[HSF] how others will see us

[Hgrmd at aol.com]

Don,
  You primary Opcab'ers always refer to the lower stroke rate with off  pump 
as compared to on pump.  When I used to do a significant number of  stand 
alone CABG's, about half of mine were off pump.  Like you, I was  impressed that 
the stroke rate seemed lower and the patients brighter after off  pump.  
However, that impression has not been borne out in multiple large  studies comparing 
the two.  Since I probably haven't done 12 standalone  CABG's this year, I no 
longer prefer to do those cases off pump, since I believe  the stress and 
skill set are higher.  Certainly, I would have no hesitation  in doing it off 
pump if presented with a hostile aorta, or a simple LIMA to the  LAD.  If there 
are large, well done, prospective studies showing the  neurologic superiority 
of OPCAB to on pump, please share that with us.
Hal