[HSF] off-pump CABG and mesenteric ischemia

[Tea Acuff]

Just keep doing what you are doing, Prasanna. Although Ani won't like it since he can not get any credit for destorying your "literature", I bet he also at some level agrees with your efforts. 
To paraphrase the large (larger than life?) doctor Bill that does small children: literature smemature. We were arguing in Dallas what the afib data meant, and a famous doctor said that the peer reviewed literature (we should do an analysis on that term) was pretty clear that bipolar RF was the emerging consensus. I mentioned Prasanna's 8 year data of the "cautery" Gunga Din approach and reminded him that we thought we were pretty smart about the "proper" technique for CABG in the early 1990's until we noted that there was series of 800 patients from Brazil done off pump. We need to get over the "results" in general literature being what drives successful practice and focus on results in the micro. I would call this the Hunterian approach: when things are fuzzy look to your own patients, not the literature first. Cards don't care about our standards and they are half right (at least half right).  
tea



----- Original Message ----
From: Prasanna Simha M <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, May 25, 2008 6:11:01 AM
Subject: Re: [HSF] off-pump CABG and mesenteric ischemia

Well, Hal,
I agree there is no literature but I am documenting all the cases and so far
there is a striking thing - change of a monophasic pattern to a good
triphasic pattern on Doppler with initiation of NTG and the reversal with
stopping it and return of the triphasic waveform on reinitatiation and these
cases also have preservation of hepatic function. The  testing has been done
repeatedly at post shifting, 12 and 24 hours later.All these patients have
high Euroscores (for whatever it is worth) .  Let us see after a few more
cases like this. The clinical significance of this will obviously take some
time.If I become less lazy and start writing up it then probably then
literature may be available !!. It is obviously a slow process collecting
such cases and is a work in progress. One problem with selective perfusion
is that hooking it in the hepatics would be problematic and also I am
worried about the catheter itself impeding flows. The difference in venous
versus arterial NTG is also striking !! probably related to NTG metabolism,
first pass effects etc. The added benefit is renal arterial vasodilatation
when the catheter is kept suprahepatic in position.I have taken cross
sectional diameters of these vessels 9hepatic and renal) and there is an
increase in diameter = for eg as far as the hepatic arrtery in the previous
case It was 8mm and triphasic flow with NTG on, 5mm and monophasic flow off
NTG. Let us see. I was sharing my results. Let us see.
Prasanna
On Sun, May 25, 2008 at 4:18 PM, <Hgrmd at aol.com> wrote:

> Prasanna,
>  Though it seems to work in your hands, I'd have to agree with Ani  that
> your intraortic NTG perfusion of the liver has virtually no clinical
>  backing in
> the literature that I'm aware.  Certainly it makes some  theoretical sense,
> though a selective catheter the vessels would probably make  more sense.
>
> Hal
>
>
>
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-- 
Prasanna Simha M
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