[HSF] "Patients don't want cardiopulmonary bypass"

[Giulio Rizzoli]

I think Vipin has given a lot of good reasons to go off-pump.
I have used this technique occasionally on LAD and diagonals in early 90's 
when shunts and stabilizers were still to come.
I stopped after an acute LAD occlusion do to damage from a distal snare.
Started again after introduction of the stabilizers, Calafiore advice and 
having watched the operation on  the net (my first case was a triple 
vessel: LAD MO and DP). I do it occasionally because in our department it 
is routine to use CABG and off pump is reserved to selected cases and 
mostly limited to LAD and because I want to preserve my own coronaries.
Emergent or cardiac failure cases are for mixed technique: stabilizers - on 
beating heart - on pump.
I can add to Vipin my impression that anastomosis are expecially easier in 
vessels with posterior calcification and thinned atrofic anterior wall, 
because their wall remains more tonic off pump and folds down on cardioplegia.
Tea, we all now that statistics describe the forest, not the single pine ! 
Yet science has relayed on probabilities since Galileo. Sergeant presents 
solid data, based on several thausend cases, and show that indeed off pump 
might be safer (shorter early hazard phase!).
When I was doing my internship in Chicago in 1973 I listened to a talk of 
Effler in the Medical Association hall. He told the public "after all the 
Holy God has placed the coronaries on the surface of the heart so that we 
could operate on them".  I't is possible that if he was going to give the 
same talk today he woul'd add "off pump".
                                                                                           Giulio 
Rizzoli


>Michael,
>Let me correct a few misconceptions that many surgeons have about off-pump 
>surgery. The following comments (which are randomly arranged)  are based 
>entirely on my own personal experience (248 of the last 250 CABG 
>operations performed off-pump; of the 248 off-pump operations, one needed 
>a conversion intraoperatively.) ..........
>
>Can I add that the pump is always available to me. I will use the pump 
>without hesitation anytime I feel that the pump would be safer.
>Visiting cenres or surgeons that routinely perform a high proportion of 
>cases off-pump can be a big advantage.
>Vipin Zamvar

Giulio Rizzoli MD FETCS
Cardiochirurgia Padova
tel. 049 821-2408
fax 049 821-2409
e-mail giulio.rizzoli at unipd.it
web: http.//web.tiscali.it/grizzoli