[HSF] LAD ENDARTERECTOMY

[Nasser F. Abou'Seada]

Dear Hal 
You just Speak my thoughts. I totally concur with your conclusions. 

NFA

> From: Hgrmd at aol.com
> Dear Murali,
>   Believe me, I have a significant experience in doing OPCAB's.   Eight or
> nine years ago, when I was still doing a lot of stand alone CABG
procedures,
> about 40-50% were done off pump.  The point is, I'm well  familiar with
the
> technique.  However, just because you do virtually 100%  of your cases off
pump
> doesn't necessarily mean that is the way to go.   Does the average number
of
> grafts that you currently do the same as when you  were doing on pump
CABG?  If
> so, you are the exception.  Me  personally, I tended to finesse smaller
> diseases vessels that I now routinely  graft.  You don't do
endarterectomies.  I
> wouldn't either if I had to  them off pump.  Is that better for most
patients?  I
> don't necessarily  think so.
>   If you've read HSF for a few years, you know that we've debated this
issue
> to death.  I've no intention of reigniting a firestorm.   Frankly, I
mildly
> resent the implied message of superiority that strictly OPCAB  surgeons
tend to
> convey. I guarantee you I'm an experienced, more than  competent surgeon
who
> would have my group strive for only OPCAB if I really  thought it was
worth
> it. Like the majority of surgeons in the U.S., I'm not  convinced (as you
> obviously are) that OPCAB is the only way to go.  The  literature is far
from
> conclusive.  Fewer grafts and an earlier tendency  for graft closure
> (hypercoagulability?) are unresolved issues.  Fewer  strokes?  Not proven.
>   I fully realize that the cost of OPCAB is considerably less than on
pump,
> and I know that cost considerations are more paramount in different
> countries.  I'm glad I know how to do OPCAB, and I still occasionally use
it for the
> right situations (isolated LIMA to the LAD, hostile aorta). Just  realize
that
> OPCAB/ONCAB is far from resolved.
> Hal