[HSF] On pump beating heart

Sat Feb 17 16:38:35 EST 2007

Affirmative, called composite graft I believe.( i.e.  bits of conduit  
in series. )
Don
On 17/02/2007, at 3:09 PM, Tea Acuff wrote:

> Is this graft different from the "H" graft that had poor patency?  
> That is, is it a side to side anatomically, but end to end  
> functionally?
> tea
>
>
> ----- Original Message ----
> From: Donald Ross <donross at bigpond.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Friday, February 16, 2007 5:56:27 PM
> Subject: Re: [HSF] On pump beating heart
>
>
> 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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