[HSF] Geoform: A Flawed Concept?

[Tea Acuff]

Likely so. There are a lot of failed concepts. As the population studies show there are varying numbers of patients that either do not benefit compared to controls, or don't benefit despite the therapy. I do think that there is a general pattern in these failures. The more we replace for an intrinsic failure of the system the more the new system fails to respond compared to the original. Conversely the more we tend to restore, particularly with less approximation or destruction, the better the new system responds in the form of the original. Sometimes we have no choice. You are right in perservering in learning mitral repair, even if replacement has come a long way from the earliest days. This is a daunting curve for LVAD or total heart replacement.

tea


----- Original Message ----
From: "Hgrmd at aol.com" <Hgrmd at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Saturday, August 18, 2007 7:45:40 AM
Subject: [HSF] Geoform: A Flawed Concept?


Dear Members,
  About a week ago, I was referred a 75 yo lady (the mother in law of  one of 
colleagues) who had intractable CHF and a loud MR murmur.  Six weeks  
earlier, she had been operated down in Miami (though she was initially told by  her 
son in law to be operated by me, she refused to leave Miami).  She had  double 
vessel disease, severe MR,  and a bad EF.  The surgeon did a  LIMA to the LAD 
only.  He didn't graft the RCA because he said the  territory was already 
infarcted. The mitral was repaired with a Geoform  band.  Apparently, she 
initially did well, but had a slow progressive  downhill course over the next several 
weeks.  
  She was admitted to one of my hospitals with severe CHF and  hemolytic 
anemia.  Extensive workup revealed 3+ MR with an eccentric  anteriorly directed 
jet on TEE.  The LIMA to the LAD was widely  patent.  The EF was 25%.  The 
anemia was presumably due to severely  turbulence around the ring.
  Two days ago, I took her back to the OR.  At operation, I  found the 
Geoform ring to be completely intact.  When I filled the LV with  saline, there was 
a diffuse leak around P1 and P2 area.  I grafted the  PDA.  I removed the 
Geoform ring and replaced it with an ETlogix  ring.  The postop echo was perfect, 
and she's currently extubated.   However, she's extremely debilitated, and I 
still feel this could go either  way.
  I took several pictures intraop and have them on a CD.   Prasanna, how can 
I get them to you so you can post some of them?  I think  this is a very 
important case, because I feel the Geoform is a fatally flawed in  its design.  
Anecdotally, I know of several failures with this ring from  centers around the 
country.  It's my position that Edwards  should critically look at removing it 
from the market.  
  BTW, if anyone knows Steve Bolling, please forward this email to  him.  He 
needs to be aware of how his invention is performing.

Hal


Hal 



************************************** Get a sneak peek of the all-new AOL at 
http://discover.aol.com/memed/aolcom30tour
_______________________________________________
OpenHeart-L mailing list

Send postings to:
OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies and 
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------