[HSF] Another Victory for the LAD Stent.....
Michael Firstenberg
msfirst at gmail.com
Sat Feb 9 23:24:48 EST 2008
Besides, I think overall the data on redo-CABG - unlike any other
redo (i.e. AVR/MVR/aorta etc) is pretty sparse and limited to clearly
defined indications.......
I had a senior mentor who always used to say - "no one ever died of
circ disease".......
-m
On Feb 9, 2008, at 8:23 PM, jbflegejr at aol.com wrote:
> Left thoracotomy is worth considering for redo with patent LIMA to
> LAD. The lateral wall of the heart can be nicely exposed and even
> the PDCA. It is not so easy in very obese patients or very
> emphysematous patients. The axillary artery is good for proximal
> anastomosis for SVG or radial artery. The LIMA may be used for a
> proximal anastomosis and only a short conduit is needed for the
> obtuse marginal. John Flege
>
>
> -----Original Message-----
> From: Edward Bender <ebender001 at charter.net>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Sat, 9 Feb 2008 5:54 pm
> Subject: Re: [HSF] Another Victory for the LAD Stent.....
>
>
>
>
>
>
>
>
>> Either we believe in something or we don't.
> This is not an "either or" situation. I think repeat CABG can be a
> difficult operation, with less likelihood for complete
> revascularization.
> Also, there is an albeit small but real risk of damage to the LIMA
> graft. On
> balance, if a catheter based approach can avoid the risks of repeat
> surgery
> with a good likelihood of symptom relief, then I'm all for it. If,
> on the
> other hand, the risks of PCI are higher than that of surgery, then
> I would
> push for repeat CABG.
>
> I just know that, in my hands, sometimes even finding a decent OM
> branch to
> graft in a redo is difficult. I have also seen cases where the
> LIMA has
> been left completely untouched, yet, by retracting the heart to get
> to the
> OM territories, the LIMA kinks, causing ischemia, which is
> sometimes not
> temporary.
>
>> I suspect if a redo CABG was a much easier operation we would have
>> a different
>> view.
> And if the queen had balls, she'd be king!
>
> Ed Bender, MD
>
>
> On 2/9/08 4:38 PM, "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=aolcmp00300000
>>> 0> > 025> > 48)> >
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