[HSF] "Patients don't want cardiopulmonary bypass" - the great con

[Tohru Asai]

Dear Dr. Zhou
Basically I agree. However in the real world, for example in Japan, the
ordinary cardiac surgeons don't have more than 100 cabg cases per year. In
such a situation, they are never able to perform a high quality off pump
CABG in really high risk patient group ( maybe 5 to 10 patients per year ).

So I have started to make all of my isolated CABG off-pump since 1999.Off
pump CABG is only as good as on-pump CABG, when OPCAB technique is surperb.
Otherwise low quality off-pump surgical revascularization accelerates
further imbalance toward inappropriate PCI.

I believe the quality of revascularization is the most important, whether it
is done on or off. But it is easier said than done, especially to perform
consistently excellent OPCAB. It certainly requires a higher set of skill
and strategy. The postoperative angiogram was a great feedback to confirm
them for my developing period.
-- 
Tohru Asai



> In my experience, some patients should be done on pump, some should be off
> pump. For most of our patients, probably no difference. I think it is
> important to know both technique and use them in the right situations.