[HSF] Full metal jacket

[zzhoumd at pol.net]

Tohru,

Thanks for your detailed explanation. One of the concern in multiple sequential grafts is the risk of losing multiple distals if the sequential graft goes down. It seems that you rooutinely doing them and not worried about it.

 Z Zhou


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-----Original Message-----
From: Tohru Asai <toruasai at belle.shiga-med.ac.jp>

Date: Thu, 03 Jan 2008 23:56:02 
To:<OpenHeart-L at lists.hsforum.com>
Subject: Re: [HSF] Full metal jacket


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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