AW: [HSF] Tandem LAD lesions

[Tea Acuff]

I hope that you were successful on the third try...it ain't over til we say its over....
tea


----- Original Message ----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, March 11, 2008 7:53:38 PM
Subject: AW: [HSF] Tandem LAD lesions

I have done many LAD-LAD sequential LIMA grafts, and once I did it 3 times.
I always try to make D1-LAD sequential with LIMA if the D1 is of good
calliper. May be you need to clamp the aorta. Epiaortic echo as control
gives you a basis of security where to clamp.
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Prasanna Simha
M
Gesendet: Montag, 10. März 2008 02:00
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: [HSF] Tandem LAD lesions

Options - vein/arterial graft to Diagonal _ LIMA to LAD
Sequential D1 LAD with LIMA (preserves an artery for further surgeries)
Split plaque and one long patching of LAD at site of split (may have a
higher anastomotic failure rate unless patch is long enough)
Choice will be dictated by coronary anatomy, how parallel the vessels
are and how high is the diagonal.
Prasanna

On Sun, Mar 9, 2008 at 11:19 PM, Michael Firstenberg <msfirst at gmail.com>
wrote:
> I have been asked for an off-pump LIMA to LAD on a patient in whom the
>  cardiologists think is not a good candidate for long-term Plavix (long
>  story, but let me just say related to a previous gunshot wound to his
head).
>
>  He has a high-grade proximal LAD stenosis, but he also has a mid/distal
high
>  grade stenosis with a nice diag. inbetween.
>
>  My thoughts are grafting the diag with a vein and the distal LAD with a
LIMA
>  (or maybe even a free RIMA off the LIMA to the diag).
>
>  Would anyone do anything different (like put the LIMA to the Diag) and
>  something else to the distal LAD?
>  (of course with current "pay for performance measures" I may get "dinged"
>  for not putting a LIMA to a LAD)
>
>
>
>  -michael
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-- 
Prasanna Simha M
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