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

Thu Mar 1 14:08:31 EST 2007

Stented vessels must be by-passed at operation and stent /stents crushed by 
a clamp.
erdinc

>From: jbflegejr at aol.com
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: Re: [HSF] Re: Follow up to the New York Times article Stents vs. 
>CABG
>Date: Thu, 01 Mar 2007 07:32:38 -0500
>
>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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