[HSF] New case- CAD + Leriche

[Ani Anyanwu]

> I worry about not having a good and safe way to use a IABP and the possibility of severe lower extem ischemia if we have any problem with low output. > > > Tom
 
 
Dr Martin
 
In such a case we would go straight to temporary mechanical support (LVAD) and not mess around with IABP if we have low-output. 
 
Few reasons for this rationale: 1) In reality IABP is probably of limited effectiveness in increasing cardiac output except if cause is myocardial ischemia 2) Avoids risk of vascular complications 3) The alternative - IABP with high dose catecholamines causes selective vasoconstriction in some vascular beds and may predispose to renal, hepatic, gastrointestinal and limb complications. We feel that having a patient with a good cardiac output from the onset, without need for vasoconstrictors may be preferable for organ perfusion and may prevent decline into multi-organ failure. 
 
In this setting we leave the VAD in for 3 to 4 days then explant - at this time myocardial stunning should subside, as should bleeding and need for transfusions, the patient can be diuresed to a nice low CVP and such a short period will hopefully avoid VAD related complications.
 
Ani



> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] New case- CAD + Leriche> Date: Fri, 16 May 2008 07:51:32 -0400> From: tdmartin2000 at aol.com> CC: > > Gentlemen> Thanks for the input so soon. To answer some of the questions posed so far- he does pass the eyeball test and in fact works at the info desk at our hospital, he does smoke but "down to 5 a day", his mitral and aortic valves are OK and I think the low if may be secondary to his MI, his legs are fairly ischemic and currently I do not know the status of his vessels below the inguinal lig. I have thought about all of these approaches and am considering either ax-fem (which I am not?a real fan of) or combined ABF/CAB which I have done on several occasions.> I worry about not having a good and safe way to use a IABP and the possibility of severe lower extem ischemia if we have any problem with low output. > No one has addressed the issue of timing yet in the face of a nonQ infarct?> > Tom> > > -----Original Message-----> From: Hgrmd at aol.com> To: OpenHeart-L at lists.hsforum.com> Sent: Fri, 16 May 2008 7:05 am> Subject: Re: [HSF] New case- CAD + Leriche> > > > John,> Agree with your comments except for the ascending aortic graft to the > iliac. Guaranteed much simpler is a conventional axillary (either right or > left) > bifemoral bypass. Ax-fems have been used for years with good results. For > the first 8 years of my practice, at least half of my time was spent doing > peripheral vascular surgery (I still do a few carotids). I don't currently > read much about vascular surgery, but I know that this is a simple, relatively > atraumatic procedure. BTW, do you know of any studies comparing the 2 > techniques?> > Hal> > > > **************Wondering what's for Dinner Tonight? Get new twists on family > favorites at AOL Food. > (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001)> _______________________________________________> 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> -----------------------------------------> > _______________________________________________> 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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