[HSF] LAD ENDARTERECTOMY

[Nasser F. Abou'Seada]

very well said 

NFA 

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of Tohru Asai
> Sent: Saturday, January 13, 2007 2:24 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] LAD ENDARTERECTOMY
> 
> I personally do not perform endarterectomy with OPCAB. Although my
isolated
> coronary bypass had been performed 99.9% off-pump in past 7 years (over
800
> cases).
> 
> Reason why I avoid endarterectomy is simple. No proven safety to avoid
acute
> , subacute and longterm thrombosis. If you lose LIMA to LAD grafting
during
> followup, the patient will suffer fatal MI and/or CHF without question. In
> addition, hypercoagulability certainly exits in OPCAB, compared with
on-pump
> cases,such procedure carries even higher risks.Don Ross (hello!) gave a
> thoughtful comments on this. Very impressed. Wise Tea's comment are
> represent silent majority's opinion, I guess.
> 
> Instead, what I do is aggressive multi-arterial sequential grafting to
each
> branches. Arterial grafts especially IMA stay open in midterm, even in 1
mm
> coronary arterial branches in angiograms.
> 
> So, I think that the question is not whether you can or cannot do such a
> thing, but whether you should or not.
> 
> I want to ask those who perform endarterectomy with OPCAB following
> questions.
> 1. Do you really follow all patients postoperatively in long term?
> 2. Do you have confirmation study (MDCT and/or angiogram) in early and
long
> term follow up?
> 3. What evidence do you have for the safety of such procedure?
> 
> Once coronary endarterectomy was abandoned in history because of miserable
> outcome due to sudden occlusion, then coronary bypass became evidence
based
> treatment for longevity and secondary prevention for MI. (which PCI has
> never achieved, and probably will not.)Current medications certainly quite
> different from ones in old days, but history may repeat itself.
> 
> Resected specimen and early postop angio were really impressive, but so
> what? Do you envy masturbational interventionalists?
> Any comments welcome.
> --
> Tohru Asai
> Shiga University of Medical Science
> Otsu, Japan
> 
> 
> 
> 
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