[HSF] Full metal jacket

Tea Acuff tacuff at swbell.net
Fri Jan 4 15:39:04 EST 2008 

Fire on, Don. I am sure many have finally learned to hit the delete key when they see my name. Maybe they can add you to list, but i bet technique is higher on the interest list than epistemology...
Just don't call me sweet.

tea


----- Original Message ----
From: Donald Ross <donross at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, January 3, 2008 5:05:51 AM
Subject: Re: [HSF] Full metal jacket

Sweet of you to say so Prasanna, however,  I am  reluctant because I  
have given it so many times over the years.
You know about pearls and porcae?
Better, I  think, for those few who are really interested in getting  
out of the convenient  vein-mammary rut to contact me directly.
BTW we have an interesting paper in press demonstrating a reduced  
stroke incidence  between the instrumented and non instrumented aorta  
in opcab patients. When it is published I will give the forum the link.
Don

> Don, it would be wonderful to hear your experience in the list. Mnay
> wouldbenefit from your pearls !!
> Prasanna
>
> On Jan 3, 2008 3:51 AM, Donald Ross <donross at bigpond.com> wrote:
>
>>
>> On 03/01/2008, at 12:50 AM, zzhoumd at pol.net wrote:
>>
>>>
>>> Sorry, I did not make the question clear.
>>>
>>> How to you make the incision on the vein graft,
>> longitudinal
>>> . Do you do anything different if the vein is small
>> no
>>> but do not have enough vein
>> get more
>>> . How many maximal sequential anastomosis you will do?
>> No limit ( 4 is  not infrequent )
>>> Do you believe sequential is better than single?
>> No, just more efficient of time and conduit
>>> When you do LIMA to Diag and LAD, how do you make incision on the
>>> LIMA.
>> Same as above,
>>> is diamond anastomosis better?
>> No, just more convenient and and easier to measure and avoid kinks
>> and saves precious arterial conduit when your graft crosses the
>> target between 50 and 90 degrees.
>>
>> Zho,
>> If you need more detailed technical information about my multiple
>> arterial graft techniques talk to me off the forum by email or skype.
>> Cheers,
>> Don
>>>
>>> Thanks!
>>>
>>> Z
>>>
>>> Sent via BlackBerry by AT&T
>>>
>>> -----Original Message-----
>>> From: "Prasanna Simha M" <prasannasimha at gmail.com>
>>>
>>> Date: Wed, 2 Jan 2008 10:06:10
>>> To:OpenHeart-L at lists.hsforum.com
>>> Subject: Re: [HSF] Full metal jacket
>>>
>>>
>>> Ah but the tips and tricks to determine the "just right length !!
>>> Prasanna
>>>
>>> On Jan 2, 2008 10:00 AM, Donald Ross <donross at bigpond.com> wrote:
>>>
>>>> Same as any other graft: not too long, not too short but just  
>>>> right.
>>>> ( Goldilocks technique)
>>>> BTW skeletonised arteries are the most forgiving and preferred by
>>>> Goldilocks and others.
>>>> Don
>>>> Is a southern cross and angry Texan or the progeny of him and his
>>>> domestic help?
>>>> On 19/12/2007, at 8:56 AM, Zhandong Zhou wrote:
>>>>
>>>>> Dr. Asai,
>>>>>
>>>>> How do you avoid kinking in sequential grafts.
>>>>>
>>>>> Z Zhou
>>>>>
>>>>> ----- Original Message -----
>>>>> From: "Tohru Asai" <toruasai at belle.shiga-med.ac.jp>
>>>>> To: <OpenHeart-L at lists.hsforum.com>
>>>>> Sent: Saturday, December 15, 2007 7:56 AM
>>>>> Subject: Re: [HSF] Full metal jacket
>>>>>
>>>>>
>>>>>> Nasser
>>>>>> Thanks for your compliment. Since I am an originator of the
>>>>>> thread, I am
>>>>>> resposible to show the outcome.
>>>>>>
>>>>>> At the operation, since she was diabetic and circumflex was  
>>>>>> fairly
>>>>>> large
>>>>>> with not critically stenotic and good native coronary flow, I
>>>>>> decided not to
>>>>>> use arterial conduit for cx. Other target vessels were all 1.0 mm
>>>>>> to less
>>>>>> than 1.5 mm at most. My strategy was to pick up these with
>>>>>> sequential
>>>>>> technique and arterial graft usage. Arterial graft has ability to
>>>>>> adjust its
>>>>>> luminal size to distal vessels. So we rarely see thrombosed
>>>>>> occlusion in
>>>>>> early phase like saphenous vein.
>>>>>>
>>>>>> I do isolated CABG in mostly off-pump fashion and did it. But as
>>>>>> Dr.Zhou
>>>>>> suggested, On-pump cabg may be especially preferred for this kind
>>>>>> of thin
>>>>>> target as long as bleeding due to clopidogrel is not a concern.
>>>>>>
>>>>>> I check all graft flows in OR with transite time flowmeter. I
>>>>>> cannot find
>>>>>> the operating record now, but I remember good diastolic  
>>>>>> augumented
>>>>>> flow in
>>>>>> all three conduits. Heparin was reversed half dose. No  
>>>>>> significant
>>>>>> bleeding
>>>>>> was observed.
>>>>>>
>>>>>> Lately the cardiologist, who took over the previous man,
>>>>>> thankfully sent
>>>>>> CD-ROM of postop angiograms. I made a few pictures from it and
>>>>>> attach to
>>>>>> this mail.
>>>>>> --
>>>>>> Tohru Asai
>>>>>>
>>>>>
>>>>>
>>>>> ------------------------------------------------------------------ 
>>>>> --
>>>>> --
>>>>> ----------
>>>>>
>>>>>
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>>>
>>> --
>>> Prasanna Simha M
>>> _______________________________________________
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>
>
>
> -- 
> Prasanna Simha M
> _______________________________________________
> OpenHeart-L mailing list
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