[HSF] SVR via left thoracotomy

[Tea Acuff]

Ed,
A left thoracotomy approach should be quite easy. SVR with a beating heart is perferred by some. If the scar is old I wouldn't hestitate. I prefer to do the grafts beating and the ventriclar repair arrested to size the cavity, but with old scar you shouldn't have to worry about fragile tissue. De-airing is a piece of cake as the vetriculotomy is anterior. Any leaks you might have will easily de-air for you. An 18 gauge needle thru the incision and patch does the same if you don't. You won't have to address the patent Lima and can avoid it altogether.
Tea


----- Original Message ----
From: Tdmartin2000 at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Saturday, October 14, 2006 6:49:29 AM
Subject: Re: [HSF] SVR via left thoracotomy


We do the apical aortic conduits all from a thoracotomy and have even placed 
VADs via L thoracotomy. It gives excellent exposure. The apex could be seen/ 
accesssed via a relatively small lateral incision. I would personally probably 
fibrillate the heart and do it at 28 degrees but it can certainly be done warm 
beating. The problem with this approach is always deairing but with the apex 
open it's not too hard to keep the apex up. Pain however is greater as with 
many thoracotomies. I would probably use a rib block or possibly a pain pump in 
this elderly lady as your problems will not be intraop but post op and most 
likely pulmonary. Early extubation I think helps.

Tom Martin
U of Florida
Gainesville
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