[HSF] On pump beating heart

Fri Feb 16 05:49:35 EST 2007

Don,
I know that is not so orthodox, but in these pts I use the proximal part of the RIMA as inflow for the sequential vein graft (T-T). I wrote a paper on a few cases that was published in the HSF. At that time I had no flowmeter but I had good results from a clinical standpoint. In a recent case the pt had ST depression in the ICU, I asked to restudy the patient and there was a stenosis at the anastomotic site. I reopened the chest and I redid the anastomosis after a low dose heparin. Everything was OK. This technique is useful because there is no risk to jeopardize the LIMA-LAD. I would really appreciate the opinions from all of you.

Giuseppe

Giuseppe Rescigno M.D.
Cardiothoracic Surgeon

Lancisi Hospital
Torrette - Ancona
Italy

On Friday, February 16, 2007, at 12:32PM, "Donald Ross" <donross at bigpond.com> wrote:
>Hey, Ed you could go the whole hog (or roo) and hang everything to  
>the imas.
>In some folks it is hard to fond a soft spot.
>Don
>On 16/02/2007, at 10:13 AM, Edward Bender wrote:
>
>> I echo Johns praise, Roberto.  In some of my patients where the  
>> aorta is heavily calcified, the is one spot somewhere on the aorta  
>> that is soft.  I use epi-aortic ultrasound, and, if no exophytic  
>> plaque, will use the heartstring device to sew on the top end  
>> (sorry for my acquired Aussie idiom).
>>
>> Ed Bender, MD
>>
>>
>> On Feb 15, 2007, at 4:43 PM, rowlesjohn at aol.com wrote:
>>
>>> Roberto
>>>
>>> Your operation for this elderly, high risk gentleman is a classic  
>>> example of the less is more philosophy to facilitate an excellent  
>>> outcome. Did the heart distend during the fibrillation and if so,  
>>> how was it managed?
>>>
>>> Thanks,
>>>
>>> John Rowles
>>>
>>>
>>> -----Original Message-----
>>> From: battr at medizin.uni-leipzig.de
>>> To: OpenHeart-L at hsforum.com
>>> Sent: Thu, 15 Feb 2007 9:36 AM
>>> Subject: AW: [HSF] On pump beating heart
>>>
>>>
>>> Today I have done our N° 50 case of sever atherosclerotic aorta +  
>>> 2-3 vessel
>>> disease. The patient , 83 years old, was unstable, and with 3  
>>> vessel disease
>>> + left main, MI I grade. In TEE we recognized MI II grade. I  
>>> canulated the
>>> axyllary artery, as the whole aorta was calcified. Went on pump, did
>>> LIMA-LAD and veins to obtuse marginal and RCA. The heart  
>>> fibrillated by
>>> doing the obtuse marginal, after which could be easily  
>>> defibrillated. I
>>> anastomosed the veins to the innominate artery (truncus) at 34  
>>> degrees.
>>> Sorry, Hal, I did not touch the Mitral.
>>>
>>> He came out of pump without drugs, he is now awake at ICU waiting  
>>> to be
>>> extubated.
>>>
>>>
>>>
>>> I remembered that email from Tea, and want to know what is he  
>>> doing in these
>>> cases. Hal, would you have done aortic replacement on DHCA to just  
>>> access to
>>> the mitral?
>>>
>>>
>>>
>>> We presented our experience last week with 49 cases in Hamburg.
>>>
>>> Roberto
>>>
>>>
>>>
>>>   _____
>>>
>>> Von: OpenHeart-L at hsforum.com [mailto:OpenHeart-L at hsforum.com] Im  
>>> Auftrag von
>>> Tea Acuff
>>> Gesendet: Montag, 22. Juli 2002 15:23
>>> An: OpenHeart-L
>>> Betreff: Re: [HSF] On pump beating heart
>>>
>>>
>>>
>>> Just a few clarifications.  I have experienced acute ischemia (or  
>>> at least
>>> what we attribute to be acute ischemia). My point is not that  
>>> never occurs,
>>> but it is that I am very poor at predicting when it will occur and  
>>> have been
>>> amazed at the cases it did not (since I violate most of the  
>>> "rules").  If I
>>> am suspicious, I will precondition as a test (which frequently  
>>> passes), I
>>> don't like to shunt. I pace the RCA if necessary. If I can't  
>>> position an
>>> important vessel, I will add RV support or CPB.  I think that a  
>>> beating
>>> heart techique "de-embolizes" the vessel much better than retrograde
>>> cardioplegia for redo's and avoids a sometimes difficult cross  
>>> clamp.  We
>>> should think first beating heart and secondarily off pump unless  
>>> there is a
>>> specific reason to avoid the pump eg bad aorta, bad lungs,  
>>> emergency on
>>> anticoagulants,etc.
>>> Tea Acuff
>>>
>>>
>>>
>>> In a message dated 7/21/02 6:02:17 PM Central Daylight Time,
>>> mkcd at comcast.net writes:
>>>
>>>
>>>
>>>
>>>
>>>
>>> On pump and full Myocardial arrest although there are several  
>>> surgeons who
>>> advocate going on pump for hemodynamic support then doing beating  
>>> heart
>>> assisted. Anyone with this approach care to share your experience  
>>> with us ?
>>>
>>> Mercedes
>>>
>>>
>>>
>>>
>>>
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