Surgical Principles in the Direct Reconstruction of Left Coronary Flow

Patient Selection and Current Practice Strategy for Off-pump Coronary Artery Bypass Surgery

“…A larger cohort of off-pump patients may be associated with different selection criteria that may in turn alter the propensity analysis. Factors not taken into account in this retrospective analysis due to limitations of the database and that may impact conclusions include (1) variations in coronary anatomy such as calcified, intramyocardial, or small coronary arteries, (2) variations in individual surgeon skill and experience, (3) long-term patency and event-free survival. These questions can only be answered in a large, multicenter, prospective, randomized trial with long-term follow-up.…”

“…1 The still, bloodless field provided by cardioplegic arrest of the heart combined with the technological advances of cardiopulmonary bypass around the same time, overshadowed the off-pump approach to become the dominant modality in coronary surgery. 2,3 Resurgence in beating heart surgery began in the early 1990s in an attempt to decrease the morbidity associated with CABG without jeopardizing benefits, and was spurred by the observed benefits of avoiding CPB and its associated deleterious effects. 4 -6 Early development of off-pump coronary artery bypass was hindered by crude instrumentation, as well as limited exposure through small incisions.…”

Coronary Artery Surgery

“…This can be accomplished with an acceptable operative mortality (Edwards et al 1970, Effler 1969a, b, Green et al 1970. It is adaptable for all major coronary arteries, providing an immediate augmentation of coronary blood flow with instant improvement in myocardial perfusion (Johnson, Flemma, Harding, Cooper & Lepley 1970, Johnson, Flemma, Manley & Lepley 1970, and is usually followed by a dramatic relief of symptoms. Hyperidrosis, or grossly excessive sweating, is a rather unusual and distressing condition which although amenable to effective surgical treatment has received less attention than it deserves.…”

Myocardial Metabolism after Collagen-Tube Revascularization of the Ischemic Heart: Experimental Study and Review of Literature*

“…Field et al (24) had 35 patients with 45 venous bypasses. Johnson et al (39, 40) reported about 181 patients with a total of 207 coronary bypasses; in 36 per cent there were multiple arterial implants as additional steps, and in more than 60 per cent there were double and triple vein grafts. Favaloro and associates (22, 23) operated from May 1967 to June 1970 upon 951 patients using 1,086 saphenous vein grafts, 40 per cent of which included double vein grafts.…”

“…A comparison of reports on mortality rates must allow for the criteria used in the selection of patients and the indications for operation. Johnson and his Milwaukee group (39–41), and others, accepted rather desperate cases for operation. Accordingly, their mortality was high, with an overall rate of 22 per cent—21 per cent for triple vein bypasses and 7 per cent for double vein bypasses.…”