[HSF] To "T" or not to "T"

Wed Jan 2 09:48:10 EST 2008

I think there was data to show that adding coumadin did not actually help in
early vein graft closure and the only thing that really helped was Aspirin
within 6 hours of surgery.
Prasanna

On Dec 19, 2007 3:21 AM, Zhandong Zhou <zzhoumd at pol.net> wrote:

>
> The early vein graft failures are usually due to poor vein quality,
> kinking or slow blood flow which forms thrombus inside the vein. You do not
> usually see thrombus inside arterial graft. Kinking is also less common with
> arterial graft. I think coumadin is better than plavix in preventing vein
> graft closure in early post op period.
>
> Z Zhou
>
>
> ----- Original Message -----
> From: "Tea Acuff" <tacuff at swbell.net>
> To: <OpenHeart-L at lists.hsforum.com>
> Sent: Monday, December 17, 2007 2:46 PM
> Subject: Re: [HSF] To "T" or not to "T"
>
>
> > How is this different than the "causes" we place on Vein graft failure?
> >
> > tea
> >
> >
> > ----- Original Message ----
> > From: "zzhoumd at pol.net" <zzhoumd at pol.net>
> > To: OpenHeart-L at lists.hsforum.com
> > Sent: Monday, December 17, 2007 6:45:38 AM
> > Subject: Re: [HSF] To "T" or not to "T"
> >
> >
> > In my experience and talk to the interventional cardiologists, arterial
> graft failure is mainly due to technical failure or competitive flow. If one
> branch become string, there is a reason for it.
> >
> > Z Zhou
> >
> > Sent via BlackBerry by AT&T
> >
> > -----Original Message-----
> > From: Donald Ross <donross at bigpond.com>
> >
> > Date: Mon, 17 Dec 2007 15:54:01
> > To:OpenHeart-L at lists.hsforum.com
> > Subject: Re: [HSF] To "T" or not to "T"
> >
> >
> > Tea,
> > For  the LAD I use a SVG form the aorta ( non-clamped of course) and
> > for other arteries I mostly don't graft if the lesion looks like  it
> > would be amenable to stenting should it cause trouble in the future.
> > Don
> >
> > On 17/12/2007, at 3:34 PM, Tea Acuff wrote:
> >
> >> And what do you do with other 50-75% lesions in large distribution
> >> vessels?
> >>
> >> tea
> >>
> >>
> >> ----- Original Message ----
> >> From: Donald Ross <donross at bigpond.com>
> >> To: OpenHeart-L at lists.hsforum.com
> >> Sent: Sunday, December 16, 2007 10:13:39 PM
> >> Subject: Re: [HSF] To "T" or not to "T"
> >>
> >> Tohru,
> >> Nobody can argue with surgeons who has such a high incidence of early
> >> recaths as yourself.
> >> However, I was intrigued by your observation that the lima to LAD was
> >> more likely to go down distally  if it supported a T graft.
> >> How often do you see this and are you sure the cause wasn't a non
> >> significant LAD lesion?
> >>
> >> This is an important question for me as I have put 944 arteries  onto
> >> the LMA as T grafts. ( 617 radials, the rest rimas )
> >> I only get a recath if the clinical result is sub-optimal and
> >> fortunately that is rare. ( Usually the grafts are patent)
> >> If, as you say, there are a lot of graft occlusions which have no
> >> clinical consequence then I probably have my fair share.
> >> Hopefully they are associated with non significant lesions which
> >> explains my blissful ignorance.
> >> Don
> >>
> >>
> >>> Dave
> >>> I appreciate your detailed comment. I agree in-situ RIMA is better
> >>> than RGEA
> >>> but in-situ RIMA has limitation to reach target sites, such as PDA
> >>> and low
> >>> marginals in many patients. These targets are not good for in-situ
> >>> RIMA but
> >>> it consistently reaches anywhere in LAD and proximal parts of
> >>> marginal and
> >>> ramus ( via oblique sinus). RIMA's patency is reported to be
> >>> excellent, as
> >>> good as LIMA's, when it is used in in-situ fashion for grafting left
> >>> coronary territories. And free RIMA is not consistently as good as
> >>> in-situ
> >>> LIMA. So free RIMA branching off LIMA is not the best. I can tell
> >>> you that
> >>> even I see a few cases of distal LIMA after giving RIMA off became
> >>> string at
> >>> a few years after CABG. Whereas in-situ RIMA-LAD, in-situ LIMA-OM,
> >>> and
> >>> in-situ RIMA-OM are consistently good in mid and long term. This is
> >>> not only
> >>> my opinion, but most Japanese surgeons ( who live in a strange
> >>> country) know
> >>> it as a sort of common sense with watching many angiograms, I guess.
> >>>
> >>> I tell you that there were many patient recovering uneventfully
> >>> with their
> >>> postop angiogram demonstrating graft occlusions! So how can you
> >>> know you are
> >>> doing all right. I personally could achieve more than 95% patency
> >>> including
> >>> vein graft in early postop angiograms, mostly due to avoiding
> >>> multi-branching composite configuration.
> >>>
> >>> I am aware that some are concerned about RIMA crossing midline
> >>> anteriorly,
> >>> but I don't mind to perform resternotomy ( actually did several
> >>> cases for
> >>> redo cab, aortic arch, AVR, mitral, tricuspid cases) as long as I
> >>> did the
> >>> first operation. I usually make vertical slit hole just anterior to
> >>> SVC to
> >>> enter pericardial space, in-situ RIMA easily reach distal LAD
> >>> almost always.
> >>> They did very well without entry problem at all in my experience.
> >>> Surprisingly skeletonized IMA and GEA conduits looked as if they
> >>> had been
> >>> harvested yesterday. I recommend you not to make y composite LIMA
> >>> and RIMA
> >>> routinely. I know it is not as good as you expect from my "strange"
> >>> upside
> >>> down countryman view.
> >>>
> >>> Problems of arterial conduits are more related to flow competition.
> >>> Once it
> >>> stringed, nobody can tell that it may come back when the native
> >>> stenosis
> >>> becomes critical. There are a few reports of re-growing of "string
> >>> sign",
> >>> but clinically many recurred angina or MACE in real (strange) world.
> >>>
> >>> Only 75% stenosis of proximal RCA is not consistently good for any
> >>> arterial
> >>> conduits. I had seen many early postop angiograms of shrinked RIMA,
> >>> RA,
> >>> RGEA. Obviously saphenous vein is the best in the situation, unless
> >>> you tie
> >>> off RCA, which I have never done.
> >>>
> >>> Well, my logic became too long! In summary, I often do
> >>> RIMA,LIMA,GEA all
> >>> in-situ skeletonized with some sequential graftings to young but
> >>> severe
> >>> diffuse 3vessel disease. SV is still useful in moderately stenotic
> >>> large
> >>> target vessels or hemodynamically unstable bad urgent cases.
> >>> ---
> >>> Tohru
> >>>
> >>>
> >>> _______________________________________________
> >>> 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
> >> -----------------------------------------
> >
> > _______________________________________________
> > 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
> > -----------------------------------------
> >
> >
> >
> > -----Inline Attachment Follows-----
> >
> > _______________________________________________
> > 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
> -----------------------------------------
>

-- 
Prasanna Simha M