[HSF] Full metal jacket

[Tea Acuff]

How is it justified? 

If we were not in an upside down world, where results don't matter (except that you are alive so the doctor must have been right), but prescribed quidelines do (or are becoming) as a measure of rewards, we would know what we do or no one would accept us. Where do our upside down world views come from? Who is teaching the public what is the best practice in medicine? 

Everyone look in the mirror. 

Then look for an imaging or other demonstation technique not to spin the patient, but to prove and add value for the particular patient not the experimental population.


tea


----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Saturday, December 15, 2007 8:46:28 AM
Subject: RE: [HSF] Full metal jacket

Tohru

Amazing operation and amazing images. Having post-op angiogram is good feedback and validates your OR strategy. Do you get post-op angiography for all patients or specific scenarios? How is this exam paid for and justified? We have not been able to get such studies in hospitals I worked in UK or USA except whwn patients are symptomatic.

Ani



> From: toruasai at belle.shiga-med.ac.jp> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Full metal jacket> Date: Sat, 15 Dec 2007 21:56:39 +0900> CC: > > Nasser> Thanks for your compliment. Since I am an originator of the thread, I am > resposible to show the outcome.> > At the operation, since she was diabetic and circumflex was fairly large > with not critically stenotic and good native coronary flow, I decided not to > use arterial conduit for cx. Other target vessels were all 1.0 mm to less > than 1.5 mm at most. My strategy was to pick up these with sequential > technique and arterial graft usage. Arterial graft has ability to adjust its > luminal size to distal vessels. So we rarely see thrombosed occlusion in > early phase like saphenous vein.> > I do isolated CABG in mostly off-pump fashion and did it. But as Dr.Zhou > suggested, On-pump cabg may be especially preferred for this kind of thin > target as long as bleeding due to clopidogrel
 is not a concern.> > I check all graft flows in OR with transite time flowmeter. I cannot find > the operating record now, but I remember good diastolic augumented flow in > all three conduits. Heparin was reversed half dose. No significant bleeding > was observed.> > Lately the cardiologist, who took over the previous man, thankfully sent > CD-ROM of postop angiograms. I made a few pictures from it and attach to > this mail.> --> Tohru Asai 
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