[HSF] Re: Follow up to the New York Times article Stents vs. CABG

Thu Mar 1 06:45:21 EST 2007

This raises again the debate as to whether the stented vessel should have been bypassed initially.

Ani
  ----- Original Message ----- 
  From: Tony Furnary<mailto:tfurnary at starrwood.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Thursday, March 01, 2007 1:24 AM
  Subject: RE: [HSF] Re: Follow up to the New York Times article Stents vs. CABG

  Similar story...
  48yo male smoker 6 months s/p successful DES to RCA for 90% lesion. Presented again with recurrent angina from 70% LMT,  50% LAD and 65% OM (that were all there in August when DES was placed); RCA DES now widely patent.  Sent for surgery to LAD/OM.  Held Pavix for 4 days.  Then LIMA >LAD & SVG > OM (because of lower grade lesion, despite age).  

  Bled a bit post-op, got 1 pack of platlets which stopped bleeding.  Next day  bradycardia, ST depression in I, III, and AVF followed by VT / VF.   Shocked back -- low BP; high PAp's ; cardiogenic shock.  Took immediatly back to OR.... RV akinetic with Acute RV infarct.  Opened PDA and RPL -- no flow in either as DES had thrombosed.  Emergent CABG with SVG's to both.  RV recovered & so did patient.  Now at one month and feeling fine with 4 grafts.  Off Plavix for life.

  -----Original Message-----
  From: hgrmd at aol.com<mailto:hgrmd at aol.com> [mailto:hgrmd at aol.com]
  Sent: Wed 2/28/2007 6:35 PM
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
  Cc: 
  Subject: Re: [HSF] Re: Follow up to the New York Times article Stents vs. CABG

  Ed,
    I can't wait to use your term "Plavix junkies" the next time I'm talking to an interventionalist.  In certain aspects, it's probably worse than having a mechanical valve.  Using heparin or Lovenox overlap, the unprotected window for a procedure is only about 24 hours.  In contrast, the Plavix junkie must stop at least 5 days in order to get the procedure done.  I'm thinking about selling my J&J stock in anticipation of it being "Mercked".
  Hal 

  -----Original Message-----
  From: ebender001 at charter.net<mailto:ebender001 at charter.net>
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
  Sent: Wed, 28 Feb 2007 6:55 PM
  Subject: Re: [HSF] Re: Follow up to the New York Times article Stents vs. CABG

  Let me also add a case. 75 year old male with previous CABG and subsequent DES to RCA vein graft feeding a hyperdominant RCA. He has a small skin cancer from his arm that needs to be removed. Plavix stopped for 5 days, gets a skin cancer about the size of a dime removed, and has a huge infarct immediately after surgery. He required redo CABG, but did well after prolonged hospital stay. We have hundreds of thousands of Plavix "junkies" out there. I smell multiple class action lawsuits in the making. 

  Ed Bender, MD 

  On Feb 28, 2007, at 5:26 PM, hgrmd at aol.com<mailto:hgrmd at aol.com> wrote: 

  > Cary, 
  > Thanks for sharing this unfortunate case. I've heard and seen > similar. It's slowly dawning on the interventionalists that they > really screwed up, and that these DES patients are analogous to > those with mechanical valves. The lawyers will soon be in another > feeding frenzy. 
  > Hal 
  > 
  > -----Original Message----- 
  > From: CSPassik at aol.com<mailto:CSPassik at aol.com> 
  > To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  > Sent: Wed, 28 Feb 2007 5:26 PM 
  > Subject: [HSF] Re: Follow up to the New York Times article Stents > vs. CABG 
  > 
  > 
  > HSF'ers, 
  > 
  > I would like to share for your mutual interest an unfortunate case > I saw 
  > yesterday. 51 yo man, active, skinny in good shape. He presented > with an MI 
  > 7/05 and underwent multiple drug-eluting stents to his LAD and CX > for 2-v CAD. 
  > 
  > Big vessels, good angiographic result and good residual LV > function. Newly 
  > diagnosed with early stage prostate CA and was scheduled for a > robotic 
  > Davinci prostatectomy. His Plavix and ASA was thus stopped two > weeks ago. 
  > Cardiology workup included stress testing which was somewhat > equivocal so he 
  > was 
  > cathed last Friday. Stents all looked widely patent. Cardiologist > thus said 
  > "low risk for heart problems"-start his antiplatelet meds ASAP > post-op. He was 
  > 
  > about 2/3 of the way through his port access prostate yesterday > when he had 
  > ST segment changes and therafter coded/CPR. Operation aborted-with > an open 
  > bladder leaking into the belly and a cath lab visit-- occluded > stents in both 
  > vessels-successfully opened but poor reflow and expired. 
  > In summary, these drug coated stents are, IMHO, going to turn out > to be a 
  > disaster for the patients who ever need anything done at any time > in the 
  > future that will require stopping their Plavix. They have created a > new 
  > disease! I 
  > suspect we will all be seeing and hearing more of these cases, > and I also 
  > suspect the stent manufacturer's will try to tell us that this is > just one 
  > case,not reaching statistical significance, blah, blah blah. Too > bad this poor 
  > man didn't have a nice 2V CABG in 05. 
  > Cary Passik 
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