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May 23/30, 2001

Revascularization Methods for Coronary Artery Disease

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;285(20):2580-2581. doi:10.1001/jama.285.20.2580

To the Editor: The article by Drs Prêtre and Turina1 succinctly reviews trials examining the benefits of percutaneous transluminal coronary angioplasty (PTCA) vs coronary artery bypass graft (CABG) surgery and newer percutaneous transluminal coronary interventions (PTCIs) such as intracoronary stenting, and minimally invasive coronary surgery. The least invasive surgical approach to revascularize diseased coronary arteries uses off-pump techniques on the beating heart. Although data suggest that elimination of the heart-lung machine reduces morbidity and mortality,2 we disagree with the authors that complete revascularization using these techniques is achieved in some patients with 3-vessel disease.1 The main obstacle to complete revascularization of the beating heart has been difficulty in exposing coronary targets on the lateral and inferior wall of the heart without hemodynamic alterations.2 In our experience, the strategy of using the single-suture technique to place traction on the pericardium in a fashion that creates ectopia cordis has proven safe and effective in accomplishing off-pump grafting of all coronary territories, including those located in topographically difficult areas.2 Success in achieving complete revascularization using beating-heart techniques are clearly related to the operative experience of the surgeon.3 In our experience, complete revascularization can be achieved in more than 89% of patients who are referred for surgical revascularization.2

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