[HSF] Restrictions after aortic surgery

Sun Dec 9 19:10:52 EST 2007

Glad you follow my bad ventricle arguement. Just one more push in the same direction.

 Should we really wait for the ventricle to be bad, before we can save additional muscle and ultimately long term prognosis? Where else in the real world do we wait until the chips are down and the horse out of the barn, before it is proper to plan for the future? As I have queried before in more abstract terms, is our method of study, and thereby our evidence, adequate for our needs? Is mortality benefit over a couple or five years the best and only legitimate end point?

tea

----- Original Message ----
From: Dr Patricio Villanueva <pfvil at intramed.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, December 9, 2007 4:46:12 PM
Subject: Re: [HSF] Restrictions after aortic surgery

Ok Prasanna, if you operated, wich conduits use?
I would prefer saphenous vein, to the two branches, secuential bypass 
grafts.
Do you do the RCA Prasanna? or not.
Tea the LVEF is normal in this patiente, if would be bad, I agree with you, 
would be an indication to surgery to protect the muscle.
Patricio
----- Original Message ----- 
From: "Tea Acuff" <tacuff at swbell.net>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Sunday, December 09, 2007 7:21 PM
Subject: Re: [HSF] Restrictions after aortic surgery

> As to the first case bravo on the surgery, but having given him hope for a 
> full life why would you declare him a medical invalid now? Why not do it 
> at the start and forget surgery?
>
> As to the second I go out on a limb here (our evidence is often indirect 
> as the direct evidence is insufficient). If we assumed for argument sake 
> that this patient had ventricular dysfunction, would we recommend 
> revascularization. I think that if we can prove, or at least disprove non 
> recoverible ventricular muscle, the correst answer is to revascularize and 
> protect. I think we are not only to think about intermediate mortality, 
> but even longer term ventricular preservation. (So should the 
> cardiologists after the first stent or so). Ischemic burden, I believe, is 
> a real disease, and the therapeutic calculus is more complex than our 
> operate, PCI or medical therapy question with multiple choice answers 
> allow (remember the NEJM test?). Conduits? Also many choices over time, 
> but the goal of the first few years are most important.
>
> Do you judge or have evidence of significant ischemic burden?
>
> tea
>
>
> ----- Original Message ----
> From: Prasanna Simha M <prasannasimha at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Sunday, December 9, 2007 3:51:40 PM
> Subject: Re: [HSF] Restrictions after aortic surgery
>
> That may be generally true but if a patient is symptomatic and
> nonangioplastiable there is a role for CABG in non LAD lesions. They will
> probably not improve survival but will resolve symptoms.
> Prasanna
>
> On Dec 9, 2007 10:29 PM, Dr Patricio Villanueva <pfvil at intramed.net> 
> wrote:
>
>> Dear Mitch Lirtzman:
>>                                If there is not LAD lesion, there is not
>> indication to surgery.
>> This would be the first rule in CABG, but some times, some surgicals 
>> teams
>> had done, but.......
>> Try to send back to the cardiologist.
>>
>> Patricio Villanueva
>> Argentina
>> ----- Original Message -----
>> From: "Mitch Lirtzman" <drmitch at cox.net>
>> To: <OpenHeart-L at hsforum.com>
>> Sent: Sunday, December 09, 2007 4:33 PM
>> Subject: [HSF] Restrictions after aortic surgery
>>
>>
>> > Colleagues,
>> > A few months ago, I posted a case about a 59yo man that we did asc.
>> aortic
>> > aneurysm, posterior LVA, and MVR. He's doing exceptionally well and
>> tells
>> > me that in looking back, he had no idea how bad he really felt compared
>> to
>> > now. He's back to work and in being very compliant, he hasn't lifted
>> > anything heavier than 10#. He'd like to lift up to 50#, and is looking
>> for
>> > less exertional work. Any opinions regarding lifting post op
>> restrictions?
>> >
>> > On another subject, I have a 42yo AA female smoker, non-diabetic,
>> > overweight but not morbidly obese. She was admitted thru ER with STEMI
>> and
>> > had a BMS placed in her occluded proximal OM, a large vessel. Two large
>> > branches from this each have 90% ostial lesions, the RCA is occluded 
>> > and
>> > perfused from the left. The LAD is normal as is LVEF. The cardiologist
>> > wants me to bypass the remaining vessels to complete the revasc...sort
>> of
>> > a reverse hybrid. My question is choice of conduits. Comments?
>> > Thanks in advance.
>> >
>> > Happy Holidays to all.
>> > Mitch Lirtzman
>> >
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>
>
>
> -- 
> Prasanna Simha M
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