[HSF] Too scared to touch.....

Wed May 2 21:05:22 EDT 2007

In fact the Canadian data on left main disease and urgent versus planned 
surgery goes against "conventional " practice.
Prasanna
Ben Bidstrup wrote:
> In countries like Australia where the public system creates waiting 
> lists, many patients with what is usually referred to as critical LM 
> or 3VD get sent home and wait. If they have no symptoms, they may not 
> get done for months. Do they die, rarely. The studies have been done 
> and do not show an inordinate mortality. Now, of course medical 
> therapy is better than it used to be and they are treated well. Quite 
> a few bounce back and it it those who get done.
> I am not saying it is right, but it is another piece of evidence we 
> must consider. The Canadians have also a lot of data on this. Tuman 
> comes to mind.
>
>
>> Hal,
>> Please read carefully, In never said anything about critical left mains.
>> Also if you carefully see what I said I said where is the evidence . 
>> Some things that we practice need not necessarily be right.
>>
>> Prasanna
>> hgrmd at aol.com wrote:
>>> Don,
>>>   I agree with you.  If Prasanna wants to send out critical LM's or 
>>> LAD's hanging by a hair after an MI, that's his business.  Around 
>>> here, if such patient went home without surgery and boxed, we'd 
>>> definitely hear about it.
>>>  Hal  -----Original Message-----
>>> From: donross at bigpond.com
>>> To: OpenHeart-L at lists.hsforum.com
>>> Sent: Wed, 2 May 2007 4:40 AM
>>> Subject: Re: [HSF] Too scared to touch.....
>>>
>>> When they have LM or TVD + poor LV....... most of my patients. I 
>>> hope, therefore, you are not trying to put me out of a job? Don On 
>>> 02/05/2007, at 10:53 AM, prasannasimha wrote:
>>>> Where in literature has it been shown that a patient who is stable 
>>>> > after an MI benefits from urgent in house revascularization ? 
>>>> Prasanna
>>>> Donald Ross wrote:
>>>>> Also, one wonders about the not infrequent peri-op AMIs during 
>>>>> non->> cardiac surgery that come our way for revascularisation 
>>>>> prior to >> discharge. Is this unnecessary surgery as well, given 
>>>>> it carries the same >> indications as regular coronary surgery? 
>>>>> Don On 01/05/2007, at 10:04 PM, Hgrmd at aol.com wrote:
>>>>>
>>>>>> Ajit, I invested the time it took to read all of Prasanna's >>> 
>>>>>> abstracts. I'm still not convinced that medical therapy with 
>>>>>> beta-blockers is >>> the way to go for nearly every case. Again, 
>>>>>> if a stress test in an asymptomatic >>> patient shows a lot of 
>>>>>> myocardium with reversible ischemia, it would be >>> potentially 
>>>>>> foolhardy not to cath that patient. Over the years, we've been 
>>>>>> >>> referred lots of patients with left mains or critical 3vd 
>>>>>> that were cathed prior >>> to an elective noncardiac procedure 
>>>>>> (usually carotid, ischemic leg, or AAA). >>> We did the CABG, 
>>>>>> they eventually got the vascular procedure, and they did >>> 
>>>>>> fine. I've yet to recall "graft closure" while the subsequent 
>>>>>> case was done. In >>> light of the problems with DES, the 
>>>>>> cardiologists are much more likely to use >>> bare metal stents 
>>>>>> in such scenarios. I do agree that beta blockade, possible Swan, 
>>>>>> and a competent >>> cardiac anesthesiologist suffice for the vast 
>>>>>> majority of cardiac >>> patients getting noncardiac surgery. 
>>>>>> However, there are plenty of asymptomatic >>> cardiac time bombs 
>>>>>> waiting to explode for those that never cath and treat >>> 
>>>>>> preemptively. Hal
>>>>>>
>>>>>>
>>>>>> ************************************** See what's free at 
>>>>>> http://>>> www.aol.com. 
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