In Reply:—

The comments of Dr. Glower et al.  are much appreciated. All would agree that operative personnel (surgeons, anesthesiologists, perfusionists, nurses) become more comfortable and efficient with procedures involving new technology with increased exposure and experience. Although normalizing operative time is important from an economic standpoint, I believe that normalizing cardiopulmonary bypass time and demonstrating equivalent intermediate and long-term morbidity and mortality (when compared with conventional cardiac surgery) are the most important issues regarding port-access cardiac surgery. We, as have others, revealed that port-access cardiac surgery significantly increases cardiopulmonary bypass time when compared with similar procedures performed conventionally, which likely increases perioperative morbidity (neurologic, pulmonary, renal, hematologic). How port-access cardiac surgery compares with conventional cardiac surgery in terms of intermediate and long-term morbidity and mortality remains to be determined. I am always uncomfortable with the often-stated comparison of the development of port-access cardiac surgery to the development of laparoscopic cholecystectomy. I do not believe it is a fair comparison because the technical challenges that confront the cardiac surgeon (coronary anastomoses, valve repair and replacement, and others) are far greater than the surgeon’s performing a cholecystectomy.

University of Chicago, Chicago, Illinois.