We congratulate the authors on the interesting topic regarding surgeon-department cases volume and their relationship to surgical outcome concerning off-pump coronary artery heart surgery [1]. We concur and present our personal experience on the subject.
We believe that mortality as well as morbidity (as expressed by perioperative ischaemia/myocardial infarct, need for reoperation, perioperative stroke, perioperative renal failure requiring dialysis) following off-pump heart surgery is highly associated with the volume of cases operated in each centre and by each surgeon seperately. We have observed that an experienced on-pump surgeon, commencing to deal with off- pump surgery requires a learning curve period necessary for aquiring method-specific surgical skills of about two years and 200-250 cases. The same goes for the whole surgical team, which needs to be trained so that all perioperative procedures, from induction to anaesthesia until transfer to the intensive care ward become fully standardized. After this point, there is a significant improvement in results regarding the aforementioned parameters of morbidity and mortality, to a point where these are comparable or even better than the ones of patients operated on heart-lung machine. This also includes the hot topic of the number of revascularized coronary vessels, traditionally a weak-point of beating coronary artery heart surgery.
Conflict of interest: none declared
References
- 1.Sepehripour AH, Athanasiou T. Is there a surgeon or hospital volume-outcome relationship in off- pump coronary artery bypass surgery? Interact CardioVasc Thorac Surg. 2012 doi: 10.1093/icvts/ivs448. doi:10.1093/icvts/ivs448. [DOI] [PMC free article] [PubMed] [Google Scholar]