[HSF] A question of conduits

[murali vettath]

Dear Mitch,
 
It was nice to know that you are doing OPCABs  most of the time and have been able to avoid conversions. 
For those circ grafts, I would suggest you visit centers which do them routinely, and fine tune your technique, as its not easy to just say, you do this or that.
 
I would suggest lifting the head end up and avoiding distention first. Then use expose to vertcalise the heart and maintain hemodynamics. 
I routinely use shots of atropine to increase the heart rate and there by the stroke volume.
 
with these you should be able to do any circ vessels comfortably.
regards,Dr Murali Vettath. Sr Consultant & Chief cardiac surgeon. Director- Malabar Institute of Medical sciences. Mini Bypass rd.Govindapuram kozhikode. 673016 kerala. India.www.mvettathcts.com> Date: Tue, 25 Mar 2008 22:58:58 -0500> To: OpenHeart-L at hsforum.com> From: drmitch at cox.net> CC: > Subject: [HSF] A question of conduits> > 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> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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