[HSF] The Great con....

[Tea Acuff]

I use it more as a test than a treatment. I don't usually bother. As i have said before, seldom is the LAD the "dangerous" or unpredictable vessel.

tea


----- Original Message ----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, December 30, 2007 12:21:56 PM
Subject: Re: [HSF] The Great con....

larger incisions - oh no!!!

just curious - we do ischemic preconditioning of the LAD.......what do you
hard core OPCABbers think of that?


-michael


On 12/30/07, Zhandong Zhou <zzhoumd at pol.net> wrote:
>
> Patience and teamwork are the key in OPCAB. There is no way to position
> the heart without altering the geometry of the heart. The main cause of the
> hypotension when lifting the heart is likely due to the distorsion of the RV
> outflow tract. LV is a high pressure system, it can take some pressre from
> the stablizer. To archieve relatively stable hemodynamics, it is important
> to make sure that the anesthesiologist is paying attention. Promptly adjust
> the table angle, such as head up or down greatly helps the hemodynamics. If
> your PAs know how to retract the shunt to help the anastomosis is very
> helpful. Always graft the occluded artery or the culprit artery first. a
> larger incision also helps.
>
> Nowadays, heart surgery is influenced by patients choice, cardiologists,
> media, politicians and hospital administrations. Like other service oriented
> professionals, more product lines help stay in competition and provide
> better patient care.
>
> Z Zhou
>
>
> ----- Original Message -----
> From: "Prasanna Simha M" <prasannasimha at gmail.com>
> To: <OpenHeart-L at lists.hsforum.com>
> Sent: Sunday, December 30, 2007 1:05 AM
> Subject: Re: [HSF] The Great con....
>
>
> > The methodologgy used is wrong if we are going to get "gross hemodynamic
> > instability in more than 1 % of patients getting  isolated CABG .Falling
> MAP
> > less than 65 ,bradycardia, rising LAP or PAP on cardiac dislocation are
> all
> > indications that the dislocation is improper and needs reassessment or
> > conversion. Contrary to what is done by some ,OPCABG needs to be done in
> an
> > unhurried manner with good cardiac output or else you will get into a
> > viscious spiral. Dilated transverse ventricles will be more difficult to
> > dislocate compared to vertical venricles and these need slower and
> careful
> > dislocation
> > Prasanna
> >
> > On Dec 30, 2007 11:01 AM, Michael Firstenberg <msfirst at gmail.com> wrote:
> >
> >> What is gross instability?
> >> my problem with w opcab are the huge hemodynamic pertubations that are
> >> associated w the contorsions to get exposure and my 'belief' that this
> cant
> >> be good either.
> >>
> >> Michael Firstenberg <msfirst at gmail.com>
> >>
> >> -----Original Message-----
> >> From: "Prasanna Simha M" <prasannasimha at gmail.com>
> >> To: OpenHeart-L at lists.hsforum.com
> >> Sent: 12/29/2007 11:25 PM
> >> Subject: Re: [HSF] The Great con....
> >>
> >> The intention to treat is a very important aspect lest discussed and
> there
> >> was a presentationsr in one of our conferences which showed that
> "delayed"
> >> conversions (after gross hemodynamic instability) were associated with
> a
> >> higher morbidity and mortality and early elective conversions did not.
> >> Prasanna
> >>
> >> On Dec 30, 2007 9:29 AM, <Hgrmd at aol.com> wrote:
> >>
> >> > Ani,
> >> >  You are certainly expending a lot of time and energy for
> this  debate.
> >> > It's pretty ironic, since you apparently don't do OPCAB, even   though
> >> you
> >> > believe
> >> > it is superior.  Is this some sort of edict from your  superiors that
> >> CABG
> >> > be
> >> > done on pump? Regardless of what you say, I've  successfully done
> OPCAB
> >> on
> >> > a
> >> > hostile aorta, and believe it is a useful technique  to have in the
> >> > armamentarium.  Believe it or not, I've used Salerno's warm
> >>  fibrillatory
> >> > arrest
> >> > technique for mitral repairs in patient's with unclampable   aortas.
> >> >  However, I don't
> >> > believe either one is superior to conventional  technique for your
> >> average
> >> > case.
> >> >  BTW, nobody has directly responded to my statement that
> "intention  to
> >> > treat" is often not carried out in on versus off papers.  In
> addition,
> >> >  the M and
> >> > M with emergent conversion is substantial.
> >> >
> >> > Hal
> >> >
> >> >
> >> >
> >> > **************************************See AOL's top rated recipes
> >> > (http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)
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> >>
> >> --
> >> Prasanna Simha M
> >> _______________________________________________
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> >
> > --
> > Prasanna Simha M
> > _______________________________________________
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