[HSF] On pump beating heart

erdinç naseri enaseri at hotmail.com.tr
Thu Mar 1 11:52:11 EST 2007 

Dear Don,
In your practice what myocardial reserve invesdtigations are done for the 
patients with EF of 20-25 which are candidates for OPCAB .

erdinc

>From: Donald Ross <donross at bigpond.com>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: Re: [HSF] On pump beating heart
>Date: Wed, 28 Feb 2007 18:29:52 +1100
>
>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
>>>>>
>>>>>
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