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

[Ben Bidstrup]

>Ani,
>   You shouldn't be so binary.  The risk of redo CABG is not  trivial.  Most
>patients or potential patients, myself included, would  rather have PCI if
>possible.
>
>Hal
>
I feel it depends a lot on what can be achieved with a PCI vs surgery.
What is the quality of the distal vessels? Ie is it progression of 
native disease. If the targets are good, then a redo CABG can achieve 
more than stenting.
If it is grafts that are being stented they are severely diseased and 
are likely to have further problems over time.
The difficulty is when there is a combination of both. When PCI can 
do no more, which is frequent and the patient is willing then surgery 
is an option. Maybe with all the PCI being done in these patients, we 
are losing the skills for redos. That is a bad thing. I agree that at 
times some vessels are ungraftable when you get in there, they do not 
do all that well.
This is a place for TMR if the LV is OK.
As J Pym and others recently commented, what about a Vineberg.
-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon