Reply to: Minimal extracorporeal circulation is a promising alternative for off-pump revascularization in adults

My coworkers and I appreciate Puelher and colleagues' comments, and we are pleased that they agree with the conclusions of our study.1During recent years, there has been increasing interest in the use of miniaturized extracorporeal circulation (MECC), with good outcomes reported. Off-pump coronary artery bypass grafting (CABG) has had a dramatic increase during recent years because of several advantages relative to standard CABG with extracorporeal circulation (ECC) in terms of reduced in-hospital mortality and morbidity, reduced myocardial damage, and better protection of renal and pulmonary function. Many surgeons recognize some limitations of off-pump CABG, however, such as incomplete myocardial revascularization2,3 repeated revascularization,4 and higher hospital costs.5