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

Donald Ross donross at bigpond.com
Mon Feb 11 10:13:33 EST 2008 

Mitch,
I think I have answered most of your questions in my reply to Michael.
I sympathise with the problems you have with your huge arse  
population but we are catching up fast and my impression is that the  
length of the forearm is a fixed ratio to the size of the heart  
irrespective of the width of the backside.
I think I am able to use smaller radials than I would be happy to  
anastomose to the aorta, however, because I invariably attach them to  
an ima.
So I guess you can be partially forgiven for using the fools gold of  
coronary surgery so often.
Don
On 11/02/2008, at 4:17 AM, Mitch Lirtzman wrote:

> 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)> >
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