[HSF] AATS

[Michael Firstenberg]

I am sure that the brutal way in which tissue is handled - be it vein,
radial, or even IMA can have a huge potential impact on long term patencies
- against something probably impossible to prove but something that makes
sense.  We must continue to search for why veins dont work as well as IMAs
(I in fact have an active research project in this area, but can not get
funding - hmmmm why?  probably no expensive disposable or lifelong
medications involved).  But if we put a vein to a crappy diffusely diseases
target - then of course it will go down.  May be part of it is that we are
bypass sicker and sicker patients with crappier and crappier targets.  As I
am sure our international colleagues can attest to CAD is different in
different part of the world and to categorically compare the results in one
society to another may be a little misleading.

-michael

On Sat, May 17, 2008 at 6:24 PM, <Hgrmd at aol.com> wrote:

> Ani,
>  For such an analytical fellow, I'm surprised at the conclusions  you've
> drawn about endoscopically harvested veins.  As far as I know,  there's
> never
> been a head to head study comparing open versus closed harvesting  of the
> veins
> in regards to patency.  I have the clinical experience of  having done
> CABG's
> for at least 10 to 12 years of open veins and around 6-8  years of
> endoveins.
> I certainly haven't perceived a difference in  patency.  In other words, I
> can't tell that a lot more cases are coming to  cath with closed grafts as
> compared to open harvested veins.  Indeed, there  may be a difference, but
> it has
> been imperceptible to us.
>  Our P.A.'s are extremely skilled at rapidly delivering an endoscopic  vein
> through a 2 cm stab wound (usually no incision in groin at all) that rarely
> has avulsed branches requiring repair with 7-0.  Quite frankly, I can't
>  tell
> the difference in appearance between open and closed harvested veins.
> Your
> point about dilating with blood and papaverine is well taken.  That
>  preparation
> may be less stressful to the vein's endothelium.  However, in  the end, no
> matter how you prep them, the veins die no matter what you do to  them.
>  That's
> why it is imperative that we spend more time harvesting  arterial conduits
> and
> not letting concerns about time supervene.
>
> Hal
>
>
>
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