[HSF] On pump beating heart

Sat Feb 17 10:56:27 EST 2007

Giuseppi,
Non-aortic inflow, is the key to brain safe opcab or oncab and I  
applaud your use of the rima for that purpose. One of my colleagues  
often attaches the radial to it proximally and uses the distal piece  
for the Cx as  T graft from the lima.

I have occasionally used the rima as the inflow for composite grafts 
( via transverse sinus) and have also had an anastomotic stenosis  
using the and to end technique. I now, always do a side to side  
anastomosis in this situation which I believe is fool proof. ( Very  
necessary for me! )
My preferred configuration, however,  which covers most  
contingencies  is to use the rima for the LAD and the lima for Cx as  
well as  inflow for a T graft to the rest of the heart.
  If the angina is stable and there is no L main I just use a lima  
plus T graft.
Don

On 17/02/2007, at 12:49 AM, Giuseppe Rescigno wrote:

> 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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