[HSF] Bicuspid aortic valve and dilated ascending aorta

[Zhandong Zhou]

The main advantage of this incision is to avoid sternotomy. Patient have no restriction after 2 weeks. My patient went to hunting 3 weeks after surgery and he can use gun without worried about recoiling. I used to use midline incision with L to the right. It bleeds a lot more than thoracotomy either from the right IMA or bone marrow. However, the exposure is a little better with mini sternotomy. For AR, the surgery is not difficult at all.

Z Zhou

----- Original Message ----- 
From: "Ani Anyanwu" <anianyanwu at hotmail.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Tuesday, April 24, 2007 6:12 AM
Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta


Dr Zhou

I am curious to know why patients would prefer this to a (mini) midline incision - scars seem to be of similar length and in a similar place except one is transverse and other is longitudinal. 

For a woman presumably it is on superior aspect of mammary gland? I can understand the cosmetic attraction of submammary inscisions but what is the advantage (and evidence if available) for this approach?

Thanks

A Anyanwu
  ----- Original Message ----- 
  From: Zhandong Zhou<mailto:zzhoumd at pol.net> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Monday, April 23, 2007 11:29 PM
  Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta


  Dear Hal,

  I agree with you that mini AVR first then follow him with yearly CT.

  I used to do AVR through mini sternotomy. I recently started using mini 
  thoracotomy by entering 2nd ICS with femoral cannulation. I attach a picture 
  to show the incision. It is more difficult to do it. However, patients like 
  it.

  Z Zhou



  ----- Original Message ----- 
  From: <Hgrmd at aol.com<mailto:Hgrmd at aol.com>>
  To: <OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>>
  Sent: Monday, April 23, 2007 9:14 PM
  Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta


  > Dear Dr. Zhou,
  >  I've never done an AVR through a 2nd ICS mini thoracotomy.  I  always use
  > the "L" from the sternal notch to the right 4th ICS.  It's not  as nice
  > cosmetically, but you can easily go to a full sternotomy should  technical
  > difficulties arise.  This approach is especially nice for  redos.
  >  As for the 4 cm aorta, I don't think that meets criteria in a non 
  > Marfan's
  > patient.  I thought the cut off was 4.5 cm.  Tom Martin, what  do you 
  > think?
  > Hal
  >
  >
  >
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