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

Sun Feb 10 22:40:33 EST 2008

If the crap is cleaned off the ima and it is put behind the lung and  
thymus it is not an issue in redo surgery.
The most dangerous thing is a patent diseased SVG so why use the damn  
fool  things in the first place?
The use of the SVG except in exceptional circumstances is  outmoded,  
sloppy and dumb. Is it any wonder cabg is having a problem competing  
with: " just a little spring and you will be home tomorrow"?
How is that for restraint?
A rant with no mention of opcab.
Don
BTW I have used 864 radials ( two professional pianists, Hal) with no  
ischaemic complications.

On 10/02/2008, at 2:17 PM, Michael Firstenberg wrote:

> 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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