[HSF] FYI NEJM Article--On versus Off Bypass

[Tea Acuff]

While helpful, the rear view mirror is useful but not sufficient. It  
likely is not the most important.
But thankfully we are not yet limited completely to the view from the  
back seat, even as we move more towards it.

Tea

Sent from my iPhone

On Nov 7, 2009, at 5:08 PM, "Tohru Asai" <toruasai at belle.shiga- 
med.ac.jp> wrote:

> Tea, Don, Hal, Ani and others,
>
> Surprisingly, I found my self having not been supervised at all in  
> past
> 15 years, since I came back from US! Rare in Japan, too.  Now I am
> regarded as one of the hard-core experts in arterial OPCAB in my  
> country.
> The enviroment is different. But I was lucky that I came back to  
> Japan,
> where we liberally perform postop angiography and CTA and afford to  
> use
> intraoperative graft confirmation tools ( Medistim and/or SPY lately).
> About 10 yers ago, it was crucial when I switched my all CABG to off-
> pump. Grart course, its length, torsions, detailed shape of distal
> anastomosis all are routinely demonstrated in the conference with my
> fellow cardiologists. The initial pilot series of 30 patients showed  
> no
> graft occlusion, then with Experience Based Medicine, I decided to
> become an OPCABer.
>
> Regarding VA system, I feel gratful to Manhattan VA, where I had basic
> training in cardiac surgery by NYU attendings. Obviously it was  
> prior to
> BMS or DES era. Well supervised, relatively free decision-making
> responsibility, and tremndous amount of exposure, all were great
> nutrition for a young Japanese boy...
>
> Quality control in OPCAB is the very important issue. I feel that we
> need a certain graft confirmation for the feedback. Otherwise, we are
> just like driving a car without rear view mirror...Did I say this  
> before?
>
> Tohru
>
> Tohru Asai
> Professor and Director,Cardiovascular Surgery
> Department of Surgery
> Shiga University of Medical Science
> Otsu Japan
>
>
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