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

[Tea Acuff]

I listened to the data on this talk and saw some some fancy footwork (statistical curves) analyzed by intent to treat (defined as therapy in 6 weeks) or based on crossover. It was pretty and seemed quite scientific. There were lots of colored (red and blue mostly, Prasanna) lines and p values. It was great.

Unfortunate i started thinking about this process. How can we do a scientific experiment without randomization? I quess we could just do series of protocols and then based on whether we did something or not arrange them in the orders that made the most sense to us based on our clear understanding of the factors involved. That should be pretty good for us surgeons and the public. 

tea


----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Saturday, February 9, 2008 4:38:05 PM
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=aolcmp003000000> > 025> > 48)> > _______________________________________________> > OpenHeart-L mailing list> > > > Send postings to:> > OpenHeart-L at lists.hsforum.com> > >
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