[HSF] Significant MR after previous CABG

[Michael Webb]

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com]On Behalf Of hgrmd at aol.com
Sent: Monday, August 22, 2005 12:52 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Significant MR after previous CABG


I don't know about mild MR, but probably moderate.
Hal 
 
-----Original Message-----
From: ASEEM PAWAR <aseem70 at yahoo.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Mon, 22 Aug 2005 19:05:35 +0100 (BST)
Subject: RE: [HSF] Significant MR after previous CABG


So, can we now in the light of all the data/insights we have, rightfully ask for 
the "hand-over" of a CABG+ mild MR patient from the interventionists??
 
              ....aseem

"Goldman, Scott" <GoldmanS at MLHS.ORG> wrote:
I agree with Mark. We get echos on all CABG pts preop. Our colleages are often 
only looking to place stents and many pts are inadequitly worked up. MR,AS,AI 
may br overlooked.

Scott


-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com on behalf of Mark Levinson
Sent: Sun 8/21/2005 2:17 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Significant MR after previous CABG


On Aug 20, 2005, at 4:18 PM, Hgrmd at aol.com wrote:

> Next week, I'm operating on a 64 yo lady for Class III-IV MR. Of 
> note, she
> had an uneventful CABG 2 years ago by another member of my group. 
> On cath a few
> days ago, her 4 grafts are OK and the LV has an EF of 35%. I went 
> back and
> checked the transthoracic echo report from that admission and noted 
> that the
> preop MR was "moderate" with an EF of 40%. My point of discussion 
> for HSF is
> that I operate on this type of scenario atleast once or twice a 
> month. Unlike
> Elefteriades at Yale, I believe that moderate or greater ischemic 
> MR should be
> repaired at the initial surgery. Serrano from Mayo has convincing 
> data that
> even moderate MR adversely impacts the 10 year survival as compared 
> to CAD
> patients with no MR. Obviously, this policy isn't practiced on an 
> 88 yo. But on
> your average patient, you do the patient an incomplete service if 
> you leave
> them with moderate MR after revascularization. My final point is 
> TEE should be
> used on all cases so that this situation can be minimized


For the past 2 years, I have asked that every CABG case get a preop
echo regardless of symptoms at presentation. MR or AI is often seen
and I have learned that if this is not corrected, some will present 
in the near
future for another surgery in the setting of CHF and open grafts.

If you use intraoperative TEE routinely, you will see the MR, but then
you do not have "informed consent" from the patient to perform a repair.
Thus, it is advisable to get routine echos on anyone headed for CABG.
The patients want these fixed rather than taking the risk of a second
surgery. In the era of routine repairs for MR, these valves do not 
need
to be replaced so the echo is worth the trouble.

Mark





Mark M. Levinson, MD
Founder, Editor-in-Chief,
The Heart Surgery Forum
WWW: 
Email: 
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