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

[Michael Firstenberg]

that case was a few years ago and I do not remember the details.....

Our ecmo pt is waking up a little - he is a project of one of my  
partners, so we will have a better sense of the plan in the next few  
days.  If he wakes up we will probably convert him to LVAD +/- RVAD  
depending on his heart, transplant status, social situation, etc.     
We have 2 acute VADs (<30 days post-op), there must be the flu around  
since we have 2-3 more with FUO work-ups, a CVA, a drive line, and 2  
chronics who we cant DC.  This is a lot for us now - we usually have  
2-3 acutes and another 2-3 chronics.

We only use ecmo 4-6 /year.... dont like it too much....

Our average LOS for all comers is about a month and I keep hearing we  
make money off VADs --- even the few hits we take on no insurance  
patients (I think we get them on Ohio Medicaid).......

-m


On Feb 10, 2008, at 6:52 PM, Ani Anyanwu wrote:

>> 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>  
>> -----------------------------------------
> _________________________________________________________________
> Get Hotmail on your mobile, text MSN to 63463!
> http://mobile.uk.msn.com/pc/ 
> mail.aspx_______________________________________________
> 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
> -----------------------------------------