[HSF] Too scared to touch.....
psimha
prasannasimha at gmail.com
Wed May 2 22:57:28 EDT 2007
There is no evidence base for stable left main. Only for unstable left
main to be specific.(The Canadian study some years back seemed to
expound it elegantly)
Prasanna
Ani Anyanwu wrote:
> 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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