Comments on “Is Single LIMA-LAD Bypass Appropriate for OPCAB Training?”

Is Single LIMA-LAD Bypass Appropriate for OPCAB Training?

Training scientists and passing ones' experience to the next generation is charismatic. Additionally, every one of us has been in the status of a trainee. With this concern, we would like to add our thoughts to the brilliant article that has focused on beating-heart surgery training, published by Drs. Naito, Reichenspurner, and Sill (Naito S, Reichenspurner H, Sill B. Is Single LIMA-LAD Bypass Appropriate for OPCAB Training? Thorac Cardiovasc Surg. 2024 Feb 23. doi: 10.1055/a-2260-5218).

Training in beating-heart surgery has two components. The first component comprises achieving hemodynamic stability during the stabilization and verticalization of the heart, while the second parameter focuses on the quality of the anastomosis.

Performing perfect anastomosis skills can be achieved through on-pump surgery training; in any case, the immobilization methods for the heart are highly effective nowadays, thanks to contemporary devices used in beating-heart surgery, making the anastomosis technique on a beating heart similar to that on a resting heart. Additionally, nowadays there are many beating-heart simulators designed for coronary artery bypass surgery residency training. These simulators focus on the technique of anastomosis on a moving heart rather than on hemodynamic stability.

While training heart surgeons in beating-heart surgery, emphasis should be given to positioning the heart in a suitable state during off-pump procedures, preparing the patient's circulation to accept volume reduction, and providing medical support.

Last but not least, anastomosis to the left anterior descending artery (LAD) might be the easiest among all other anastomoses; nevertheless, LAD is the most crucial vessel for revascularization.

In our opinion, training for beating-heart surgery should commence with procedures on the arrested heart (including verticalization of the heart) rather than starting directly with LAD anastomosis. It is advisable for the resident or novice beating-heart surgeon to first become proficient in properly positioning the heart. We suggest a progression in difficulty, starting from the right coronary artery or posterior descending artery, then moving to the Cx, followed by the obtuse marginal, the diagonal branch, and finally the LAD, after gaining overall experience in suturing anastomosis. The LAD is left for last in the training due to the significance of correct revascularization, as well as the impact of a perfect LAD anastomosis on subsequent procedures.

Publication History

Received: 29 March 2024

Accepted: 28 May 2024

Article published online:
23 June 2024