Ann Thorac Surg 1999;67:104
© 1999 The Society of Thoracic Surgeons
Invited Commentary
Enio Buffolo, PhDa
a Department of Cardiovascular Surgery, UNIFESP-EPM, Rva Botucato 740, 04023-900 São Paulo SPCEP, Brazil
Invited commentary
The article by Lonn and coworkers raises a question about less invasive cardiopulmonary bypass. I have used the technique of myocardial revascularization with full cardiopulmonary bypass to make the marginals in a beating heart without clamping the aorta for a long time. In my series, if you operate on patients with a very low ejection fraction without cardiac arrest and aorta cross-clamping, bad ventricular function is no more of a risk factor for death or low cardiac output in the immediate postoperative period. This experience led me to conclude that what has been called myocardial protection is in reality myocardial aggression. The technique proposed by Lonn and coworkers avoids the oxygenator using the patient’s own lungs, making this technique an attractive one. I must choose the exact indication for this approach because there are a lot of surgical maneuvers and devices to reach the marginals without any extracorporeal support. In these situations if some instability occurs it is due to right heart failure and perhaps it would be better to use an axial pump supporting the right ventricle instead of the left heart. Nevertheless it is a new and interesting approach that opens a new field of applicabilities in other surgical procedures.
Related Article
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Beating heart coronary surgery supported by an axial blood flow pump
- Urban Lönn, Bengt Peterzén, Bo Carnstam, and Henrik Casimir-Ahn
Ann. Thorac. Surg. 1999 67: 99-104.
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