[HSF] Full metal jacket

[Donald Ross]

Very interesting Tohru,
The main difference in our techniques is, I guess, the fact that the  
size of the conduit never prevents me from doing a diamond anastomosis.
Provided the conduit is bigger than the coronary which is invariably  
the case.
If the coronary incision is too long for the diameter of the conduit  
( to do a diamond ) I shorten the coronary incision with a few  
sutures in the heel.
Don
On 04/01/2008, at 1:56 AM, Tohru Asai wrote:

> Dear Zhandong
> Don has already answered his strategy. But I would put my thought as
> well.Hope it helps.
>
>> How to you make the incision on the vein graft?.
> longitudinal
>
>> Do you do anything different if the vein is small but do not have
>> enough vein.
> No. Vein is almost always larger than artery, so I don't care. But  
> if its
> quality is poor,I will harvest other arterial conduit.
>
>> How many maximal sequential anastomosis you will do?
> As far as its size and course look fine, max 4 for SVG, Max 3 for  
> LIMA, Max
> 3 for GEA.
>
>> Do you
>> believe sequential is better than single?
> It depends. Single vein to thin target with poor run-off will not  
> survive in
> long term, I guess. But we don't know real data.
>
>> When you do LIMA to Diag and LAD,
>> how do you make incision on the LIMA.
> Longitudinal. Lately I do RIMA to LAD, then LIMA to Diag and OM  
> more often,
> give a little more respect to LAD ( deserve for single IMA).
>
>> is diamond anastomosis better?
> I use "diamond" or "parallel"(in-line by Don), depending on the  
> more natural
> angle between the conduit and the side-to-side target site. And in  
> thin
> arterial grafts, I generally avoid diamond anastomosis.and use  
> parallel
> anastomosis often. In diamond, I make incision on arterial (or  
> vein) graft
> no more than 1/3 of its circumference in order to avoid seagull  
> deformity.
> In most cases, I usually use diamond for SVG, GEA, RA and some IMA  
> with care
> taken for reasons mentioned above. On the contrary, I generously use
> "parallel" anastomosis quite often when the angle is OK.
> -- 
> Tohru Asai
>
>
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