AW: [HSF] Twisting of Vein grafts

erdinç naseri enaseri at hotmail.com.tr
Mon Mar 12 20:00:05 EDT 2007 

dear Dr. salerno,
As always very well said.The quality of the anastomoses must be checked by 
flowmeters of the latest generation.Personally I am still dreaming of having 
one of them and to attach the proof of the graft flow to the patient's file.
erdinc


>From: "Salerno, Tomas" <TSalerno at med.miami.edu>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: <OpenHeart-L at lists.hsforum.com>
>Subject: RE: AW: [HSF] Twisting of Vein grafts
>Date: Mon, 12 Mar 2007 11:16:43 -0400
>
>Dear Roberto:
>
>At least in principle, can we agree that quality control of the anastomoses 
>is something that should be mandatory? Same for Xray after chest tube 
>insertion, central line insertion, angiogram after stenting,  etc, etc.
>Angiogram in the operating room is not practical and most centers cannot do 
>it. SPY is an alternative.
>
>I realize that even in North America, majority of surgeons do not want to 
>perform quality control of the anastomoses, the majority feeling that they 
>do perfect anastomoses under magnification and see no need for extra time 
>determining whether flow is present or not. I have been surprise when doing 
>the easiest possible LIMA-LAD to find out that it is occluded! And my first 
>reaction is to blame the flowmeter, since I do not believe it was possible 
>that this anastomoses was occluded. Humble experience...
>
>
>Tomas
>
>-----Original Message-----
>From: openheart-l-bounces at lists.hsforum.com 
>[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Dr. Roberto 
>Battellini
>Sent: Monday, March 12, 2007 11:16 AM
>To: OpenHeart-L at lists.hsforum.com
>Subject: AW: AW: [HSF] Twisting of Vein grafts
>
>You know as I know that we need an angiogram if we want perfection.
>
>BTW, we have 3 Flowmeters here, which we use in 100% of our cases, one is
>the Cardiosonix.
>But WE are NOT the world, Tomas.
>Roberto
>
>-----Ursprüngliche Nachricht-----
>Von: openheart-l-bounces at lists.hsforum.com
>[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Salerno, 
>Tomas
>Gesendet: Samstag, 10. März 2007 13:49
>An: OpenHeart-L at lists.hsforum.com
>Betreff: Re: AW: [HSF] Twisting of Vein grafts
>
>Please include how you know the anastomoses is patent
>
>Tomas
>
>----- Original Message -----
>From: openheart-l-bounces at lists.hsforum.com
><openheart-l-bounces at lists.hsforum.com>
>To: OpenHeart-L at lists.hsforum.com <OpenHeart-L at lists.hsforum.com>
>Sent: Sat Mar 10 07:32:36 2007
>Subject: Re: AW: [HSF] Twisting of Vein grafts
>
>Dear Roberto,
>I completely agree with you. Could you please expand your concepts about
>"how to construct a perfect anastomosis" ? (OT I miss Leipzig very much)
>
>Giuseppe
>
>Giuseppe Rescigno M.D.
>Cardiothoracic Surgeon
>
>Lancisi Hospital
>Torrette - Ancona
>Italy
>
>
>
>On Saturday, March 10, 2007, at 06:45AM, "Dr. Roberto Battellini"
><battr at medizin.uni-leipzig.de> wrote:
> >Dear Giuseppe,
> >Effective quality control during an anastomosis is to look every stich, 
>to
> >perform a cobra anastomosis, to suture the heel and toe in  a line, etc.
> >Flowmeasure is quality control after, and detects may be 75% stenosis but
>no
> >50% ones.
> >All residents should not think that because they make total arterial and
> >after flowmeasure, the quality will be all right.
> >...after my experience...
> >Roberto
> >
> >-----Ursprüngliche Nachricht-----
> >Von: openheart-l-bounces at lists.hsforum.com
> >[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Giuseppe
> >Rescigno
> >Gesendet: Donnerstag, 8. März 2007 14:45
> >An: OpenHeart-L at lists.hsforum.com
> >Betreff: Re: [HSF] Twisting of Vein grafts
> >
> >Ani,
> >the same happens in Italy. I see many surgeons still using last century
>ways
> >of checking run off (fingers, pulse etc.). When they ask why I
> >systematically use the flowmeter, I answer that I would choose a surgeon
> >with an effective quality control of his work.
> >
> >Giuseppe
> >
> >
> >Giuseppe Rescigno M.D.
> >Cardiothoracic Surgeon
> >
> >Lancisi Hospital
> >Torrette - Ancona
> >Italy
> >
> >
> >
> >On Thursday, March 08, 2007, at 10:55AM, "Ani Anyanwu"
> ><anianyanwu at hotmail.com> wrote:
> >>Most US surgeons do not have a flowmeter - I suspect even that most do 
>not
> >want one.
> >>
> >>Ani
> >>  ----- Original Message -----
> >>  From: Dr. Roberto Battellini<mailto:battr at medizin.uni-leipzig.de>
> >>  To: 
>OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >>  Sent: Thursday, March 08, 2007 2:51 AM
> >>  Subject: AW: [HSF] Twisting of Vein grafts
> >>
> >>
> >>  Tomas,
> >>  We are in a very wide world (WWW). Coronary surgery is done also in
> >Africa
> >>  (I know this because we have a Fellow from Tanzania in Leipzig, we had 
>2
> >>  from Takijistan, etc). In many countries it is economically impossible
>to
> >>  become a Flowmeter!. Think that at the beginning of coronary surgery,
> >there
> >>  was also no Flowmessung in USA. Would you close Cardiac Services in
>other
> >>  countries only because they have no Flowmeter? My answer is no.
> >>  Prasanna, do you have Flowmeter?
> >>  Roberto
> >>  -----Ursprüngliche Nachricht-----
> >>  Von:
> >openheart-l-bounces at lists.hsforum.com<mailto:openheart-l-bounces at lists.hsfo
>r
> >um.com>
> >>  [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Salerno,
> >Tomas
> >>  Gesendet: Donnerstag, 8. März 2007 00:46
> >>  An: 
>OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>;
> >OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >>  Betreff: RE: [HSF] Twisting of Vein grafts
> >>
> >>  we need to come to terms that CABG is an operation that requires 
>quality
> >>  control of the anastomoses at the end of the operation and after
> >protamine
> >>  administration. The technology is here, is simple and reliable, and
> >clearly
> >>  avoids simple problems such as kinked grafts.
> >>
> >>  Tomas
> >>
> >>  ________________________________
> >>
> >>  From:
> >openheart-l-bounces at lists.hsforum.com<mailto:openheart-l-bounces at lists.hsfo
>r
> >um.com> on behalf of Dr. Roberto
> >>  Battellini
> >>  Sent: Wed 3/7/2007 6:04 PM
> >>  To: 
>OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >>  Subject: AW: [HSF] Twisting of Vein grafts
> >>
> >>
> >>
> >>  He said they have no Flowmeters!
> >>  He needs another answer, such as : do double mammaries, etc.
> >>  Roberto
> >>
> >>  -----Ursprüngliche Nachricht-----
> >>  Von:
> >openheart-l-bounces at lists.hsforum.com<mailto:openheart-l-bounces at lists.hsfo
>r
> >um.com>
> >>  [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Ben
> >Bidstrup
> >>  Gesendet: Mittwoch, 7. März 2007 23:26
> >>  An: 
>OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >>  Betreff: RE: [HSF] Twisting of Vein grafts
> >>
> >>  Very similar to the cardiologists having to ensure proper stent
> >>  deployment with IVUS . So you can lean on the management.
> >>
> >>  >This can be avoided by measuring flows in the grafts or performing
>other
> >>  >type of quality control of the anastomoses prior to closure.
> >>  >
> >>  >Tomas
> >>  >
> >>  >-----Original Message-----
> >>  >From:
> >openheart-l-bounces at lists.hsforum.com<mailto:openheart-l-bounces at lists.hsfo
>r
> >um.com>
> >>  >[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of David
>Harris
> >>  >Sent: Wednesday, March 07, 2007 4:52 PM
> >>  >To: 
>OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >>  >Subject: Re: [HSF] Twisting of Vein grafts
> >>  >
> >>  >I`m sure your cardiologist was thrilled, and
> >>  >considered stenting the next 20 cases :-) The best way
> >>  >to avoid this is to use double internal thoracic
> >>  >arteries for all patients, followed by radial as next
> >>  >choice, and using veins only where a thoracic cannot
> >>  >be used, and where a radial should be avoided because
> >>  >the stenosis is less than 60 to 70 %.
> >>  >
> >>  >Then we will also be in a better position to criticise
> >>  >cardiologists for overuse of stents
> >>  >
> >>  >
> >>  >--- rashid akther
> ><rashid_akther at yahoo.co.in<mailto:rashid_akther at yahoo.co.in>> wrote:
> >>  >
> >>  >>
> >>  >>    We had   an unexpected   twisting and thrombosis
> >>  >>  of an OM vein graft which was noted   at
> >>  >>  rexploration for bleeding. We   have checked the lie
> >>  >>  of the vein graft   with heart in the lifted up
> >>  >>  position   and thought that twist   should have
> >>  >>  happened with changed  lie of the graft after
> >>  >>  dropping it.
> >>  >>
> >>  >>  How to prevent   twisting   of vein grafts?[ We do
> >>  >>  not have flow probes to check the flow at the end of
> >>  >>  the procedure]
> >>  >>
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> >>  >Dr. David G. Harris, FCS, MMED,
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> >>  --
> >>  Ben Bidstrup FRACS FRCSEd FEBCTS
> >>  Consultant Cardiothoracic Surgeon
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