Con: Beating-heart surgery for coronary revascularization: Is it the most important development since the introduction of the heart-lung machine?

Contrary to what the media tend to suggest, beating-heart coronary artery b ypass grafting (BHCABG) is not a new technique. It has been performed since the advent of coronary revascularization but, until recently, was largely abandoned in favor of cardiopulmonary bypass (CPB) and cardioplegic techniq ues. However, with the introduction of minimally invasive coronary surgery and mechanical methods for target-artery stabilization, interest in BHCABG has been renewed. In carefully selected cases, this approach has the advant ages of simplicity, avoidance of the inflammatory response caused by CPB, a nd a decreased need for blood transfusion. Nevertheless, BHCABG may be tech nically difficult in some patients, and it involves a steep learning curve. Potential risks include incomplete revascularization, ischemia during temp orary target-artery occlusion, and suboptimal anastomoses. Because of the n eed for special equipment, BHCABG can be expensive and time consuming. It m ay benefit older or sicker patients who are poor candidates for CPB, especi ally those with left anterior descending or right coronary artery lesions, but it should be used with discretion and not be considered for all coronar y patients. (Ann Thorac Surg 2000;70:1779-81) (C) 2000 by The Society of Th oracic Surgeons.