[HSF] LAD ENDARTERECTOMY

[Nasser F. Abou'Seada]

Good question 
I do echo your query ??

NFA

> From: Tea Acuff
> What is a "Vettath top end" (proximal)?
> tea
> 
> 
> ----- Original Message ----
> From: Donald Ross <donross at bigpond.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Friday, January 12, 2007 12:22:16 AM
> Subject: Re: [HSF] LAD ENDARTERECTOMY
> 
> 
> Murali,
> You certainly are the expert, working in South India.
> However, I don't think our elderly calcified disease can be the same
> as yours.
> I often tell myself I will just put on a patch graft but invariably
> find I am cutting calcium which doesn't splay open and can't be sutured.
> Incidentally I have now done 85 Vettath top ends but am tending to
> use the imas for inflow in most cases, only doing top ends if they
> are unavailable or a prophylactic vein graft is needed.
> Don
> 
> On 12/01/2007, at 2:22 PM, murali vettath wrote:
> 
> > Don,
> >
> > It was interesting to note that Endarterectomy is performed so
> > extensively, though most of the time the patency of the graft down
> > the line is quite questionable.
> >
> > i used to see them happen when I was in australia. since 1999, we
> > have changed our technique after coming down to India, and we no
> > longer perform endarterectomy .
> >
> > though we come across a large number of diffusely diseased LAD in
> > our day to day practice, we stick to our technique of Patch
> > angioplasty sans endarterectomy, there by trying to retain the
> > intima as far as possible.
> >
> > We have performed nearly 200 of such procedures so far and the
> > absence of peri op infarction and the post operative angiographic
> > results on the studies we have performed in patients after 2yrs
> > have been gratifying.
> >
> > We have been performing all these off pumpas with all other OPCABs
> > dr Murali Vettath
> >
> >
> >> From: Donald Ross <donross at bigpond.com>
> >> Reply-To: OpenHeart-L at lists.hsforum.com
> >> To: OpenHeart-L at lists.hsforum.com
> >> Subject: Re: [HSF] LAD ENDARTERECTOMY
> >> Date: Fri, 12 Jan 2007 11:18:34 +1100
> >>
> >> I used to do a lot of (unnecessary as it turned out)
> >> endarterectomies  to clean out the proximal lad and revascularise
> >> the septals.
> >> The results were good with no  problems till we changed from
> >> bubble  to membrane oxygenators.
> >> Then I started to have acute closures with unpleasant
> >> consequences,  due I believe to healthier platelets.
> >> Needless to say I now only do occasional endarterectomies for the
> >> same indications as Gustavo and others.
> >> My protocol is my usual aggressive early aspirin and clopidogrel
> >> supplanted by 6 months warfarin.
> >>
> >> I have seen several late( > 10 years ) angiograms of that early
> >> set  with patent grafts to  their enarterecomies.
> >>
> >> No, Thomas I have never measured flows but  they are always  done
> >> on  the beating heart using one of my  long shunts.
> >> Incidentally, if the shunt is held up distally it means you have
> >> more  prawn guts to extract.
> >> Don
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