[HSF] DES-SVG anastomosis

[Donald Ross]

I would add plavix for 6 weeks incase there is aspirin resistance.
Don
On 19/03/2008, at 1:47 PM, Mladen Kocica wrote:

> Hi,
>
> Has anybody actually saw intracoronary stent intraoperatively? I  
> can't sleep tonight, because I did so yesterday on purpose.  
> Moreover, I've done the atherocut of it. Yet, to have a real  
> nightmare, I sew the graft to the end of it. Enough? Why nightmare?
> The patient received 1 DES on proximal LAD 2 years ago. He stopped  
> Plavix 1 year ago and 6 months ago, he returned with svere angina.  
> Cath revealed 70% and 90% in-stent-stenoses with patent distal LAD.  
> Without any logical reason, he was adviced to continue with pills.  
> Of course, he finally came to us, with no relief.
> I hoped to OPCABG him, according to (bad estimation) still valid  
> cath! As devil never sleeps, I decided to open the pericardium  
> before LIMA harvesting, and I was astonished with LAD appearance.  
> It was petrified on entire lenght. No place to cut. Than comes the  
> crazy part. Open LAD endarterectomy. I got several septals and  
> diagonals free, and at the most proximal point, I met HM the stent,  
> "gazing" at me. A hell of a scene. I read a lot about autopsy  
> findings of severe inflammation arounf this piece of iron, but this  
> was my first eye-to-eye meeting with this kind of reality. If all  
> peri-stent tissues are the same - do not dare to remove stents. Its  
> impossible. Nevertheless, the cavity of it was apparent, as well as  
> neointimal proliferation, occluding its lumen. I started wash-out  
> with cardioplegia and "re-opened" the stent with 1.5mm aterocut.  
> The final act was to "cover the hole" I've made. I sew the SVG heal  
> for the BMS and patched the opened LAD with the rest of the vein.  
> This thing was working!?! Entire procedure uneventfull. ECG normal.  
> Patient stabile in ICU. Ordered heparin with target aPTT 85-100. No  
> bleeding. I intend to continue with aspirin and to switch heparin  
> with OAT, after chest tube removal.
> Has anybody did such stupid thing so far. Its been 12 hours since  
> we finished, and everything is still quiet. I do expect that stents  
> would close again, but I can't swear.
> So, I am ready. Shoot, please!
>
>
> Mladen J. Kočica, M.D.
> Consultant Cardiac Surgeon
> Clinic for Cardiac Surgery
> Clinical Centre of Serbia
> 11000 Belgrade
> Serbia
> Phone: +381(11)3670609
> E-mail: kocica at sezampro.yu
> URL: www.kocica.org <http://www.kocica.org/>
> CTSNet: www.ctsnet.org/home/mkocica
>
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