[HSF] To "T" or not to "T"
Prasanna Simha M
prasannasimha at gmail.com
Wed Jan 2 17:19:51 EST 2008
How long do you give Coumadin for ?
Prasanna
On Jan 2, 2008 5:14 PM, <zzhoumd at pol.net> wrote:
>
> It was my observation. I usually see vein grafts looked better if they are
> on coumadin for some reason.
>
> Z Zhou
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: Ben Bidstrup <benjamin.bidstrup at bigpond.com>
>
> Date: Wed, 2 Jan 2008 18:54:16
> To:OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] To "T" or not to "T"
>
>
> There was the French study EPPAC 1991, which looked at the use Vit K
> A + persantin and Vit K A without persantin. Rates were pretty grim!
>
> >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
> >> >>>
> >> >>>
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> >
> >
> >--
> >Prasanna Simha M
> >_______________________________________________
> >OpenHeart-L mailing list
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> >-----------------------------------------
>
>
> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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Prasanna Simha M
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