[HSF] A question of conduits

[Tea Acuff]

Sounds cute.

Let me tell you what is a different, or perhaps not so different but not much spoken, way of looking at this problem. Don Ross obliquely mentioned this, but dove in anyway.

I don't see any reason to do anything fancy. To the credit of others it seems that they are probably doing a variation of their rountine. Since I am as Bill noticed similar to some of the OZ characters, I can't make much sense of the literature in helping us that much. The wizard is largely a fraud.

However, as I look at the patient he seems to say that none of his clogged arteries are critically important to him. This leaves one with the opinion that either the diagonal is a major vessel for him (you have the advantage of actually seeing the cath), or the more normative position that actually the LAD is his only critical vessel but has noncritical disease. The other distributions have the advantage of already being closed without killing him or his ventricle, thus these cards are played. Thus depending on his quality and size of Lad and Lima, I would SAVE his Lima for the LAD either now or later. RSV or any conduit should be just fine for this patient for his other vessels.

tea


From: Mitch Lirtzman <drmitch at cox.net>
To: OpenHeart-L at hsforum.com
Sent: Tuesday, March 25, 2008 10:58:58 PM
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

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