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

Sat Feb 9 23:10:10 EST 2008

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)> > _______________________________________________> >
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