[HSF] 3V CAD + AnLV + AAA

[Igor Rudez]

Dear Prasanna, dear John,
Thanks for your thoughts, I will try to fix them both simultaneously. May
the Force be with me!
;-)

Igor

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of psimha
Sent: Tuesday, August 28, 2007 3:34 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] 3V CAD + AnLV + AAA


Igor , both can be done simultaneously as they are notorious to burst 
during the post op period. You can do the proximal anastomosis if 
required under CPB too if there is any difficulty. In view of his low EF 
he is not a candidate for high beta blockade and AAA correction first 
followed by staged CABG in the same hospital admission. Try to get a 
high thoracic epidural placed - helps in these patients in the post op 
period . I am partial for a retro peritoneal approach for all abdominal 
aortic surgery though mid line will also do fine..
Prasanna
Igor Rudez wrote:
> Dear Forum members,
> Dear friends,
>
> I would like to hear your opinion about a patient referred to me: 
> 71-y.o. male with triple vessel CAD (occluded LAD, OM1-2, and RCA) 
> with LV aneurysm (MR 1+) and LVEF of 30%. In addition he has 
> infrarenal AAA which seems to be growing (from 70 mm up to 90 in 
> couple of months). Refused cardiac surgery so far but now he is 
> willing to do everything one can do to survive. What to do?
> Perform cardiac surgery first and the do AAA as a second stage? Do it
> simultaneously? Do AAA first? Not to do anything?
>
> Every comment is highly appreciated.
> Thanks in advance.
>
> Igor
>
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