[HSF] RCA osteal lesion-osteal reconstruction

[Ani Anyanwu]

No arterial graft has been shown to be better than a> saphenous vein on the right side (In fact radials have been found to be> worse if the lesion is less than 80 %). There is no survival benefit of a> precrux arterial RCA graft and the RIMA is better preserved for the left> system where there is a possible shred of an evidence that a second IMA may> be better.> Prasanna
 
Prasanna
 
I think we are misrepresenting the data to prove a point here. 
 
Firstly, we chose to interpret the data how we like, and pick the studies we wish to emphasize to justify our practice, but a critical study of the literature will not reach the conclusion that arteries and veins are equivalent on the right system, or indeed any coronary artery, if one starts comparing apples with apples and oranges with oranges. True the benefit of an arterial graft may not be as pronounced on the RCA as the LAD but the same biological arguments exist. I have often said (and I have done this in public forum) that i can argue logically from the literature that a vein and mammary are also equivalent on the LAD distribution - something I certainly do not believe.
 
Secondly, single vessel CAB with right coronary grafts are not done for survival benefit, so saying there is no 'survival benefit of a precrux arterial graft' really does not have significant implication as there is no survival benefit of majority of isolated RCA grafts either.
 
Having been to my cath lab several times I have seen numerous interventions of diseased vein grafts to the RCA - i have never seen one to a diseased arterial graft. Maybe they do not exist, but I for one have put quite a few. One think is clear - the vast majority of vein grafts have a limited life expectancy but the same cannot be said of any arterial graft. I know Buxtons group will present data at the AATS in few weeks that arteries and veins are equivalent in latest analysis from their RCT but that too has heavy flaws.
 
One thing is certain is I would never have my chest opened for a single venous bypass (but would consider so for a single arterial graft). It is such dated operations (vein grafts for single vessel disease) by surgeons - who will often use flawed data to justify their practice - that mark the death of our speciality. With veins for single vessel disease, how can we compete with the high technology modern PCI options? To be fair you do say PCI is the first choice here but we should uniformly be able to offer a viable alternative (arterial grafting to the RCA).
 
Ani
 



> Date: Sat, 26 Apr 2008 21:02:12 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] RCA osteal lesion-osteal reconstruction> CC: > > A single RCA lesion should receive a PCI if possible. If not then it can> receive any graft. No arterial graft has been shown to be better than a> saphenous vein on the right side (In fact radials have been found to be> worse if the lesion is less than 80 %). There is no survival benefit of a> precrux arterial RCA graft and the RIMA is better preserved for the left> system where there is a possible shred of an evidence that a second IMA may> be better.> Prasanna> On Sat, Apr 26, 2008 at 8:47 AM, yadav del <yadavluck at yahoo.com> wrote:> > >> > We have a 60 yr old female patient admitted with acute inferior MI with> > RV extension . At admission she was in shock and complete heart block,severe> > MR and severe TR.She improved with temporary pacemaking.> > Repeat echo after 3 weeks shwoed mild mr mild tr, EF 60% and coronoro> > angiogram showed RCA [large and dominant] with 98% osteal lesion .> > Dobutamine echo showed viable RCA territory.> >> > What is the optimal surgical treatment? RCA graft or osteal> > reconstruction?> >> >> > ---------------------------------> > Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it> > now.> > _______________________________________________> > 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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> 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> -----------------------------------------
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