[HSF] Hybrid Coronary Revascularization

[Tea Acuff]

David,
Are you suggesting "constraint CAB" where one goes in able to do multiple vessels but does not or "can't CAB " where one can't do CAB because of an approach or other possibile anatomical morbidities (undefined)?
tea


----- Original Message ----
From: David Harris <drdharris at yahoo.co.uk>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, October 29, 2007 6:07:50 AM
Subject: RE: [HSF] Hybrid Coronary Revascularization

If you are doing an OPCAB or MIDCAB, the Plavix is not
really a problem, and we carry on after omitting it
for 24 hrs. Then you will also not have a coagulable
state, as we restart it and give clexane postop.

The other option is to do the CABG first (on or off
pump, surgeon`s choice), then do the single or double
stent (usually RCA) just before discharge, as long as
the patient has not come in with unstable angina, and
as long as this is not the culprit lesion.

If the patient comes in with acute coronary Syndr, and
its a RCA, then cariologist should stent it and
hopefully be kind enough to leave the other vessels to
you. If he remains stable he can be brought back after
a month, and plavix can be stopped.

Dave
--- erdinç naseri <enaseri at hotmail.com.tr> wrote:

> 
> In hybrid revascularization you have the options of
> doing the stent work prior or after the minimaly
> invasive CABG.Doing it priorly will have the
> following drawbacks:
> 1.Risk of bleeding if the patient is on
> antiplateletes through the operation.
> 2.Risk of stent occlusion if a previously
> antiplateled(  DES used) patient stops taking it.
> 3.Risk of stent occlusion perioperatively in
> off-pump surgery( due to hypercoagulable state).
> I have painfull experiences in type 1. and 3.
> erdinc
> _______________________________________________
> OpenHeart-L mailing list
> 
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
> 
> To UNSUBSCRIBE, to CHANGE email address, or to view
> archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
> 
> All messages transmitted by the OpenHeart-L are
> subject to the policies and 
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
> 


Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411            
Fax +27-21-9006412      Mobile +27-83-3309587
_______________________________________________
OpenHeart-L mailing list

Send postings to:
OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies and 
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------