[HSF] On pump beating heart
Ben Bidstrup
benjamin.bidstrup at bigpond.com
Sun Feb 18 08:17:39 EST 2007
Don,
Can you give the reference for mating earth worms?
>Ani
>
>>
>>Could you please expand on your technique of
>>'side to side' for an 'end to end' anastomosis.
>You can extend the reach of either ima by adding
>artery or vein as a "composite graft" For this
>I always do a "side to side" by clipping the
>blind ends of the grafts, making a slit in them
>about twice the diameter of the smallest then
>lay them side to side like mating earth worms
>and whack them together leaving a wide clean
>opening. Often the blind ends are re clipped
>close to the anastomosis to eliminate any cul de
>sac. I use a side to side technique for
>coronaries as well.
>Go to http://beating-heart.com/home.htm and
>click on "movies" to see a lima to lad "side to
>side"
>>Where the RIMA is used as inflow, how long a
>>stump do you have to use? Do you also construct
>>the T-graft as a side to side?
>You can extend it from anywhere depending on its
>size and whether you want to use the cut off
>piece for another graft.
>The T graft is done "end to side" with the "end"
>spatulated to achieve a long slit on the "side"
>>
>>Also could you broaden on why stability of
>>angina and Left Main Disease should influence
>>grafting configuration?
>I choose to use both imas if I believe there may
>be a chance of hypo-perfusion. ie tight L main,
>unstable angina on small imas.
>My logic is that if grafts are not likely to
>have to supply critical blood flow immediately
>the you can get away with one ima for inflow (
>remember the ima doesn't reach its full
>potential for some time and has reduced flow in
>the first 24 hours as well)
> I have been burned in the early days of Tector
>inspired lima T rima on pump from inadequate
>inflow.
>Don
>>
>>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: Friday, February 16, 2007 6:56 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<mailto: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<mailto: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<mailto:battr at medizin.uni-leipzig.de>
>>>>>>To: OpenHeart-L at hsforum.com<mailto: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>
>>>>>>[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<mailto: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
>>>>>>
>>>>>>
>>>>>>
>>>>>>
>>>>>>
>>>>>>_______________________________________________
>>>>>>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>
>>>>>>-----------------------------------------
>>>>>>___________________________________________________________________
>>>>>>__
>>>>>>___
>>>>>>Check out the new AOL. Most comprehensive set of free safety and
>>>>>>security tools, free access to millions of high-quality videos
>>>>>>from across the web, free AOL Mail and more.
>>>>>>_______________________________________________
>>>>>>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<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<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
>>-----------------------------------------
>_______________________________________________
>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
>-----------------------------------------
--
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon
More information about the OpenHeart-L
mailing list