Inertia of Success

“To exist is to change, to change is to mature, to mature is to go on creating oneself endlessly.”Henri Bergson In a recent editorial, Bonchek and Ullyot1 raised concerns regarding minimally invasive coronary bypass surgery. Their purpose was to “stimulate discussion and debate,” and to that end, we wish to challenge several of their assertions. While we totally agree that unbridled enthusiasm with a blind eye toward critical analysis is dangerous, equally precarious is taking the stance that we have a perfect operation that cannot or should not be made better. We believe that we are at a strategic inflection point in cardiac surgery and are in danger of becoming obsolete. In the history of information systems, the typewriter made a valuable contribution; however, it subsequently was made obsolete by computers. Although there is no question that coronary artery bypass surgery has changed the management of coronary artery disease dramatically, we need to realize that we are in the field of coronary revascularization and not just coronary artery surgery. Incremental progress, carefully measured, documented, and reported, should be encouraged rather than always accepting the status quo.The authors begin by limiting the obvious successes of minimally invasive surgery to technically simple operations that require “a minimum of precision and almost no sewing.” Our colleagues in general surgery would most likely disagree that their successes in laparoscopic Nissen procedures and inguinal hernia repairs were not precise and did not requiring sewing. Although cardiac operations are technically more complex, this does not mean that we should ignore the principles, techniques, and enabling technology developed from technically simpler operations and extend them to more complex procedures. Is this not the nature of evolution?The authors relate their own experience of isolated internal mammary artery (IMA)–to–left anterior descending coronary artery (LAD) grafting …