[HSF] RV failure management strategies

[prasannasimha]

Leaving an incomplete correction can lead anyway to disaster.
One thing that I do not like to leave is Afib it can make a mess of both 
perioperative and postoperative management.
I have shifted to using a Goretex strip TV plasty after various 
discussions in the forum. I really have not had a bad experience with a 
De Vega in rheumatics probably related to their thicker annulus but I 
felt that if literature says it fails putting a strip hardly takes extra 
time and eliminates guitar stringing which is the basic mechanism of 
failure. It doesn't take much time either. I cannot use a preformed ring 
for obvious reasons.One thing is that I have not had problems per se 
with the Goretex /Pericardial strip annuloplasty.
I have had many of these rotten cases and have pulled out these but some 
cases are lost. I presume others too would have a similar experience.
Prasanna

Hgrmd at aol.com wrote:
> Dr. Rey,
>   I politely but firmly disagree with your premise that doing the bare  
> minimum is always the best philosophy in cardiac surgery.  Indeed,  sometimes it is 
> true in patients who are extremely frail and old.  However,  most of the time 
> this policy is a mistake.  The key is knowing how to do  many procedures 
> swiftly and effectively.  If you think giving a lifetime of  amiodorone is better 
> than a Cox-maze, you are mistaken. Amiodorone  pulmonary and hepatic toxicity 
> and very real and very well described.   Besides, pharmacologic control of AF 
> is notoriously ineffective.  It takes  me less than 15 minutes to do a left 
> sided cryomaze with a long term success  rate of 92%.  Nearly all right side 
> procedures (maze, tricuspid  valvuloplasty) are done off clamp during the 
> terminal portions of the pump run  while the body is rewarming and the heart is 
> recovering.  Without a doubt,  the DeVega has been shown to be inferior to a rigid 
> or semirigid prosthetic ring  when doing valve repair.  Is it cheap and fast?  
> Yes.  Would I  want one done to me or my family member?  No.  It generally 
> takes me  20-25 minutes to install a simple mitral ring from the time I incise 
> the left  atrium to the time I put in the last atriotomy stitch.  With today's  
> techniques of myocardial preservation, that amount of time in 
> inconsequential.  Numerous studies have shown that the DeVega repair in both the mitral and  
> tricuspid position has a strong tendency to degrade with time.  Note the  
> November '06 Annals paper by Tirone David's group on this subject.   Also note my 
> discussion at the end of the paper.
>   I can't tell you how many cases of severe MR in the presence of a  recent 
> AVR that I've had referred to me over the years.  The initial  surgeon thinks 
> and hopes that the "moderate" MR will disappear in the presence  of severe 
> aortic stenosis.  Don't count on it.  My policy is fix it  once and fix it right.
> Hal
> _______________________________________________
> 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
> -----------------------------------------
>
>