RES: [HSF] Re: [HSF ] OPCAB pitfall

[Donald Ross]

>
>
> When you say 'prophylactic vein grafts' what exactly do you mean  
> and in what circumstances do you use it?
when an artery is contra-indicated because the coronary lesion is  
only 50%
>
> Also as Dr Salerno says, without objective testing it is difficult  
> to be certain that placing your vein on the mammary as a  
> justifiable strategy  in preference to an aortic inflow.
Every aorta is a potential source of athero-emboli.
In our experience there does not seem to be the risk you believe.
I have only done it 57 times out of 1490 opcab cases but my  
colleague  who is not keen on no-clamp top ends uses it in 10% of his  
cases.

Don




> Except where the aorta is calcified, I am not sure the benefit (of  
> avoiding aortic manipulation) outweighs the risks (of graft  
> failure). I am aware of one study that systematically studied Y  
> veins of the mammary with angiography, albiet in a small group  
> (N<30), and found several of the distal lima (to LAD) to have  
> stringed, the vein preferentially taking the flow.
>
> Thanks
>
> Ani
>   ----- Original Message -----
>   From: Donald Ross<mailto:donross at bigpond.com>
>   To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart- 
> L at lists.hsforum.com>
>   Sent: Wednesday, January 31, 2007 3:54 PM
>   Subject: Re: RES: [HSF] Re: [HSF ] OPCAB pitfall
>
>
>   Theofilo,
>   I am sure your greater effort to achieve total arterial
>   revascularisation is better than using a vein and will probably
>   protect you from graft thrombosis in even severe cases of
>   thrombophilia. There is no data of course but a can't recall an
>   arterial graft failing in this manner.
>   Why then do we occasionally use vein?
>   Apart from non-significant lesions where an artery is containdicated
>   the words lazy and stupid come to mind. Although in some elderly
>   obese arteriopathic folk it may be meddlesome to take out another  
> ima
>   or do a laparotomy.
>   What about putting the proximal SVG onto the ima?
>   This has been done in our unit for some time without any apparent
>   problems mainly to avoid aortic manipulation. We believe it should
>   not be attempted if the vein is > 1 1/2 times the size of the ima at
>   the site of anastomosis. It is sometimes done even for prophylactic
>   vein grafts providing there is a competent valve in the vein to
>   prevent back flow from the coronary into the ima which could
>   compromise it due to competitive flow.
>   Don
>
>   On 01/02/2007, at 2:04 AM, Theofilo wrote:
>
>> Dear Don,
>> I've being doing BIMA's for more then 3 years now, mostly inspired
>> by you,
>> and hipercoag is something that calls the attention in OPCAB -
>> mainly in
>> endarterectomies where in initial cases I had 1 AMI interrupted by
>> mechanical thrombolisys and Antiplatelet drugs with considerable
>> muscle
>> loss. I used only a few SV attached to LIMA ("Y") fashion with no
>> knowledge
>> of problem (no knowledge). Since then I'm also always concerned about
>> hipercoag post anastomosys. Anyway the hole thing doesn't look ok
>> to me and
>> now I wouldn't put a vein unless no RIMA, Radial or Epigastric
>> available.
>> Would you tell us if you've seen the same problem with arterial or
>> it's a
>> venous thing?
>> BIMA's and OPCAB the medicine for CAD and stents as well.
>> Theofilo Gauze
>> _______________________________________________
>> OpenHeart-L mailing list
>>
>> Send postings to:
>>  OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>>
>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>> http://mmp.cjp.com/mailman/listinfo/openheart-l<http://mmp.cjp.com/ 
>> mailman/listinfo/openheart-l>
>>
>> All messages transmitted by the OpenHeart-L are subject to the
>> policies and
>> disclaimers posted at:
>> http://www.hsforum.com/listdisclaim<http://www.hsforum.com/ 
>> listdisclaim>
>> -----------------------------------------
>   _______________________________________________
>   OpenHeart-L mailing list
>
>   Send postings to:
>    OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>
>   To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>   http://mmp.cjp.com/mailman/listinfo/openheart-l<http:// 
> mmp.cjp.com/mailman/listinfo/openheart-l>
>
>   All messages transmitted by the OpenHeart-L are subject to the  
> policies and
>   disclaimers posted at:
>   http://www.hsforum.com/listdisclaim<http://www.hsforum.com/ 
> listdisclaim>
>   -----------------------------------------
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the  
> policies and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------