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

[Michael Firstenberg]

it is a function of the data - a redo CABG is a whole different  
animal, particularly in the face of a patent LIMA-LAD.  As the CCF  
data suggests - and we all probably already know - redo revasc. with  
a patent LIMA is not something to be taken lightly - regardless of  
how good you are.

-michael



On Feb 9, 2008, at 10:07 PM, Ajit Damle wrote:

>
> "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)> > _______________________________________________> >
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