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

Sat Feb 9 23:15:13 EST 2008

I have not seen any - but I/we do not use a lot (nor were many used in my
travels).  I have heard of nerve injuries..... hard to tell if permanent as
follow-up gets a little fuzzy.  My former general surgery chair had a radial
and he noticed a difference.  I have heard of necrosis and even a lost hand
- but that may be urban legend.......

I think patients have enough "nerve" problems from brachial plexus
stretching, axillary cut downs, positioning, cath sticks, IABP, and so on
(my mom had a "frozen shoulder" after her mini mitral that needed PT for a
year)..... I am not too keen to go looking for trouble......

amazing what patients will tell you about their surgery when you actually
follow them up....

-michael

On Feb 9, 2008 11:10 PM, Michael Firstenberg <msfirst at gmail.com> wrote:

> there are redo's, and then there are redo's.........often it is probably a
> function or being lucky rather than good..... and depends on what the safety
> net is........
>
> On Feb 9, 2008 11:03 PM, <hgrmd at aol.com> wrote:
>
> > I agree with you, Michael.  I don't know the average mortality for a
> > redo, but I'm sure it's not trivial.
> >
> > Hal
> > Sent from my Verizon Wireless BlackBerry
> >
> > -----Original Message-----
> > From: Michael Firstenberg <msfirst at gmail.com>
> >
> > Date: Sat, 9 Feb 2008 22:17:17
> > To:OpenHeart-L at lists.hsforum.com
> > Subject: Re: [HSF] Another Victory for the LAD Stent.....
> >
> >
> > 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)> > _______________________________________________> >
> > > 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
> > > -----------------------------------------
> > >
> > > _______________________________________________
> > > 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
> > -----------------------------------------
> >
> > _______________________________________________
> > 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
> > -----------------------------------------
> >
>
>