Ann Thorac Surg 1998;66:1241
© 1998 The Society of Thoracic Surgeons
Original articles: cardiovascular
Invited commentary
Mohammad Bashar Izzat, FRCS (CTh)a
a Division of Cardiothoracic Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Invited commentary
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 Invited commentary
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The role of the new minimally invasive coronary artery bypass techniques in routine clinical practice will ultimately depend on verifying its success, measured in terms of graft patency. Calafiore and associates have already demonstrated that left internal mammary artery to left anterior descending coronary artery grafts can be performed as successfully off-pump as they can be on-pump. Nevertheless, to assume that all surgeons possess technical abilities or experience in off-pump grafting similar to theirs is clearly an overly ambitious leap of faith. Each surgeon needs to verify his or her own ability to perform off-pump coronary artery grafting satisfactorily, particularly during the early phase of one’s learning curve.
This timely article describes one method of left internal mammary artery to left anterior descending coronary artery graft evaluation using Doppler flow velocity. It appears simple and reliable, and can reduce the need for postoperative angiography. Clearly, this is a valuable technique, and it should be familiar to every surgeon performing off-pump coronary artery grafting. This method, however, yields physiologic but not anatomic information, and it is not applicable intraoperatively when inadequate grafts, if encountered, can be easily revised. Angiography, therefore, continues to be the gold standard for graft assessment. In this context, interesting data are also presented by Calafiore and associates documenting that certain abnormalities on the immediate postoperative angiogram may be transitory and can resolve spontaneously. How to distinguish transitory from permanent abnormalities remains to be determined. For now, it seems reasonable to propose that grafts with apparent angiographic abnormalities should be deemed technically less than adequate and be revised.
Although the ideal noninvasive graft assessment modality is yet to be discovered, the advent of new coronary artery surgical techniques has already highlighted the importance of documenting graft patency as opposed to relying solely on clinical outcome measures. The development of new graft assessment modalities may lead to an overall improvement in the results of off-pump coronary artery grafting.
