[HSF] Drug eluting stents- Another Warning

[Tea Acuff]

We are still lingering under the old mantra that PCI is a temporal and temporalizing intervention for the patient while CAB is an irreversible step. The overlap of these therapies is now great, and the full metal jet problem may surpass the irreversibility of CAB intervention. We need to speak more directly about this to ourselves, to our colleagues, and to the public.

In following this line of reason, I would treat an unprotected DES or one I wished to unprotect as an old vein graft without stenosis: with concern and technically it depends since I don't have a fixed rule.

tea


----- Original Message ----
From: "tdmartin2000 at aol.com" <tdmartin2000 at aol.com>
To: openheart-l at lists.hsforum.com
Sent: Saturday, December 22, 2007 4:42:32 PM
Subject: [HSF] Drug eluting stents- Another Warning

Several weeks ago I did a AVR/MVR/TVr on a elderly lady that had had a Cypher drug eluting stent placed in the mid portion of a very dominant RCA 21?MONTHS prior to surgery. Preop cath showed the RCA/stent to be widely patent. Plavix was stopped?several days?before surgery. To make a long story short, she did reasonably well early, but developed refractory biventricular failure fairly acutely and died several days post op. As the reason for failure was in question, we asked for an autopsy. Oviously we missed the diagnosis as the path specimen revealed a thrombosed RCA stent and a large post/inferior infarct. 
I am perplexed now as to what to do with these stents even this far out from placement. Any thoughts??

Tom Martin
U of Florida
Gainesville
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