[HSF] aortic root replacement ,svere hyperbilirubinemia

[Edward Bender]

Sorry,
I just read about your aversion to upper sternotomies.  If anyone  
else uses that approach without a T or L extension, I would be  
grateful for some input.


Ed Bender, MD


On Aug 4, 2007, at 1:32 PM, Edward Bender wrote:

> 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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