[HSF] Another on vs off pump question, dilatation of IMA......

[Donald Ross]

Mitch,
You must have done a re-do with a patent ima and found the artery to  
be imbedded in the scared remnants of the peri-arterial  tissue  
including the veins making  it difficult to locate and dissect ,  
particularly if you need to gain length to rotate the heart.
If the ima has been skeletonised there is no such scaring and the ima  
sits up prettily like an undiseased SVG.
Don

On 08/06/2007, at 10:25 AM, Mitch Lirtzman wrote:

> Frankly, I can't as I can honestly say I haven't had the occasion  
> to do so. However, the fortunately exceptionally few I've had to  
> take back shortly after surgery seem to have been quite viable. To  
> be honest, for those re-explorations I have done, I just look to  
> see there's no bleeding from the vessel and that's all that's  
> necessary. I doubt anyone in that situation would evacuate the  
> clot, identify any source(s) of bleeding, wash things out quickly  
> and then look closely enough to say "AHA, those little veins are  
> thrombosed!" before closing as expeditiously as possible. I don't  
> mean to sound flip about it. I've just never checked.
> MitchAt 12:49 AM 6/7/2007, you wrote:
>> Mitch,
>> How do you explain the fact that the ima veins are always thrombosed
>> if you, unfortunately,  have an opportunity  to inspect  them next  
>> day?
>> Don
>>
>> On 07/06/2007, at 2:54 PM, Mitch Lirtzman wrote:
>>
>>> John, I would respectfully disagree with part of the last posting.
>>> As one of the "wrappers and extraluminal injectors", in well over
>>> two decades, dark blood has never come out of the LIMA at the time
>>> of unclamping for grafting. I'm one of the leave-it-on-the-pedicle
>>> guys with accompanying veins. As stated, I don't skeletonize and
>>> have never had problems with graft length. My guess is that the
>>> vasa vasorum remain intact...or whatever circulation others have
>>> postulated, and the vessel remains a living organ. BRB across the
>>> table.
>>> Mitch LirtzmanAt 08:45 PM 6/6/2007, you wrote:
>>>> Don, you and others have said that you clamp and divide the IMA
>>>> and lay it
>>>> aside until time for the anastomosis, some with it wrapped in a
>>>> sponge soaked
>>>> with papaverine and/or verapamil, some after injecting the same
>>>> drugs into the
>>>>  lumen, and later found the IMA to be plump and pulsating. Perhaps
>>>> there is
>>>> another explanation. When you open the IMA after it has been
>>>> clamped for some
>>>> time, the blood in the lumen is dark, desaturated, meaning that
>>>> the oxygen
>>>> has  been extracted, which must mean that the vessel wall has been
>>>> ischemic.
>>>> Could it  be that when the smooth muscle cells become ischemic,
>>>> they lose there
>>>> capacity  to contract and the vessel wall relaxes and dilates and
>>>> the drugs
>>>> have nothing  to do with it? John Flege
>>>>
>>>>
>>>>
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