[HSF] On pump beating heart

[hgrmd at aol.com]

Tea,
  Knowing you as I do, I've no doubt that you speak the truth about your OPCAB experience (For once, I'm not kidding with you.).  I like the analogy of conversing with the heart and waiting for a response.  You have to be sure that the heart will tolerate that particularly position for the few minutes it takes to construct the anastomosis.  However, I still maintain that a lot of OPCAB surgeons and their publications tend to ignore the emergent conversions with their inherent high M and M.  
  If you don't want to have a pump in the room while you do OPCAB, that's your business.  I don't think it would be a particularly strong selling point to your patients and referrals.  I would also conveniently not let your carrier know of your plans.
Hal
 
 
-----Original Message-----
From: tacuff at swbell.net
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 21 Feb 2007 10:49 AM
Subject: Re: AW: AW: [HSF] On pump beating heart


It could happen, and does it if one does not develop an understanding of what is 
acceptable in positioning or not. It is like a conversation with the heart. You 
have to wait a minute or two for the response, but it can save you much misery. 
It is like rushing into a small bleed on the aorta or ventricle with big sutures 
and clamps. Or paying no attention to your wife. I haven't converted emergently 
in several years. I can actually only remember one case of converting during the 
anastomosis over the past decade. I have massaged the heart occasionally, but so 
have all of you other reasons. Temporary bumps are temporary bumps and is a 
characteristic of working on the heart not the technique per se.  The conversion 
was a long endarterectomy and the patient kept having VT, but could wait for the 
pump. I am thinking of not even having the pump set up any more, since we don't 
use it without telling before hand that the heart is talking trash to me. 
Honestly, I get in more trouble
 with emergent need for CPB after I have weaned off the stupid thing. That is 
not nearly as common as the (good?) old days, but I am willing to bet it is much 
more common (even relatively) than is the need for an experienced off pump 
surgeon to crash on. Do I lie? I doubt it. I see what goes for normal in other 
ORs.
tea


----- Original Message ----
From: "Hgrmd at aol.com" <Hgrmd at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, February 19, 2007 6:25:08 AM
Subject: Re: AW: AW: [HSF] On pump beating heart


Roberto,
  I've done OPCAB on unstable patients.  It's scary as heck until  you get 
the LIMA plugged in.  In a patient who had already fibrillated, I  wouldn't 
consider using it, nor would I want any surgeon doing as such on one of  my 
family 
members.  Can you get away with it?  Probably.  But I  think it's foolhardy.  
As I said previously, a lot of papers on OPCAB don't  take into consideration 
the emergent conversions when they compare the 2  modalities.  The few papers 
I've seen on emergent conversion to on pump  show extremely high death and 
morbidity.
Hal
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