[HSF] POo MVR Severe TR, Lv dysfnction

[A]

Hal:
I am interested in your criteria for repairing TR. Could you please
elaborate some more on them. I find it very interesting. Thanks

Ahmed

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Hgrmd at aol.com
Sent: Monday, August 27, 2007 4:15 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] POo MVR Severe TR, Lv dysfnction

Tea,
  For one thing, I don't repair every tricuspid valve that lies on my
table. 
 I repair the ones that have an annular diameter of 40 mm or  greater, 
regardless of the amount of TR, on post-induction TEE.  I also  repair
tricuspids, 
regardless of size, that have or have had moderate or worse  TR.  Am I 
repairing too many?  I obviously don't think so.  The  real problem, Tea, is
that you 
or I don't carefully follow by echo every single  patient we do. However, 
several large series that have, notably Serrano's  experience at Mayo, show
that 
even moderate TR adversely effects the long term  survival of patients.  As
I 
said before, what really impressed me and made  me a convert to aggressive 
repair were the times that adding the tricuspid  repair made a dramatic
difference 
in my ability to get a patient off CPB without  a balloon pump.
  Again, you've yet to answer the question as to how many triciuspid  valves

you repair per year.  I suspect very few.  Until you have a  significant 
experience in handling this problem, I'm not sure I would cast  aspersions
on those 
who do.  Maybe if you did, you would find  that some of the postop edema and

occasional low output states would be  avoided.  
 
Hal 



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