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

[Michael Firstenberg]

..... and the IMA was placed on the inner sternum for use as a bypass
conduit to the LAD?


-michael


On 12/23/07, Giulio Rizzoli <giulio.rizzoli at unipd.it> wrote:
>
>
> 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  and having watched
> the
> operation on  the net (my first case was a triple vessel LAD MO and DP),
> but occasionally because in our department it is routine to use CABG and
> off pump is reserved to selected cases and mostly limited to LAD.
> Emergent cases are a mixed technique and done with 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
>
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