[HSF] ugly vein grafts

Sat Jul 4 18:36:37 EDT 2009

Left hand from right side of table. Both Medtronic and Edwards make a  
cannula designed for this. I use 24 F and on gravity it will drain 3L/ 
min with table at height for me (67 inches tall). With vacumn 6L/min  
is achieved so full flow bypass can be done with this one cannula. John
On Jul 4, 2009, at 4:18 PM, Roberto Battellini wrote:

>
> That´s different.Do you make the punction with right hand and  
> staying onthe left side of the table or with left hand on the right  
> side?
>
> other details?
>
> Roberto
>
>> From: flege19 at gmail.com
>> To: OpenHeart-L at lists.hsforum.com
>> Subject: Re: [HSF] ugly vein grafts
>> Date: Sat, 4 Jul 2009 16:06:13 -0400
>> CC:
>>
>> I did them all myself after the patient had been prepped and draped
>> for sternotomy and had no carotid punctures. I made the puncture just
>> above the clavicle between the sternal and clavicular insertions of
>> the sternomastoid muscle. So the cannulae and tubing were all in the
>> operative field and under my control. I would never delegate this to
>> an anesthesiologist or to anyone not under my control. John Flege
>> On Jul 4, 2009, at 2:11 PM, Roberto Battellini wrote:
>>
>>>
>>> John, haven´t you seen carotid artery punctions by cannulating the
>>> internal yugular?
>>>
>>> We did. It is operator dependent.The femoral vein is easier.
>>>
>>> Our anaesthetists do it only for mitral+tricuspid MICS
>>>
>>> Roberto
>>>
>>>> From: flege19 at gmail.com
>>>> To: OpenHeart-L at lists.hsforum.com
>>>> Subject: Re: [HSF] ugly vein grafts
>>>> Date: Thu, 2 Jul 2009 09:22:26 -0400
>>>> CC:
>>>>
>>>> In my impressionable youth I was warned that instrumentation of the
>>>> femoral veins injured the intima which in the presence of sluggish
>>>> blood flow posed a risk for thrombus formation and pulmonary
>>>> embolism.
>>>> I never subjected this theory to strict scientific scrutiny but  
>>>> ever
>>>> since have avoided the femoral veins as much as practical. True, I
>>>> haven't had significant problems with the newer cannulae, nor did I
>>>> with the older cannulae, since I have very rarely used the femoral
>>>> vein for cannulation. The 5mm incision in the base of the neck is
>>>> only
>>>> slightly larger that that made for an introducer which rarely  
>>>> leaves
>>>> much a scar. I have always been concerned for the sterility of the
>>>> inguinal region and tried to avoid it when there are good
>>>> alternatives. John Flege
>>>> On Jul 1, 2009, at 10:02 PM, Prasanna Simha M wrote:
>>>>
>>>>> It may be less damging to the femoral vein (Wha tproblems have you
>>>>> encountered that really were significant with the newer cannulae ?
>>>>> and why
>>>>> should it "spare " the jugular ? (apart from giving one pretty
>>>>> visible cut
>>>>> on the neck ?
>>>>> Prasanna
>>>>>
>>>>> On Thu, Jul 2, 2009 at 6:36 AM, John Flege <flege19 at gmail.com>
>>>>> wrote:
>>>>>
>>>>>> Cannulation of RA via Rt IJV is easier, more direct, and less
>>>>>> damaging to
>>>>>> the femoral vein. Full bypass is achieved with a 24F cannula
>>>>>> inserted
>>>>>> percutaneously and with some suction. John Flege
>>>>>>
>>>>>> On Jul 1, 2009, at 1:14 PM, Douville, Chuck wrote:
>>>>>>
>>>>>> Don two great points. I am not certain that they are common
>>>>>> knowledge
>>>>>>> actually. How about a poll? How many HSF surgeons cannulate the
>>>>>>> femoral vein
>>>>>>> when reoperating with a diseased right graft running around the
>>>>>>> right atrium
>>>>>>> today and how many simply do a conventional redo CABG with RA  
>>>>>>> and
>>>>>>> aortic
>>>>>>> cannulation??
>>>>>>>
>>>>>>> ________________________________
>>>>>>>
>>>>>>> From: openheart-l-bounces at lists.hsforum.com on behalf of Donald
>>>>>>> Ross
>>>>>>> Sent: Tue 6/30/2009 1:26 AM
>>>>>>> To: OpenHeart-L at lists.hsforum.com
>>>>>>> Subject: Re: [HSF] ugly vein grafts
>>>>>>>
>>>>>>>
>>>>>>>
>>>>>>> Chuck,
>>>>>>> In the old day when I did a lot of redos for ugly patent vein
>>>>>>> grafts,
>>>>>>> because of bad experiences from embolism, I tried to divide the
>>>>>>> graft
>>>>>>> prior to mobilisation if that entailed any possibility of  
>>>>>>> handling
>>>>>>> the
>>>>>>> graft.
>>>>>>> It is also the reason that I put the R grafts around the L  
>>>>>>> side so
>>>>>>> that it wouldn't be vulnerable to manipulation during  
>>>>>>> mobilisation
>>>>>>> of
>>>>>>> the RA. If you have such a graft it is good idea to place the
>>>>>>> venous
>>>>>>> line peripherally.
>>>>>>> Don
>>>>>>> On 29/06/2009, at 7:41 AM, John Flege wrote:
>>>>>>>
>>>>>>> The same applies to a right system graft particularly if it  
>>>>>>> has a
>>>>>>>> large runoff but one may not be tempted to replace it with an  
>>>>>>>> IMA
>>>>>>>> or
>>>>>>>> other arterial graft. Either way, if a functioning SVF graft is
>>>>>>>> diseased it should be divided and replaced with another SVG.
>>>>>>>> There
>>>>>>>> is ample evidence and personal experience to indicate that
>>>>>>>> arterial
>>>>>>>> grafts may not be able to provide enough flow acutely to meet  
>>>>>>>> the
>>>>>>>> demand. John Flege
>>>>>>>> On Jun 28, 2009, at 3:59 PM, Douville, Chuck wrote:
>>>>>>>>
>>>>>>>> Right; what about a bad right system graft?
>>>>>>>>>
>>>>>>>>> Sent from my iPhone
>>>>>>>>>
>>>>>>>>> On Jun 28, 2009, at 10:02 AM, "John Flege" <flege19 at gmail.com>
>>>>>>>>> wrote:
>>>>>>>>>
>>>>>>>>> Beware of dividing a patent diseased SVG to the LAD and
>>>>>>>>> replacing
>>>>>>>>>> it with an IMA. John Flege
>>>>>>>>>> On Jun 28, 2009, at 11:23 AM, Douville, Chuck wrote:
>>>>>>>>>>
>>>>>>>>>> Colleagues, are any of you dividing really ugly vein grafts  
>>>>>>>>>> at
>>>>>>>>>> re-
>>>>>>>>>>> do CABG any longer? If so, which grafts, and at what point
>>>>>>>>>>> during
>>>>>>>>>>> the operation? Thank you chuckdouville
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>>>>>
>>>>>
>>>>>
>>>>> -- 
>>>>> Prasanna Simha M
>>>>> _______________________________________________
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