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

[Ajit Damle]

"I find it very interesting to observe how willing surgeons are to give up
repeat revascularization in the setting of prior CABG"

Great post, Ani!! Ain't we smart!

Ajit









-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Ani Anyanwu
Sent: Saturday, February 09, 2008 4:38 PM
To: openheart-l at lists.hsforum.com
Subject: RE: [HSF] Another Victory for the LAD Stent.....

I find it very interesting to observe how willing surgeons are to give up
repeat revascularization in the setting of prior CABG to the cardiologist
and how the stent, which we all despise as primary therapy, suddenly becomes
an excellent tool in setting of vein graft disease or new native disease. 
 
Either we believe in something or we don't. If a patient has severe circ and
right  disease we argue CABG is better than DES but when that patient is a
reoperation, we question the role for surgery.
 
I must say I have seen a few of these diseased vein grafts either
angiographically, at surgery or at autopsy. I may be naive but I find it
hard to believe how a stent (in a vein graft) can be the solution for vein
graft disease. Even if effective how about the 50% or so of patients who
develop recurrent angina not because of vein graft disease but progression
of native disease, don't those native vessels do better with CABG anymore?
 
I suspect if a redo CABG was a much easier operation we would have a
different view.
 
Ani
 
 



> Date: Sat, 9 Feb 2008 15:38:36 -0600> Subject: Re: [HSF] Another Victory
for the LAD Stent.....> From: ebender001 at charter.net> To:
OpenHeart-L at lists.hsforum.com> CC: > > 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> > > > > > > > **************Biggest Grammy Award surprises
of all time on AOL Music.> >
(http://music.aol.com/grammys/pictures/never-won-a-grammy?NCID=aolcmp0030000
00> > 025> > 48)> > _______________________________________________> >
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> >
-----------------------------------------> > >
_______________________________________________> 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>
-----------------------------------------
_________________________________________________________________
Telly addicts unite!
http://www.searchgamesbox.com/tvtown.shtml__________________________________
_____________
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
-----------------------------------------