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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 . . . [Full Text of this Article]

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RELATED ARTICLE

Choice of Revascularization Strategy for Patients With Coronary Artery Disease
René Prêtre and Marko I. Turina
JAMA. 2001;285(8):992-994.
EXTRACT | FULL TEXT  

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The Hybrid Approach to Coronary Artery Revascularization: Minimally Invasive Direct Coronary Artery Bypass with Percutaneous Coronary Intervention
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ABSTRACT