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

[Donald Ross]

I expect Hal thinks most of us are either one or the other ( (-:( )

On 02/02/2007, at 2:41 AM, Tea Acuff wrote:

> Don Ross wrote:
>                              the words lazy and stupid come to mind
>
> I think that I resemble that remark.
> I was wondering how to label my view points! Thanks for the  
> orientation. Come to think of it, I bet Hal thinks the same of my  
> "suture" annuloplasty.
>
> cheers,
> tea
>
>
> ----- Original Message ----
> From: Donald Ross <donross at bigpond.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wednesday, January 31, 2007 2:54:57 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
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