[HSF] Full metal jacket

[Tea Acuff]

I follow Tohru's style more although I don't have number rules and prefer to take a conduit to one "area" of the heart. I use more "multiple end to sides" by U graft and what i should perhaps call saphenous sequential "T" grafts(by using the stump of a branch as a side. 

I still think that a large portion of patients have moderate coronary stenosis in distributions that may also need consideration at the time of CABG.

What if anything does a U due to your model, Prasanna, since there is still a distal after the U?

tea 
 


----- Original Message ----
From: Tohru Asai <toruasai at belle.shiga-med.ac.jp>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, January 3, 2008 8:56:02 AM
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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