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Editors' Note |
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by Gianni Angelini, M.D.
Is Off-Pump Surgery for Everybody?
There is now a large body of evidence in the literature suggesting that coronary artery bypass on the beating heart (OPCAB), by avoiding the deleterious effect of CPB, offers a procedure with lower morbidity and significantly lower healthcare costs. Despite the advantages of OPCAB and the adaption of this technique worldwide, a significant number of surgeons still question the merit of performing anastomosis on the beating heart. Lawrence Bonchek (someone who I have always held in great respect for his surgical skill and common sense) suggested that the superior results reported for OPCAB compared to conventional CABG merely represents the work of superior surgeons who had adapted a new and more technically challenging technique, and questioned the assertion that off-pump surgery would be safely incorporated into the practice of more surgeons.
There is now evidence that OPCAB surgery can indeed be incorporated into surgical practice without any detriment to patients, and that this technique can be taught to residents safely. Most of these reports, however, come from centres which have contributed to the development of OPCAB surgery and do perform a high proportion of coronary revascularisation using this technique.
Here we publish the opinions of several trainees, one of whom, Dr Tavilla, has completed his training and is now a member of staff at the Cardiothoracic Centre in Leiden, and the others who are still in training. We hope that these personal overviews will be followed by many other comments from trainees. Please do make an effort to let us know what you think, whether your experience was good, bad, or mediocre, and please, once again, don't pull any punches!
Guest Commentaries
Dr. Giuseppe Tavilla: Learn First to Walk Before You Start Running!
Dr. Innes Wan: Hands-on Experience with Trained OPCAB Surgeons
Dr. Rodrigo Paez: Perforning OPCAB Operations From the Beginning
Dr. Sharif Al-Ruzzeh: OPCAB Training Experiences of a "Lucky Trainee"
Dr. Ashish S. Shah: Never Say Never...Never Say Always
Dr. Vinod H. Thourani: Coming Full Circle
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