[HSF] On pump beating heart

[erdinç naseri]

Hal,
Yes ,previously the percentage of my beating attempts was higher and it is 
50% now a nd will remain so.There are times that grafting some  coronaries 
on pump is challenging.It would be impossible to graft them safely off-pump( 
my view!)
You are right .There is no surgical technic which is suitable for 100% of 
the cases.
ERdinc


>From: Hgrmd at aol.com
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: Re: [HSF] On pump beating heart
>Date: Thu, 22 Feb 2007 08:14:54 EST
>
>Erdinc,
>   Your solutions for hemodynamic stability during OPCAB are  excellent.
>However, I was intrigued by your closing statement in which you  said you
>currently do 50-60% of your cases OPCAB due to the concerns of long  term 
>patency.  Is
>this percentage higher or lower than previous?  If  lower, I suspect you,
>like many others have concerns about the technical  adequacy of graft
>construction during OPCAB, particularly with small or  diffusely diseased 
>targets.  I
>know it's testimonial only, but I recently  saw a 2 year old 5 graft OPCAB 
>in
>which one vein graft and the LIMA were still  functioning. The vessels with 
>the
>closed grafts appeared easily  graftable.  Was it poor quality conduit, or 
>was
>it poor quality surgery?  I think OPCAB is a great modality to have in the
>armamentarium, especially  for isolated LIMA to the LAD or patients with a
>hostile aorta.  In  addition, in poorer countries, OPCAB with reusable 
>equipment is
>undoubtedly more  economical. However, the vast majority of the surgical
>community in America  has yet to be convinced that "100%" OPCAB is the way 
>to go.
>Anyone who  does that has to be compromising, whether it be denying
>hemodynamically unstable  patients surgery, or perhaps doing fewer or 
>poorer quality
>grafts in patients  with horrible targets.  Parenthetically, I don't think 
>100%
>anything is  generally prudent.  Certainly, if I did 100% mitral repairs, I
>would have a  lot of crappy repairs leave the OR.  The solution should fit 
>the
>problem.
>
>Hal
><BR><BR><BR>**************************************<BR> AOL now offers free
>email to everyone.  Find out more about what's free from AOL at
>http://www.aol.com.
>_______________________________________________
>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
>-----------------------------------------