Alexander Albert - Operative Techniques in Coronary Artery Bypass Surgery: An Illustrated Guide to Personalized Therapy

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The surgical myocardial revascularization has proven to be a long-lasting therapy against myocardial ischemia and its consequences such as infarct and death. The surgical trauma related to this approach has been associated with damage to the physical and mental integrity of the patient, sometimes even neurological trauma and early lethal risk. Medical professionals have accepted this and compared themselves against reported national or international databases, but patients and society disagree and prefer alternatives with reduced early risk and visible loss of physical integrity, even at the cost of late benefit. It is therefore of utmost importance not to consider the current CABG approach as good enough but to reengineer constantly its process toward an annihilation of risk and an optimization of late success.

Over half a century of its availability, a few surgeons and centers were able to adapt their surgical approach to the evidence, the science of learning, the science of early and late process management and monitoring. Possible risk-reducing approaches as off-pump surgery, no-touch aorta as well as minimally invasive approaches but also early and late benefit-increasing approaches as complete arterial revascularization have not become the daily routine. Simulation training on low-fidelity modeling, OSATS-based assessments, and online mobile educational workplaces have proven to be lasting game-changers in preparing younger surgeons for the realities of a surgical theater. In my personal experience, around 6000 surgeons worldwide have been through such an educational pathway in our My Virtual Surgery project.

The authors of this book propose in an illustrative way how a traditional medium, such as a book, can become a complete repository of the spectrum of approaches and processes. This guide is based on the daily processes of the team surrounding Alexander Albert and Artur Lichtenberg, their previous mentors, and the patients. The strength of this guide is that it presents possibly competing surgical concepts. These concepts are placed in the perspective of the patients variability, risk profile, anatomy, and obviously and most importantly the patients own expectations. Every patient is different; therefore, John W. Kirklin (Mayo Clinic), Eugene H. Blackstone (Cleveland Clinic), and I developed a scientific approach toward personalized therapy in bypass surgery in the form of patient-specific prediction 30 years ago. The authors implemented this concept and used pragmatic checklists that lead toward flowcharts directing the decisions of the multidisciplinary teams.

Alexander Albert has been my mentor and guide in studying the science of learning and how it could impact surgical proctoring, in addition to process management toward an optimization of the surgical result. We shared a common interest in large datasets as well as mathematical modeling, while I had the privilege of guiding him toward expertise at a global level in OPCAB techniques. All these concepts are apparent or hidden in a subliminal way in this illustrated guide.

Each possible surgical strategy is deconstructed in teachable components, described step-by-step. The anastomosis technique in very reduced airspace, a mandatory skill in OPCAB and lesser invasive approach, is well described. Off-pump CABG, as any surgical process, makes only sense if it is performed after extensive simulation training and following the strictest possible standard operating procedures, not allowing the slightest drift in temperature, and avoiding, where possible, even a single extrasystole. All these at the benefit of the risk/benefit balance for the patient.

It was an extreme privilege to write the foreword of this illustrated guide to personalized therapy in CABG by Alexander Albert, Alexander Assmann and colleagues. Please enjoy and share this brilliant work.