[HSF] aortic root replacement ,svere hyperbilirubinemia

[Edward Bender]

prasanna:
Tell me how you do the hemisternotomy without the T cut.  Tyrone  
David says that he does an upper sternotomy to the 3rd interspace but  
does not T or "L" it across.  He claims decreased pain.  If you just  
make one vertical cut without a horizontal cut of some sort, do you  
have problems opening, fracturing, etc.  David says the bone  
fractures and it heals well.  Before I try this (Tyrone David often  
leaves one or two key elements out of his explanations), I would like  
a little more info.

Ed Bender, MD


On Aug 4, 2007, at 11:50 AM, psimha wrote:

> ps - back to hemisternotomy (without a T cut for a change) - cannot  
> ever reach your 20 mm incision (which sort of spurred my "re- 
> interest" but I'm working on it !! ;-) . One thing absence of the T  
> cut seems to be having less pain according to my  
> residents.Observation which will not satisfy Ani's scientific  
> rigorous standards.
> Prasanna
> Hgrmd at aol.com wrote:
>> Prasanna,
>>   For a routine Bentall I probably use 2 units FFP, 10-20 units  
>> of  cryo, and 20 units of platelets.  If that takes care of the  
>> medical  bleeding, we're done.  If bleeding persists, then we give  
>> more platelets  and send off stat coags.  The amount of FFP I  
>> order depends on how many  units of packed cells have been given  
>> since the patient entered the room.   If none, no FFP.  If 2 or  
>> more, especially if the patient was on Coumadin  preop, I give 2  
>> units.  I measure the fibrinogen and platelet count during  the  
>> pump run.  If fibrinogen less than 200, 10-20 units of cryo.  If   
>> platelet count less than 120K, 10-20 units of platelets.  We still  
>> don't  use TEG as yet (I'm in the process of getting it.)   
>> Hopefully, TEG will  help me refine my blood component needs.   
>> I'll never have the low blood  bank utilization that you possess,  
>> but I'm working on it.
>>  Hal
>>
>>
>>
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