[HSF] On pump beating heart {OT}
hgrmd at aol.com
hgrmd at aol.com
Wed Feb 28 15:06:42 EST 2007
Don,
When I finally make to Oz, I want to see Bon Scott's resting place. I recently saw an old video of a live performance with him fronting AC/DC. I love that band. About 4 years ago, I saw them 3rd row center. Even wearing earplugs, my ears rang for about a day afterwards.
Hal
-----Original Message-----
From: donross at bigpond.com
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 28 Feb 2007 4:07 AM
Subject: Re: [HSF] On pump beating heart
For the rest of the forum, Billy T was an old Oz rocker who just died from a large infarct.
Ben, It was George G.
Don
On 28/02/2007, at 7:17 PM, Ben Bidstrup wrote:
> Glad it wasn't Billy T
>
>
>>> Though Don Ross does them by using his long shunts, he is in a >>> tiny minority. Perhaps the naysayers of endarterectomy who are >>> 100% OPCAB'ers would rethink their position if they tried it on >>> pump. Believe me, it works well.
>> They sure do.
>> When I was a young fella I did three long endos on an >> "inoperable" Jazz guitarist. 25 years on he is still playing and >> angina free despite his vile vein grafts.
>> Don
>>>
>>> Thanks Hal.
>>>
>>> Yes, I do endarterectomy, and I will not do this off
>>> pump. We only get the occasional patient who needs it.
>>> I have thought of taking out stents but have not been
>>> brave enough! We sometimes get those calcific horrors
>>> where there is no place to open the vessel. The last
>>> one needed 2 `traditional` long incision
>>> endarterectomies, with long patch anastomoses.
>>>
>>> Us `opcabbers` get enthusiastic when we can safely do
>>> a full revascularisation the same way we would do it
>>> on pump, we enjoy the operation more so approaching
>>> 100% makes us feel better! We still know it is better
>>> for the patient, even if marginally. But would not
>>> hesitate to go on, and not hesitate to decide go on
>>> pump pre-op if we think it safer. Just like you, I am
>>> sure, would like to repair 100% of the valves you
>>> tackle, but also would not spend too much time mucking
>>> about when it becomes clear that the valve should
>>> rather be cut out and replaced.
>>> Dave
>>> --- hgrmd at aol.com wrote:
>>>
>>>> Dave,
>>>> Thanks for the clarification. Just make sure that
>>>> you aren't finessing too vessels just so you can do
>>>> the case off pump. Like Mark, I believe extensive
>>>> endarterectomies should have a definite place in
>>>> your quiver as we continue to get patients with more
>>>> diffuse disease. Anyway, good luck with your policy
>>>> and let us know how it goes.
>>>> Hal
>>>>
>>>> -----Original Message-----
>>>> From: drdharris at yahoo.co.uk
>>>> To: OpenHeart-L at lists.hsforum.com
>>>> Sent: Mon, 26 Feb 2007 3:51 PM
>>>> Subject: Re: [HSF] On pump beating heart
>>>>
>>>>
>>>> HA HA, I knew I would get you guys going! What I
>>>> meant
>>>> was I RECENTLY started to do 100% off pump! That was
>>>> the last 20 consecutive cases! Have not hit any
>>>> rough
>>>> ones since then! I`ll keep you posted!
>>>>
>>>> Seriously though, of course I agree there are
>>>> `IMPOSSIBLE` cases! And these are probably done best
>>>> beating on the pump. But I still am convinced the
>>>> results will be better if you do 90% off pump, which
>>>> I
>>>> will generally aim for....however after recently see
>>>> patients trash their legs and their bowel after
>>>> being
>>>> on the pump I vowed I`ll try to do 100% off!
>>>>
>>>>
>>>> --- hgrmd at aol.com wrote:
>>>>
>>>>> Tea,
>>>>> Coming from a guy who does a very high
>>>> percentage
>>>>> of cases off pump, your comment about 100%
>>>> OPCAB'ers
>>>>> is well taken. Having been an avid follower of
>>>> HSF
>>>>> for a few years, I've definitely seen my share of
>>>>> breathless hyperbole (and no, I don't believe I've
>>>>> been a part of it).
>>>>> Hal
>>>>>
>>>>> -----Original Message-----
>>>>> From: tacuff at swbell.net
>>>>> To: OpenHeart-L at lists.hsforum.com
>>>>> Sent: Sun, 25 Feb 2007 10:33 PM
>>>>> Subject: Re: [HSF] On pump beating heart
>>>>>
>>>>>
>>>>> I would put froth coming out of the ET under the
>>>>> category of "potential
>>>>> problem". In reference to Chand's earlier patient
>>>>> with portal venous air, froth
>>>>> in the ET would also qualify as "unstable" even if
>>>>> the BP was 100 on pressors.
