[HSF] Another Victory for the LAD Stent.....

[Edward Bender]

If I remember correctly, there was crossover to redo CABG for refractory
symptoms in the presence of un-stentable vessels.  This has been my limited
experience, also.  The usual scenario is a patent LIMA to the LAD, occluded
native LCx and RCA, with ungrafted vessels, occluded grafts, or severely and
diffusely diseased grafts so that a filter wire would not be protective of
embolization. I usually have to do 2 or 3 of these types of cases a year.
The most distressing are the ones with severely diseased patent grafts going
to the OM branches.  I would bet most of these patients come out of the OR
with ST segment elevation.

Ed Bender, MD


On 2/9/08 2:51 PM, "Hgrmd at aol.com" <Hgrmd at aol.com> wrote:

> Ani,
>   To be honest, I didn't critically analyze the paper from CCF.   They very
> well could have done some arcane data massage to prove a point.   However,
> their conclusions basically support the policies of the surgeons in my  group
> as 
> well as the referring cardiologists.  It's rare that we do a redo  stand alone
> CABG when there is a well functioning LIMA to the LAD.  For one  thing, the
> interventionalists can generally do enough PCI to get by.  If  they can't, the
> patient is usually treated medically.  Since I haven't done  a stand alone
> CABG 
> so far this year, I can't speak authoritatively.   However, I do believe it's
> rare that we reoperate when there is a good LIMA to  the LAD.
>  
> Hal
> 
> 
> 
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