[HSF] be kind to SVG

Mon May 19 19:21:17 EDT 2008

Ok, Today I perform a mammary to lad and SVG to OM.
I dissect the saphenous vein.
I don`t distended the graft.
when I connected the vein to the cardioplegia line, that was at the same 
time connected to the ascending aorta (90mm Hg of systolic pressure), NO 
BLOOD EXIT FROM THE OTHER SIDE OF THE VEIN.
So, I have to distend the vein "gently".with a siringe.
The vein distended and a new attempt was performed.
BLOOD EXIT FROM THE OTHER SIDE OF THE VEIN.
So.
The next " with saphenous" surgery I will try to distend the vein 
controlling the pressure of the graft no trespassing 100mm of Hg.
Any comments, tips?
gustavo.
----- Original Message ----- 
From: "Dan Waters" <DWATERS at mcclinic.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Monday, May 19, 2008 9:54 AM
Subject: Re: [HSF] be kind to SVG

For preparing a SV conduit using heparinized blood at physiologic pressure, 
see Annals of Thoracic Surgery  56:385-6, 1993.  Although described at the 
time for on-pump cases, this technique works just as well for off-pump.

DJW

>>> Donald Ross <donross at bigpond.com> 5/19/2008 12:22:16 am >>>
Ani,
You are correct regarding my fear of single ima inflow for tight LM
especially if it is  dominant.
I am not sure I would have baulked at bilateral ima unless she was
diabetic and obese as well as on steroids.
If you used a vein as I did today ( radial not available ) I hope you
used a no-clamp proximal technique.
Incidentally, my case was a little old lady with a rapidly tapering
SVG from her thigh and I lysed it's valves to enable it to be non-
reversed because the distal vein was too small for a proximal
anastomosis.
Furthermore, for those who don't want to distend the SVG
hydrostatically ( which should be all of you ) a simple flush with
verapamil followed by a soak in the same stuff releases spasm as it
does for the radial artery.
Don
On 18/05/2008, at 11:26 PM, Ani Anyanwu wrote:

> Don, Hal, Michael et al
>
> We are influenced by preconceptions - that is the essence of
> decision making. What differs is what that preconception is and how
> much weight we add to it. I must agree that my preconception here
> is that all veins are bad so that is my bias.
>
> My suggestion of low vein graft patency is not however a
> preconception but based on fact. If you were to study data from the
> 1980s and 1990s, most studies you will come across found a vein
> graft patency of 85 to 90%. However, if you look at contemporary
> multicentre US studies published in last 5 years that included
> graft patency as an outcome, the story is different with patency of
> 70%.
>
> Hal - you may *think* your vein graft patency has remained constant
> over the years, but I seriously doubt that is the case and that if
> you performed angiograms you would surprised at how many of your
> patients are walking around, many asymptomatic, with blocked
> grafts. Before I go into any data, think back Hal on those patients
> you operate on (done elsewhere or by you) for ischemic MR following
> previous CABG - have you not come across several with grafts down
> to circumflex or RCA within a year or two of surgery? We certainly
> have.
>
> For anyone who wants data, a good starting point is the recent
> analysis from Prevent IV trial published recently in annals. Magee
> et al Annals of Thoracic SurgeryVolume 85, Issue 2, February 2008,
> Pages 494-500. This included data from over 3000 CABGs done 2002-3
> in 107 US centers so I find it hard to believe this will not be
> generalizable to the most of the US. About 2,000 (over 4,000) had
> one-year angiograms as per study protocol. The results? A stunning
> 46% of patients on-pump and 45% off-pump had at least one vein
> graft stenosed within a year of surgery. Analysis by graft, rather
> than patient, showed 25% of veins, both on or off-pump, were
> stenosed within a year of surgery (IMA failure rate 8%). The
> authors looked for predictors of vein graft stenosis and guess
> what? Endoscopic harvest was a predictor of early failure of vein
> graft, more so with off-pump (odds-ratio 1.8) than on-pump (odss
> ratio 1.3). This is very believable and I suspect is the case in
> all our centers.
>
> Michael - while quality of targets may have a role, do not for one
> second think US patients have the worst quality in terms of conduit
> or distals. Speak to Prasanna and he might give you a different
> perspective. Indeed one of the things that struck me on moving from
> the UK to the US was the abundance of good quality distals to graft
> here, as opposed to the tiny indian vessels typical of west london.
> I doubt one could explain decreasing vein graft patency on quality
> of conduits and targets alone.
>
> Biologically too there are reasons to believe endoscopic harvest is
> inferior and that initial intimal disruption does predispose to
> vein graft thrombosis. Unfortunately the early trials of endoscopic
> harvest were introduced without trials that included the true
> outcome (angio patency) so we may never know for sure.
>
> Don I hear you regarding anaortic grafts. I operated 2 days ago
> OBCAB*3 on an 80 year old with 90% Left main stenosis on
> corticosteroids for rheumatoid arthritis - would you do bilateral
> IMA OPCAB in him? Odd I placed a vein graft and quoted you as
> justification because I thought you taught me not to rely on a
> single IMA inflow for a tight left main? Or have you ditched the
> vein entirely
>
> Ani
>
>
>
>
>
>
>> From: donross at bigpond.com> Subject: Re: [HSF] AATS> Date: Sun, 18
>> May 2008 14:15:12 +1000> To: OpenHeart-L at lists.hsforum.com> CC: >
>> > I agree, Hal.> Ani has shown himself to be influenced by
>> preconceived ideas like the > rest of us.> Just because he has
>> seen an odd SVG acutely occluded the cause must > be traumatic
>> harvest. Ani, welcome to anecdote land!> SVGs start to fall off
>> the perch at ten years so why is a good eight > year patency so
>> special?> I can't understand why anyone would want to use them for
>> a > significant stenosis anyway, but that is just my
>> unsubstantiated view.> So, if you need a CABG Ani, Martin Misfeld
>> can now fix you up with an > anaortic arterial opcab.> Don> > On
>> 18/05/2008, at 8:24 AM, 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> >> >> >> >
>> **************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/msnnkmgl0010000002ukm/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
>
> 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
-----------------------------------------
_______________________________________________
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
-----------------------------------------

-- 
No virus found in this incoming message.
Checked by AVG.
Version: 7.5.524 / Virus Database: 269.23.21/1454 - Release Date: 5/19/2008 
7:44 AM