[HSF] On pump beating heart
prasannasimha
prasannasimha at gmail.com
Sun Feb 18 05:52:27 EST 2007
I remember this technique was described originally by a famous vascular
surgeon somewhere in the beginning of the 19th century but but cannot
seem to get it off hand.The figure was in Rutherford.
Prasanna
Ben Bidstrup wrote:
> 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
>> -----------------------------------------
>
>
More information about the OpenHeart-L
mailing list