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

[Ani Anyanwu]

What is the evidence base for emergent revasularization of Left Main? When I worked in England few years back we had patients with Left Main on the waiting list for surgery for as long as a year.

ANi
  ----- Original Message ----- 
  From: prasannasimha<mailto:prasannasimha at gmail.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Wednesday, May 02, 2007 6:43 AM
  Subject: Re: [HSF] Too scared to touch.....


  Even TVD doesn't have evidence base for emergent inhouse 
  revascularization. Only Left main.
  Prasanna
  Donald Ross wrote:
  > 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<mailto: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<http://www.aol.com/>.
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