[HSF] Full metal jacket

[Tea Acuff]

Here. Here.

Strange indeed! Much to think about at a variety of levels. A rational, truly evidence based way of thinking and behaving.

tea


----- Original Message ----
From: Tohru Asai <toruasai at belle.shiga-med.ac.jp>
To: OpenHeart-L at lists.hsforum.com
Sent: Saturday, December 15, 2007 12:27:07 PM
Subject: Re: [HSF] Full metal jacket

Ani

Thank you for your reply. I think the postop angiogram is still the most
informative even at this time, although MDCT is coming to replace it even in
our country. The biggest difference is whether or not to be able to check
flow status, especially flow competetion. MDCT gives us a static picture,
whereas Angio can show us flow balance between graft and native..etc.

I know Japanese medical economy system still allow us to get postoperative
angiogram. But at the same time, inappropriate too many PCI seems to be
allowed as well. Our system is more like socialist system. I don't get paid
by patients or per cases. Probably you think it is strange....

I personally have learned a lot from my own CABG postop angiograms for
years. (ie shape of anastomosis, graft length and course, torsion and
kinking...) Since I moved to the current center, I have been focusing on all
skeletonized in-situ arterial OPCAB (unique and demanding) and have asked
referring cardiologist to perform postop angiogram as much as possible.
Obviously we do not perform angiogram if there is renal dysfunction or
patient's unwillingness. I think it is especially precious for young
surgeons to start coronary procedures.The delicate operation such as
endarterectomy and/or onlay patch grafting, multi-branched composite
configuration, tiny target size, poor runoff need some confirmation of
outcome. 10 years ago, I was doing postoperative catheterization for my own
patient and it was a standard in our country.
Justified? I can't answer.

One thing I can tell you. There seems to be many graft occlusions without
symptom or EKG change. Fortunately I don't see many occlusions in my
patients so far...And I do not trust branched composite grafting because one
branch easily becomes string every once in a while. And endarterectomy seems
unpredictable to me even by the best hands and full regimens of
antiplatelets and anticoagulation.

Japanese cardiologists tends to evaluate cardiac surgeons by graft patency.
Just for your input.
-- 
Tohru Asai



> 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


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