Commentary

There are of course different techniques of performing off-pump coronary surgeries. But there are two basic factors, which should be considered when carrying out such type of surgeries and which are closely connected with each other – exposition and stabilization of defined region of the heart as well as ensuring optimal hemodynamic conditions and what is related to it, the necessity to maintain metabolic homeostasis in operated patients. Basic elements of exposition and stabilization of operation area include: pericardial deep sutures, using gauze tape sand gauze pads in different configurations, change in inclination angle of the operating table, using better stabilizers and movements resulting in increase of space in mediastinum: such as temporal reduction of tidal volume, pleuropericardial window, wider sternotomy opening. Elements ensuring patient’s optimal hemodynamic state or correcting in certain degree typically technical movements include first of all fluids redistribution by Trendelenburg method, crystaolids and blood products administration, application of catecholamines and mechanical left ventricle support [1]. Majority of mentioned factors from the first and the second group is closely interrelated and influences each other making some kind of “syncytium” of surgical team action. Certainly, the introduction of Octopus type stabilizers made in 1996 by C. Borst and EW. Jansen which use sucking to immobilize a certain part of heart was a crucial moment in “off pump” surgery [2]. They have been commonly used in coronary surgery since this time. Over the last several years there have been many studies comparing the usage of different kinds of heart stabilizers, but there haven’t been found one universal method which would definitely outperform other techniques [3, 4]. Certainly, posterior wall vessels exposition has been the main difficulty in this type of surgeries. For this reason I think, that the authors of this study focused on a very significant and still valid problem. The abstract of the article includes clear division of patients into three groups, but it is not clearly stated in further study how they were classified to particular groups. There is lack of pre-operative characteristics and lack of comparison of pre-operative parameters between particular groups of patients. There is also some kind of inaccuracy between the abstract and dense text in work methodology concerning particularly group III. Except the reference position,...


View full text...