In a single-session procedure, the reduction of complication rates is not only because of the reduction in the number of procedures as well as single anesthesia, but more importantly through the simultaneous access during the procedure. The robustness of the approach lies in its complementary nature. In our experience almost a quarter of single-step hybrid atrial fibrillation procedures needed a touch-up with an see more endocardial catheter ablation to finish incomplete epicardial Inhibitors,research,lifescience,medical surgical lesions. In addition, the mitral isthmus line and the cavo-tricuspid isthmus line can only be performed when combined with an endocardial approach. In redo procedures, a knowledge of the effect of the previous endocardial

procedure(s) will guide the epicardial technique. The efficacy of this procedure as well as its superiority over catheter ablation or standard surgical techniques has to be proven by large comparative studies with

long-term follow-up. Acknowledgments I gratefully Inhibitors,research,lifescience,medical thank Ken Frazier for the English revision of the manuscript. Footnotes Conflict of interest: Dr La Meir is a consultant for Atricure.
Specific patients seem to benefit from off-pump CABG compared with conventional CABG with cardiopulmonary bypass. The effectiveness of off-pump Inhibitors,research,lifescience,medical procedures is still debated in elderly patients undergoing isolated CABG operations. Ricci et al. investigated Inhibitors,research,lifescience,medical the potential benefits of coronary artery bypass grafting without cardiopulmonary bypass (CPB) for octogenarians.2 They studied 269 octogenarians who underwent coronary artery bypass grafting, of whom 172 had the operation with CPB and 97 without CPB (off-pump group). Findings suggested that: 1) A greater proportion of reoperations was observed Inhibitors,research,lifescience,medical in the off-pump cohort (16 of 97 (16.5%)) compared with the CPB cohort

(8 of 172 (4.7%)) (P = 0.002); 2) Freedom from postoperative complications was higher in the off-pump group than in the CPB group (83 of 97 (85.6%) versus 129 of 172 (75%), P = 0.04); 3) The incidence of stroke was 0% in the off-pump cohort compared with 9.3% (16 of 172) in the CPB cohort (P < 0.0005). These findings suggest that patients 80 years of age and older undergoing off-pump CABG can experience significantly lower rates of perioperative stroke and overall complications compared with those undergoing the same procedure with CPB. In the same vein, Demaria et al. studied 125 TCL patients older than 80 years of age who were operated for isolated myocardial revascularization (63 using CPB and 62 with off-pump coronary artery bypass (OPCAB)) over a 5-year period (1995–1999).3 These groups were comparable in terms of: 1) Preoperative co-morbidities; 2) Mean left ventricular ejection fraction (54.5% ± 15.3% in the CPB group and 50.9% ± 13.5% in the OPCAB group); and 3) The mean number of distal anastomoses per patient (2.