[HSF] Ischaemic cardiomapathy

Thu Mar 1 16:32:49 EST 2007

David,
That is good advice. I had done 6 or so very low EF patients bhop  
with no problems, but as you push your luck further some more help is  
needed as my last two case illustrated.
I will give the overnight balloon consideration for the next one.
Thanks,
Don
On 01/03/2007, at 7:56 AM, David Harris wrote:

> I agree with pre-op balloon in all these patients with
> EF around 20. I think you have only one chance with
> these patients. Then you can see if you can do them
> off pump, and if not, do them beating on pump. The
> timing of the balloon is important, they need at least
> overnight, but no longer. Some low dose dobutamine
> also helps, and by the time the operation time comes
> around, the heart has decreased in size. Another
> choice for all left side vessels is to do it all
> through a thoracotomy, so you need not displace the
> heart and cause hemodynamic chaos. Proximal grafts
> onto the left subclavian can also classify this as an
> `anaortic` CABG
>
>
> --- Donald Ross <donross at bigpond.com> wrote:
>
>> Ben,
>> Can't agree; if that was the case the problem would
>> come on earlier.
>> The lad grafts take ~ 5min including placement of
>> shunt. Check out
>> the "real time lima to LAD "at "movies " at
>>   beating-heart.com hardly long enough to bother a
>> myocyte.  Can't do
>> much about the anaesthetic unless you practice in
>> India where
>> epidurals suffice.
>> I think the diastolic augmentation of the balloon
>> helps to  belt
>> blood down spasmy imas.
>> Don
>> On 28/02/2007, at 7:21 PM, Ben Bidstrup wrote:
>>
>>> I think it is more than that. In poor LVs even a
>> small amount of
>>> depression by transient ischaemia to the LAD
>> despite shunts can
>>> lead to the need for more support. There is likely
>> to be some
>>> oedema after revascularisation, and the impact of
>> anaesthesia needs
>>> consideration also.
>>>
>>>
>>>> Prasanna,
>>>> I did talk to Dr Bhattacharya at the meeting in
>> Mumbai, I now know
>>>> since my registrar confirmed his distinguished
>> appearance.
>>>> He must be slick to use the RIMA exclusively for
>> his T graft .
>>>> He did, however mention that he uses the balloon
>> for sick hearts
>>>> which perhaps is the reason for his 100% record.
>>>> Now that I am reminded of this I will do the same
>> for my next <20%
>>>> EF patient since the last two done bh on pump
>> needed post op
>>>> balloons... not immediately but after a few
>> hours. I suspect the
>>>> reason relates to  transient  ima hypoperfusion
>> which intolerant
>>>> of the  low mean pressure of some low EF hearts.
>>>> Don
>>>> On 27/02/2007, at 11:49 PM, prasannasimha wrote:
>>>>
>>>>> He practices in Mumbai.(He visits multiple
>> hospitals including
>>>>> Breach Candy hospital etc)
>>>>> Prasanna
>>>>> Donald Ross wrote:
>>>>>> Prasanna,
>>>>>> Who publishes series of individual cases no
>> matter how pretty
>>>>>> the clinical results?
>>>>>> Even if they are put into print many wont
>> believe them ( Hal et
>>>>>> al ) or take any notice unless there has been
>> some some attempt
>>>>>> at science, some hypothesis formulated , some
>> conclusion to be
>>>>>> elucidated.
>>>>>> This wonderful surgeon/orchestral conductor
>> can't publish his
>>>>>> beautiful playing.
>>>>>> All one can do is to take your advice and visit
>> the man.
>>>>>> So, where does he work?
>>>>>> Don
>>>>>> PS I thought he used a balloon instead of
>> bypass in crook cases
>>>>>> which I believe is probably more morbid than
>> cpb.
>>>>>>
>>>>>> On 27/02/2007, at 10:45 PM, prasannasimha
>> wrote:
>>>>>>
>>>>>>> The worst possible scenario is a person
>> wanting to complete a
>>>>>>> 100 % OPCAB experience in time for a
>> conference etc and
>>>>>>> refusing to go on pump or at least institute
>> an IABP while the
>>>>>>> heart is demanding it !!. Saying this, in
>> isolated CABG's not
>>>>>>> in cardiogenic shock, inability to displace
>> the heart during
>>>>>>> OPCAB is more often an expression of failure
>> of the surgeon -
>>>>>>> anesthesiologist team to understand what is
>> going on.
>>>>>>> You should see Dr Bhattacharya doing a
>> multivessel total
>>>>>>> arterial revascularization on a 10 - 15 % EF
>> heart being done
>>>>>>> effortlessly to believe it. He has probably
>> the worlds largest
>>>>>>> "individual surgeon" series of OPCAB's and
>> unfortunately the
>>>>>>> blessed man doesn't publish. Watching him do
>> an OPCAB is  like
>>>>>>> seeing an orchestra play.
>>>>>>> Prasanna
>>>>>>>
>>>>>>> Ani Anyanwu wrote:
>>>>>>>> Off-pump surgery is sometimes also a crime
>> against the human -
>>>>>>>> I have seen several cases where the heart, or
>> the entire
>>>>>>>> patient, has suffered because of reluctance
>> and refusal of the
>>>>>>>> surgeon to accept conversion to CPB. It cuts
>> both ways (some
>>>>>>>> patients also suffer by having on-pump CABG).
>> We should not be
>>>>>>>> evangelists for a technique but for the
>> patient. The patient
>>>>>>>> couldn't care less whether we used CPB or not
>> - all they want
>>>>>>>> is a lasting operation at low risk so our
>> primary aim should
>>>>>>>> be to deliver this goal.
>>>>>>>>
>>>>>>>> Ani
>>>>>>>>   ----- Original Message -----   From:
>>>>>>>> NielsB at aol.com<mailto:NielsB at aol.com>   To:
>> OpenHeart-
>>>>>>>>
>>
> L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>>
>>>>>>>> Sent: Tuesday, February 27, 2007 3:09 AM
>>>>>>>>   Subject: Re: [HSF] On pump beating heart
>>>>>>>>
>>>>>>>>
>>>>>>>>   Who said it is?. It is not a crime against
>> humanity but in
>>>>>>>> some cases it is a   crime against a human.
>> The   heart lung
>>>>>>>> machine is a tool among many others,   very
>> frequently a very
>>>>>>>> important one. But it is not some holy grail
>> either. We   use
>>>>>>>> it when we need it, for CABG this is not so
>> common, then the
>>>>>>>> stabilizer   is a better tool in my humble
>> opinion.
>>>>>>>>
>>>>>>>>
>>>>>>>>   Jacob Bergsland
>>>>>>>>
>>>>>>>>
>>>>>>>>   **************************************
>>>>>>>>    AOL now offers free   email to everyone.
>> Find out more
>>>>>>>> about what's free from AOL at
>> http://www.aol.com<http://
>>>>>>>> www.aol.com/>.
>>>>>>>>
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> === 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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