[HSF] A question of conduits

[Mitch Lirtzman]

Let's start a new thread, shall we?

A 56yo male, non-diabetic smoker, admitted with NSTEMI. Cath shows total OM 
with faint distal flow as the culprit. RCA 100% w/ collateral to the PDA. 
D1 is 90% and LAD 40%-50% at most. LVEF~ 45%. Body habitus is mesomorph 
bordering on Cajun-porky.

My plan would be skeletonized RIMA to the PDA, try to get the LIMA from D1 
to OM and probably leave the LAD alone.

Any thoughts/ contrary opinions?

Now, I hope you don't mind my changing directions, but for you "OPCAB-ers" 
out there, for the last several cases, I've been able to graft every vessel 
I need to, but for the last two, in positioning for the circ, the BP would 
just not tolerate the change. Trendelenburg, Rt lateral, volume loading, 
none of it worked. And "putting the heart into the rt chest", the worst. 
Any pearls would be happily accepted.

Thanks, Mitch