, Lancaster, Pa
Director, Cardiac Surgery Mills-Peninsula Hospitals, Burlingame, Calif
We are pleased that Dr Friedrich and coworkers share our conviction that notwithstanding the "powerful public demand for minimally invasive procedures," we must require studies that directly compare these approaches with the standard operation before we subject our patients to possibly harmful innovation.
We also agree that the advent of minimally invasive coronary bypass should stimulate even closer collaboration between cardiologists and cardiac surgeons, so that patients benefit from both perspectives.
We thank Drs DuBroff and Walji for their supportive comments.
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