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

[Ani Anyanwu]

> The last descending to OM graft that I scrubbed (as a fellow) - the aorta was so bad that part of it had to be replaced to sew in a graft.> > -michael
 
Michael
 
But surely that is surgical misadventure or surgical arrongance and should not be discussed as risk of this procedure? With complete preoperative (CT scanning) and intraoperative (epiaortic ultrasound) work up, and respect for the findings, surely one should never be in this position? A clamp on the descending aorta and a graft in a heavily diseased aorta to perform CABG cannot be an example of good surgical practice. Surely only patients without substantial atherosclerosis of descending aorta should be offered this approach? 
 
How is your patient doing? I presume your salvage rate with these cases is low: how do you justify the expense and resource use in your center? How many ICU beds have you and on average how many are occupied by VAD/ECMO patients and how long to they tend to stay there? I am trying to be good as of late but I think administration thinks I am putting too many money-losing VADs.
 
Ani



> From: msfirst at gmail.com> Subject: Re: [HSF] Another Victory for the LAD Stent.....> Date: Sun, 10 Feb 2008 17:59:12 -0500> To: OpenHeart-L at lists.hsforum.com> CC: > > The last descending to OM graft that I scrubbed (as a fellow) - the > aorta was so bad that part of it had to be replaced to sew in a > graft. The patient showered everything with aortic grunge and ended > up with necrotizing pancreatitis which needed surgical management - > he survived, but it wasnt easy.> > > -michael> > > On Feb 10, 2008, at 5:45 PM, Donald Ross wrote:> > > Erdinc,> >> > I have only had one case where adhesions were bad and although > > tedious the time an effort was still less than for a frontal attack.> > I have, as yet to come across an inoperable descending aorta but we > > now check it with a cat scan and if it were a problem I would use a > > higher incision and go for the subclavialn.> > Don> >> > On 11/02/2008, at 2:46 AM, erdinç naseri wrote:> >> >>> >> Don,> >> In my hands it has always been difficult to release the pleural > >> adhesions on the side which Ima has been used.Most of the time air > >> leaks happen. Also the descending aorta in these patients are nor > >> so suitable for clamping and punching for proximal anastomoses.. > >> How do you tackle these problems.> >> Erdinc> >> _______________________________________________> >> 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 and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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