Reply to Dimarakis and Anderson

Abstract

We appreciate the comments of Dr Dimarakis and Mr Anderson [1]. We agree that this is a complex problem as reflected by the multiple approaches that they highlight. Whenever there are so many techniques, it is evidence that none is ideal. With regard to modification of our approach in recent years to achieving myocardial protection in this particular group of patients, we believe that it would be fair to say that, although the practice at Mayo Clinic remains relatively heterogeneous according to surgeon preference, increasingly the surgical staff is comfortable with leaving the patent ITA open [2]. The senior author’s (T.M.S.) practice has certainly evolved that direction. Although initially insistent upon control of the ITA to achieve absolute electromechanical silence and uniform cooling as trained in the early 1990s, the outcomes achieved by senior colleagues such as Dr Charles Mullany encouraged the adoption of this more parsimonious approach with excellent outcomes. By the end of his surgical career at Mayo, Dr Mullany preferentially performed the procedure without attempting control of ITA flow; the senior author strove to emulate this master-surgeon’s practice. Today, the senior author cools only mildly (32–34°C) and administers cold cardioplegia retrograde every 20 min. It seems to work.