A Discussion: Total Arterial Coronary Revascularization

"The Best Chance of a CABG patient is his First Operation, and the Best Myocardial Protection (whatever Off or On-Pump) is Optimal Revascularisation ". I have always been astonished by the efforts made each year in Techno-College and Postgraduate courses aiming at prompting arterial CABG in one hand and non-progression of arterial CABG statistics in the other. Many reasons aside those advocated in this video sustain such stationary state. One of the reasons may be economical concerns of hospital managers upon occupational time of the operating rooms due to extra-operative time and its adverse consequences in staff resource organizations and its attendant extra-costs. In health systems where surgeon's incomes depends on the number of cases performed and the absence of difference in incomes between using one arterial distal anastomosis or more comparing to conventional CABG, therefore it will not be surprising noticing no progression in performing rate of arterial CABG. On the other hand, surgeons are not operating alone and for most of our colleagues such as anesthesiologists and perfusionists the "Good Surgeon" is the faster one. Therefore, prompting Arterial CABG should be exerted on in a wider range of overlooked impacts such as health authorities, insurances, hospital managers, anesthesiologists, and specially cardiologists whose appropriate reclaims for arterial CABG are some paramount steps to be taken for prompting Arterial CABG. I am deeply persuaded that if surgeons had provided efforts even to use at least 2 arterial conduits (not necessarily all arterial CABG) there would be no room for comparing CABG to PCI/ Stenting in Syntax investigation, as CABG is underpowered by using conventional approach. All arterial CABG would mean Y or T grafting for the majority of the surgeons. Considering the radical changes in anatomy of coronary lesions in post-stenting area referred to CABG with lost of required linearity for distal sequential anastomoses, we should move in newer strategies to arterial CABG being prone to overcome foreseeable increasing difficulties in carrying out arterial CABG. We have recently proposed a newer strategy published in the Brazilan Journals of Cardiovascular Surgery that can be reached using following link: http://www.rbccv.org.br/pdfRBCCV/v29n4a27.pdf Finally I would congratulate Professors Turina and Tatoulis for bringing on the surface once again such relevant issues in our daily practice.