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

Sun Feb 10 11:17:10 EST 2008

Don, if I may ask a follow-up to your rant, do you do any pre-op assessment 
of the radials you harvest, or do you harvest and let the chips fall where 
they may. We have a G-Dawful lot of fat/ diabetic smokers down here and a 
large proportion are not harvestable by size or occlusive criteria. 
Sometimes we have no choice but to use an "outmoded, sloppy and dumb" vein 
graft.
Thanks, Mitch  At 05:40 AM 2/10/2008, you wrote:
>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)> >
>>>_______________________________________________> >
>>>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 anddisclaimers 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
>-----------------------------------------