[HSF] New case- CAD + Leriche

Fri May 16 11:01:16 EDT 2008

Hal.
Note the other response.
tea

----- Original Message ----
From: "hgrmd at aol.com" <hgrmd at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, May 16, 2008 10:35:08 AM
Subject: Re: [HSF] New case- CAD + Leriche

Ani,
  Bravo to both you and Dave Adams in having the courage to cite bad results from bad surgical choices.  Specifically, CCF and Barnes report poor results for ischemic mitral repair.  Guess what?  Most of the repairs were done with flexible prostheses.  Garbage in, garbage out.  Last night, I read Crabtree's and Byrne's papers in this month's Annals.  Both of them were rightly condemned by Adams.  It is imperative that we unflinchingly evaluate results, and not worry about the feelings of the authors, no matter who they are.

Hal
Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: Ani Anyanwu <anianyanwu at hotmail.com>

Date: Fri, 16 May 2008 14:31:49 
To:<openheart-l at lists.hsforum.com>
Subject: RE: [HSF] New case- CAD + Leriche

Zhandong

We use the levitronix device (marketed in USA as Thoratec Centrimag) but the last such case I used the tandem heart which has the advantage of potential for percutaneous removal.

Was nice to meet you too at AATS - not everybody liked my talk though as you can imagine...

Ani

> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] New case- CAD + Leriche> From: zzhoumd at pol.net> Date: Fri, 16 May 2008 13:15:56 +0000> CC: > > > Ani,> > Which system are you using now for such short term support?> > BTW, it was great pleasure to hear you talk and meet you in person.> > Zhandong Zhou> > Sent via BlackBerry by AT&T> > -----Original Message-----> From: Ani Anyanwu <anianyanwu at hotmail.com>> > Date: Fri, 16 May 2008 12:53:23 > To:<openheart-l at lists.hsforum.com>> Subject: RE: [HSF] New case- CAD + Leriche> > > > 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> ----------------------------------------->_________________________________________________________________> > http://clk.atdmt.com/UKM/go/msnnkmgl0010000007ukm/direct/01/_______________________________________________> 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> >
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