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anterior mini‐thoracotomy in multivessel coronary revascularization by Cyn I read with interest the article, routine minimally invasive approach via left ak 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.

Letter to the editor

Background Cardiac surgery-associated acute kidney injury (CSA-AKI) is an important and serious complication that affects morbidity and mortality. We studied both pediatric and adults using the definition of the Acute Kidney Injury Network (AKIN). Methods This is an observational retrospective cohort study done at King Abdulaziz University Hospital in Jeddah, Saudi Arabia approved by ethical committee. The exclusion criteria were baseline serum creatinine (SCr) ≥ 4 mg/dL or preexisting renal failure requiring dialysis, reoperation, death within 24 hours postoperatively, and operative mortality or missing data. 941 patients were included in the analysis using the statistical software  SPSS, version 15.0. Results 28.68% in the adult group and 20.07% in the pediatric group developed CSA-AKI. Adult risk factors included age group of 60-69 years, cardiopulmonary bypass (CPB), number of grafts and hypertension. In the pediatric group, CPB, aortic cross-clamping (ACX) and the lower preoperative SCr are the main risk factors Conclusion Conventional conservative management and preoperative Identification of predictor risk factors are essential for prevention of CSA-AKI which constitute the main strategy for optimal management.

I read with interest the articles by Wang and colleagues about comparison of risk scores for predicting outcomes after isolated tricuspid valve surgery and the commentary by Russo and colleagues about prediction of mortality in isolated tricuspid surgery1

We read with interest the case report by Ackah and colleagues1.We previously reported, in a cohort study 2, our experience in the management of coronary injury post valve procedures

The swift advances in interventional cardiology combined with the increasing risk of cardiac surgical procedures resulted in diminishing volume of coronary and valvular surgery and affected the future of cardiac surgery service and training. Application to cardiac surgery training programs have steadily declined. This cross-sectional study aimed at identifying main weakness facing cardiac surgery and advocating some recommendations to improve the status of current and future of cardiac surgery.