>>>>> One might not have to go on CPB, but it should be
>>>> a
>>>>> consideration and available.
>>>>> It would be hard to object in retrospect to CPB
>>>> even
>>>>> if you go below 100% on
>>>>> this one.
>>>>>
>>>>> I actually looked up my rate for 2004 and 2005 for
>>>>> "CABG with no CPB" at my
>>>>> primary hospital. The trend of cases is down and
>>>> the
>>>>> trend of "CAB and valve or
>>>>> other" is up. In two years I did 3 cases of CAB
>>>>> alone with CPB (including
>>>>> redo's) in 150 cases. This is a 98% rate, I think.
>>>>> Next year could be 90% or
>>>>> 100%, but it won't be 10% or 50%.
>>>>>
>>>>> Here is what I hear when surgeons tell me their
>>>> rate
>>>>> of off pump surgery.
>>>>> Although the most common thing they now say is
>>>> that
>>>>> they stopped or it is
>>>>> rountine. It is just a guess, as always I could be
>>>>> wrong, but when I check a
>>>>> reference that visits the surgeon or see what they
>>>>> do year after year I think I
>>>>> may be more right than not:
>>>>> I tried a few but wasn't comfortable.=we had some
>>>>> bad results in the first ten
>>>>> (I mean another surgeon obviously) so I stopped.
>>>>> I do 10-20%=I tried it once or twice but didn't
>>>> like
>>>>> it. I might try it again if
>>>>> I have too.
>>>>> I do 30-40%. =I do half of my single and double
>>>>> bypasses.
>>>>> I do 50%.= I almost always do single and double
>>>>> bypasses and some easy PL or
>>>>> PDAs.
>>>>> I do all of mine OPCAB.= I try do do most of mine
>>>>> off pump (work in progress) or
>>>>> perhaps it is actually my rountine.
>>>>> I do 100% off pump.= Either I am FOS or I forgot
>>>>> about the couple of problem
>>>>> patients last year. If he writes a lot of papers
>>>> it
>>>>> is even money the former.
>>>>>
>>>>> I have no one in mind when I wrote this. Promise.
>>>>> Almost.
>>>>> tea
>>>>>
>>>>>
>>>>> ----- Original Message ----
>>>>> From: David Harris <drdharris at yahoo.co.uk>
>>>>> To: OpenHeart-L at lists.hsforum.com
>>>>> Sent: Sunday, February 25, 2007 5:08:30 PM
>>>>> Subject: Re: [HSF] On pump beating heart
>>>>>
>>>>>
>>>>> I can`t remember when I last saw a patient in
>>>>> cardiogenic shock referred for surgery....we have
>>>>> excellent cardiologists who intervene
>>>>> percutaneously,
>>>>> and they do`nt turf the patient to us if half the
>>>>> ventricle has been wiped out already.
>>>>>
>>>>> --- hgrmd at aol.com wrote:
>>>>>
>>>>>> When my group does OPCAB, they don't prime the
>>>>> pump,
>>>>>> either. However, they do have a perfusionist
>>>> and
>>>>> a
>>>>>> pump in the room ready to go if the need arises.
>>>>
>>>>>> One hundred per cent OPCAB? You apparently
>>>> don't
>>>>>> offer surgery to patients in cardiogenic shock
>>>> and
>>>>>> froth coming out the ET tube. I have and do.
>>>>>> However, no way would I consider doing that type
>>>>> of
>>>>>> patient off pump.
>>>>>>
>>>>>> Hal
>>>>>>
>>>>>>
>>>>>> -----Original Message-----
>>>>>> From: drdharris at yahoo.co.uk
>>>>>> To: OpenHeart-L at lists.hsforum.com
>>>>>> Sent: Wed, 21 Feb 2007 4:48 PM
>>>>>> Subject: Re: [HSF] On pump beating heart
>>>>>>
>>>>>>
>>>>>> 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
>>>>
>>> === message truncated ===
>>>
>>>
>>> Dr. David G. Harris, FCS, MMED,
>>> Cardiothoracic Surgeon
>>> Suite A2
>>> Tygerberg Hospital, 7505
>>> Cape Town, South Africa.
>>> Tel +27-21-9762347
>>> Fax +27-21-9761157 Mobile +27-83-3309587
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>
>
> --> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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