[HSF] severe AS

[erdinç naseri]

Ani,
> > If coronary ostium was 3mm does this not qualify as left main stem stenosis? Why not coronary artery bypass? Did this correlate with pre-op angiography? Obviously your strategy worked, so the question is academic but for others faced with same situation in future should we be thinking of a bypass?1.I relooked at the CAG postop.LMCa was very short and the ostium didn't look stenotic but at operation 12 F direct ostial cannulae was very tight for it.> Also why (and how) was the patient at 30 degrees fibrillating without the heart clamped and arrested - do you usually cool to a certain temperature before clamping? 2.The heart had been in VF for a minute or so( as I learned later on).Obviously this was a mismanagement.For routine cases I xclamp at around 32 but if there is any question of difficulty of myocardial preservation I slowly and homogenously cool to 28 or 26 depending on the complexity of the operation.> Must say though that for a very complex operation a 61 minute cross-clamp is amazingly short! I suspect your expeditious operation, together with continuous perfusion, was key to the good eventual outcome; for those of us who cannot do such a complex operation (difficultly in establishing plegia, decalcifying heavily calcified valve, placing AVR and doing interposition graft) with such speed I suspect the outcome may have been different.
3.aortotomy was closed using a patch ( not an interposition of graft).The intention was to decrease the tension on the suture line.Other than that, simple AVR takes about 45 -50 minutes of x clamp .> erdinc