[HSF] radial artery-vein patch

[Donald Ross]

John,
A crappy ima is a contraindication but this is very unusual in my  
experience. Perhaps because they are skeletonised and the extra  
length puts the T graft more proximal. Even when the ima dissects it  
is usually the distal third so it can be still used as a composite  
with the radial.
Low EF and large hearts are actually an indication because you get  
all that extra radial length to play with.
If there is LM or the patient is unstable I add to the inflow by  
using both imas
Don

On 04/03/2008, at 2:03 PM, john pj wrote:

> Dr Don,
>
>   Do you think there are any conditions where one has to avoid   
> LIMA T/Ygrafts.
>
>   I have seen some surgeons avoiding T grafts  in patients with  
> small LIMA, low EF or large hearts.
>
> Hgrmd at aol.com wrote:
>   Don,
> The problem is getting through the operation with no conversion. Your
> technique also illustrates a recurring theme of mine that for a  
> particular
> procedure, better outcomes are associated with higher volume. When  
> I used to do
> a significant number of standalone CABG's, better than half were  
> done off
> pump. Now, if I get stuck with a standalone, I opt for the pump  
> unless the
> aorta is really bad, or if there are only a couple of grafts to do.  
> Again,
> thanks for sharing.
>
> Hal
>
>
>
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