[HSF] Never seen this before

Sun May 25 18:02:21 EDT 2008

I this case praise Allah, thank God and ask them to throw you back into the briar patch while they do the "important" things. What are you going to do with an axial flow pump in the briar patch? Have you been reading Michael's and Ani's posts lately? Ask your wife what she thinks if you don't believe me.
tea

----- Original Message ----
From: "DukeB60 at aol.com" <DukeB60 at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, May 25, 2008 3:54:04 PM
Subject: Re: [HSF] Never seen this before

Ani,
    Long story.  Our cardiologists didn't  like the complexity of taking care 
of them, felt the new heart failure  treatments resulted in no need for VADs 
and transplant, couldn't see a way  to meet the new CMS/UNOS scrutiny for 
numbers and they couldn't identify  one or two to specialize in  transplant and 
VADs.  After a twenty year  program in transplant and ten in VADs they decided 
they didn't want the program  any longer.  I think it is very bad timing as we 
lived through all the  developmental years of the pneumatic HeartMate, 
REMATCH, the early problems with  the XVE and finally got to the axial flow pumps 
when they decided to not  continue the program.  I had done them alone for five 
years so didn't put  up too much of a fight and have directed my attentions to 
minimally invasive  valve surgery, arrythmia and robotics.  I must say my 
practice  is comparatively a piece of cake after all the years with the VAD 
program  but the timing is certainly ill conceived when it seems everyone else is 
moving  toward VADs rather than away.  But what can you do when the  
leadership of the cardiology group took a different philosophical  path.

                  Ed

Edward P. Raines, M.D., J.D.
BryanLGH  Cardiothoracic Surgery
BryanLGH Medical Center East 
1600 South 48th  Str.
Lincoln, Nebraska 68506
Office: 402-481-8430
Cell:  402-730-9242
Fax: 402-481-8429

In a message dated 5/25/2008 3:40:54 P.M. Central Daylight Time,  
anianyanwu at hotmail.com writes:

>I  used the HeartMate coring device on the first ones but we can't reuse 
them and  since we don't do VADs any longer we ran > out.

Ed

Why  did you stop doing VADs?

Ani

> From:  DukeB60 at aol.com> Date: Sun, 25 May 2008 13:30:06 -0400> Subject: Re: 
[HSF] Never seen this before> To: OpenHeart-L at lists.hsforum.com> CC:  > > 
Hal,> Yes, I have done them on pump but know they can be done  without. I used > 
to put in VADs the same way and even though there were  those who put them in 
> off pump I always did it with pump assist while the  LV was open. What did 
> you use for the valved conduit and the LV conduit?  Did you place the LV > 
sutures prior to coring and what did you use to core  the LV. On the last case 
I > used the Medtronic coring tool. I used the  HeartMate coring device on the 
> first ones but we can't reuse them and  since we don't do VADs any longer 
we ran > out. I thought the Medtronic  tool worked fine and actually pretty 
much just > use it to score the LV  anyway then actually cut out the core with a 
15 blade > and dilate it to  the needed size with Hagar dilators.> > Edward P. 
Raines, M.D., J.D.>  BryanLGH Cardiothoracic Surgery> BryanLGH Medical Center 
East > 1600  South 48th Str.> Lincoln, Nebraska 68506> Office: 402-481-8430> 
Cell:  402-730-9242> Fax: 402-481-8429> > > > In a message dated  5/25/2008 
12:24:19 P.M. Central Daylight Time, > hgrmd at aol.com writes:>  > Ed,> Those are 
exactly my thoughts. Are you doing them without pump?  In my > case, I was 
cannulated, but didn't find it necessary.> >  Hal> Sent from my Verizon Wireless 
BlackBerry> > -----Original  Message-----> From: DukeB60 at aol.com> > Date: Sun, 
25 May 2008  13:13:42 > To:OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] 
Never  seen this before> > > Hal,> I have done four so far and even  though 
they were all very old with many > co-morbidities they have each  done very, 
very well. Rather than turn them > down for traditional surgery  it has been a 
very good alternative. > > > Ed> > Edward P.  Raines, M.D., J.D.> BryanLGH 
Cardiothoracic Surgery> BryanLGH Medical  Center East > 1600 South 48th Str.> 
Lincoln, Nebraska 68506> Office:  402-481-8430> Cell: 402-730-9242> Fax: 
402-481-8429> > > >  In a message dated 5/25/2008 11:14:42 A.M. Central Daylight Time, > 
Hgrmd at aol.com writes:> > Ed,> Did my first apico-aortic conduit last  
Thursday. No pump. Patient was > extubated on the table. Doing fine so far.  Looks 
like a nice option for > patients with a hostile ascending aorta.>  > Hal> > > 
> **************Get trade secrets for amazing  burgers. Watch "Cooking with > 
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