[HSF] On pump beating heart

Thu Feb 22 07:08:36 EST 2007

Pump not being primed is different from no pump in the OR. A quick 
perfusionist can get everything ready in 3 minutes and an exercise for 
the final year perfusion exam (mandatory) is for them to set up the pump 
primed and ready within 3 minutes to go on CPB.
Prasanna

David Harris wrote:
> I agree fully with Tea: there is no need to have the
> pump primed for an OPCAB, unless it is a potential
> problem. Similarly, with increased experience, the
> cardiologists never ask for standby for PTCA. Those
> nasty earlier conversions were during the learning
> curve, when we did not know the limits. We know where
> the limits are now, and it will be safe: limited
> traction for first graft (LAD), with a few sutures
> just above phrenic nerve, use of shunts always, not
> accepting any extrasystole, (and sorting out what is
> causing them immediately), careful manipulation for
> last grafts by verticalisation only, and not accepting
> ANY hypotension before carrying on.
> I have recently changed to 100% OPCAB, and you can
> immediately see the difference, and the major
> difference is seen not only in hospital, but during
> the first 3 months.
>
>
> --- hgrmd at aol.com wrote:
>
>   
>> 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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>
> Dr. David G. Harris, FCS, MMED,
> Cardiothoracic Surgeon        
> Suite A2                                
> Tygerberg Hospital, 7505       
> Cape Town, South Africa.            
> Tel +27-21-9762347             
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