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

[Prasanna Simha M]

The simple reason is a redo CABG with a patent LIMA is a more treacherous
operation. Doable but with far more unknowns and unpredictables to it.In a
redo there are no friends and only enemies.
Prasanna

On Feb 10, 2008 4:08 AM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:

> 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=aolcmp003000000>
> > 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
> -----------------------------------------
>



-- 
Prasanna Simha M