[HSF] On pump beating heart {OT}

Thu Mar 1 16:20:08 EST 2007

Hal,
I think Oz could accommodate you...just.
I know bugger all about rock music but I am sure my daughter could  
find somewhere to get your ears ringing again.
My piano need a work out so you would have to stay with us in Sydney.
Don
On 01/03/2007, at 7:06 AM, hgrmd at aol.com wrote:

> 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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