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

Thu Mar 1 10:35:31 EST 2007

I dont think anyone would wish a lawyer on their worst enemy (I have several
in the family - but we dont let them out much).  But, I think that we are
only at the very tip of what may be a huge iceberg.  We dont even have a
handle on what to do with the problem.  For example, what are the
thoughts/literature on:

1)  Bypassing stented lesions (mentioned previously) - does it depend how
long they have been in for and to what vessel.  What about a wide-open DES
to a prox. LAD lesions?  Tack a IMA to that? Sounds obvious to say yes - but
what about competitive flow???

2) Pre/Post OP plavix in patients needing other surgery..... stop the plavix
and you may risk stent thombosis.... continue it..... and just order the
blood products now (and still hope you dont thrombose it)

3) How many of these patients are Plavix resistant?

4) Can or should we (or anyone else for that matter) do something with some
of these patients before they come in with massive infarcts?

-michael

On 3/1/07, Jacob Lavee, MD <jaylavee at netvision.net.il> wrote:
>
> Ed and all other ambulance-chasers "aficionados" among you,
> I would be the last person on earth to have a single good word to say on
> all
> those bottom-feeders lawyers who are lurking in the shades while waiting
> for
> their chance to bite us. However, I find the general mood of rejoicing at
> our cardiologists' DES failures while wishing, almost yearning, for class
> action lawsuits somewhat disturbing. It seems to me that we ,as cardiac
> surgeons, cannot wish to hold this stick at both its ends: either we
> condemn
> those low-life lawyers whatever they do, or we should refrain from wishing
> them good luck when they are against our adversaries while attacking them
> when they are against us. JMHO.
>
> Jay Lavee
>
>
> ----- Original Message -----
> From: "Edward Bender" <ebender001 at charter.net>
> To: <OpenHeart-L at lists.hsforum.com>
> Sent: Thursday, March 01, 2007 1:55 AM
> 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 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
> >> To: 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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