To The Editor
I read with interest the article, routine minimally invasive approach
via left anterior mini‐thoracotomy in multivessel coronary
revascularization by Cynak and colleagues1. The main
problem of mini anterior thoracotomy coronary revascularization is the
limited or even bad exposure to the right coronary and posterior obtuse
marginal branches which may affect the quality of the distal
anastomosis. This is the most important technical point of a successful
revascularization. Good exposure is the cornerstone in any surgical
procedure. Surgical stress and learning experience of the surgical team
in harvesting the mammary and performing the distal anastomosis through
an “unusual “ access are also expected obstacles. Full sternotomy and
standstill heart provides the best exposure and environment for a
high-quality anastomosis with the best flow patency exceeding decades in
our literature. Median sternotomy, the most famous heart access, remains
relatively painless procedure and its complications are the most
preventable in cardiac surgery. Meticticulous surgical technique in
opening, sternal respecting closure, preoperative antibiotics and tight
glycemic control are the main factors of prevention2.
Historically, Coronary bypass surgery is the oldest, commonest and most
variant procedure in cardiac surgery. Revascularization using
cardiopulmonary bypass remains the most popular procedure in practice
and resident training programs. This procedure was challenged by several
modifications in attempt to minimize complications and attract more
patients to compete with the interventional cardiologists. These include
beating heart, to avoid pump complications, use of radial artery, or
total arterial, for better durability, hybrid procedure and recently the
use of mini right anterior thoracotomy to avoid sternotomy
complications. Robotically assisted HCR requires specialized
infrastructure and suites and mainly confined to centers of excellence.
Despite all the above advancement in coronary surgery, full sternotomy
cardiopulmonary bypass and cardioplegic arrested heart, proved to be the
most popular and gold standard reference procedures in daily surgical
practice and resident training and competing their results with any
other procedure3.
References
- Çaynak B, Sicim H. Routine minimally invasive approach via left
anterior mini‐thoracotomy in multivessel coronary revascularization.
Journal of Cardiac Surgery,2022
- .Al-Ebrahim KE, Al-Ebrahim E. Prevention, Classification and
Management Review of Deep Sternal Wound Infection. The Heart Surgery
Forum 2020 Sep 14 (Vol. 2020, p. 3153.
- Torregrossa G, Sá MP, Van den Eynde J, Malin JH, Sicouri S, Wertan MC,
Ramlawi B, Sutter FP. Hybrid robotic off‐pump versus conventional
on‐pump and off‐pump coronary artery bypass graft surgery in women.
Journal of Cardiac Surgery. 2022.