[HSF] aortic root replacement ,svere hyperbilirubinemia

Sat Aug 4 15:33:57 EDT 2007

Upper sternotomy advantages:
1.  Less disability - patients usually go back to their usual  
activities within 2-3 weeks as opposed to 4-6 weeks.
2.  Less blood loss from the sternal margins.
3.  Extremely good visualization of the aortic valve.  There is no  
need to visualize the rest of the heart.
4.  Less heat loss during the period of coming off bypass and sternal  
closure.
5.  Decreases the time and effort to de-air the heart - with CO2  
going into a small space, ambient air is displaced completely with  
very little air seen on TEE during the de-airing process.
6.  Marketing. (No apology here either)

Ed Bender, MD

On Aug 4, 2007, at 1:47 PM, prasannasimha wrote:

> Ed,
> I do the hemisternotomy from below without a cut. The thing is that  
> you need to open the sternum serially allowing it to spring (or  
> rather stretch) open. Also  there is a need to give a terminal  
> minimal turn of around a half or one cm or  to allow an angle for  
> swivel. The sternum is now opened minimally in stages (opening it  
> in one stage is an invitation for it to crack). In children it is  
> easier as their sternum is springier. This allows the sternum to be  
> slowly opened out surprisingly wide enough . I will try to get a  
> photo. The problem is that the angulations are difficult to  
> photograph well.
> Incidentally what  are the advantages you have observed with an  
> upper hemisternotomy ?
> Prasanna
> Edward Bender wrote:
>> 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
>>>>>
>>>>>
>>>>>
>>>>> ************************************** Get a sneak peek of the  
>>>>> all-new AOL at http://discover.aol.com/memed/aolcom30tour
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