[HSF] Re: Follow up to the New York Times article Stents vs. CABG
jbflegejr at aol.com
jbflegejr at aol.com
Thu Mar 1 07:32:38 EST 2007
I have no doubts that the stented vessels should be bypassed in this
setting and with SVG. I have seen disaster from clotted stents postop
and apparently so have many of this forum's participants. (Maybe I am
one of those never in doubt, often wrong). There is an immense number
of patients, and more every day, with DES and at risk. Most of those
dying of MI following stoppping of Plavix for some operation or some
other reason just get buried and no connection is made. Now that some
are getting publicity, more will be identified correctly. John Flege
-----Original Message-----
From: anianyanwu at hotmail.com
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 1 Mar 2007 6:45 AM
Subject: Re: [HSF] Re: Follow up to the New York Times article Stents
vs. CABG
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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