[HSF] Dr Jean Bachet

[Nasser F. Abou'Seada]

Dear Dr. Bachet 
Would you Please elaborate more on the Kazui's technique and the main
technical differences between that and your old perfusion technique ..

It is so wonderful that you do impart us the honourable pleasure of being
here among us in the HSForum, We all join Roberto in extending a warm
welcome to you. 

NFA

> From: Jean BACHET
> Dear Dr. Battellini,
> 
> just a few words to let you know that I have received your message.
> Concerning your question and to make it short, I have stopped perfusing
the
> brain at 12 °C while the rest of the body is maintained at 25-26°C about 4
> years ago. I presently use the perfusion mode described by Kazui. The
change
> was not due to unsatisfactory results but only to the fact that, after
> seeing me once using  Kazui's technique, my perfusionnists insisted that
> this  method was simpler and musch less expensive. I was rapidly conviced.
I
> must insist that both methods are equally safe and that the important
> features are selective antegrade perfusion of the brain and avoidance of
> deep core hypothermia.
> 
> Cordiali saluti.
> 
> Jean BACHET.


> From: "Dr. Roberto Battellini" <battr at medizin.uni-leipzig.de>
> Dear Dr Bachet,
> It´s a pleasure to have you in the forum.
> I want to ask you if in complete aortic arch cases you still use 2
> oxigenators so to keep the brain cold and the rest of the body warmer.
> Please describe how are  you performing this technique actually.
> Thanks,
> Roberto Battellini, Leipzig
> 
> Von: Jean BACHET
> Dear Prasanna,
> 
> apparently you did well as the patient is now in good condition, without
> bleeding, and extubated.
> I just would like to comment about the use of GRF glue in such cases. I
> certainly won't recommend it . GRF glue has been proposed by our group
> almost 30 years ago in surgery of acute dissection to stick together the
two
> dissected layers of the aortic wall. For this purpose it has proved to be
> quite efficacious. But it is a poor haemostatic agent and is not very
useful
> in that indication. In addition, as you know, it is polymerized with
> formaline and glutaraldehyde which are rather toxic if not used very
> carefully. Putting such products very near the main left coronary might be
> harmful (I remember seeing a sphenous bypass on a right coronary bypasss
> shrinking in a few minutes when one of the members of the operating team
> accidentaly poured on it a few cc of those aldehydes during repair of an
> acute type A dissection). For me the best haemostatic glue, so far,
remains
> the fibrin glue and I use it quite liberally (not to say systematically)
in
> all my aortic root replacements (Bentall, Valve-sparing procedures, Ross).
> It is certainly not a panacea but it surely helps.
> 
> Jean BACHET.


> From: "prasannasimha" <prasannasimha at gmail.com>
> > Today I did a Ross and had a peculiar set of problems. I would like to
> > know how the forum members would approach this.
> > Basically the case was a lady with a bicuspid aortic valve with
> > endocarditis with large vegetations. The line of cusp closure was
> > anteroposterior and the pulmonary valve was tricuspid so I managed to
> > get a homograft and did a Ross . When I opened the aorta I found the
> > Left ostium could be dissected with a good margin of tissue but the
> > right was very much adjacent to the annulus. Like in an arterial  switch
> > I took the RCA button taking a part of the annulus with it and I thought
> > I had a decent margin. I did not make a separate button for the Left
> > main ostium but left it as a tongue of the distal aorta as originally
> > described by Dr Sampath Kumar of AIIMS Delhi.
> > I went ahead with the autograft implantation and when the time came for
> > implantation of the RCA button when I lifted the button the annular
> > strip just sheared off partially and I was not even pulling !! I was
> > left with an unpleasant task of reattaching that piece with fine sutures
> > and then implanted the button but even then my bites were terrifyingly
> > close to the RCA ostium.
> > I would like to know how members would handle this situation especially
> > if the button was torn at the ostium or extended into it . One obvious
> > answer would be to oversew and do a CABG if the patient was old enough.
> > Any other methods ?
> > Patient has been weaned easily and in fact on vasodilators despite a
> > ridiculously long cross clamp time.
> > She was pretty dry on closing  but started to bleed later on and I
> > re-explored her. She was bleeding from the posterior root anastomosis
> > only if her pressures went above 110 mmHg systolic. It would stop with
> > decreased pressure. I presume some conformational change was occurring
> > of the root at higher pressures leading to the bleeding. Any way I
> > avoided going back on CPB and could suture the area of the leak with
> > induced hypotension to 50 mm Hg transiently. I packed that area with
> > some Surgicel (I was toying of placing some fat and covering the whole
> > area with pericardium but was worried if the let main may get
> > compressed.and came out and am keeping my fingers crossed. So far
> > bleeding has not occurred and I am using sedation and controlling the
> > pressure pretty aggressively. Has any one used GRF glue in that area and
> > if so is it safe near the left main ?
> > Any other tips / tricks to manage posterior aortic bleeds ? I have once
> > managed this by obliterating the transverse sinus with a series of purse
> > string sutures.
> > Prasanna