[HSF] Type I Dissection

[Tea Acuff]

There are other possible reasons such as the direction of flow with and with out the clamp. 

I think you forget that the only thing separating method from madness is comparing them both to the same outside world.

tea


----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, February 9, 2007 8:43:06 PM
Subject: Re: [HSF] Type I Dissection


My understanding was that ACP is beneficial only in arch cases (or similar procedures where circ arrest has potential to be prolonged (>30 mins). For a straightforward ascending aorta done open distally, is there sufficient marginal benefit to justify ACP? Indeed in an elective case the period of arrest for such cases is short - I recall Dr Martin saying it takes him 6 minutes - In such a case there is no need to cool beyond 25 degrees (other than to have a margin of safety) and if one is already at 25 degrees it is questionable whether ACP for say 10 minutes would add either safety or benefit. 

Also I think we should be cautious in oversimplifying what is really a complex technique. Using simple cannulae and perfusion systems may not necessarily offer the same protection as the more elaborate methods as described by Bachet and others. Sometimes we get away with a lot of corner cutting, but often and the experts/enthusiasts may appear to overcomplicate things, but more often than not one will find that there is a method and reason to their madness.

Ani

----- Original Message ----- 
  From: Hgrmd at aol.com<mailto:Hgrmd at aol.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Friday, February 09, 2007 9:23 PM
  Subject: Re: [HSF] Type I Dissection


  Ed,
    So, to do selective perfusion at 25C, you cannulate via the right  
  axillary.  When the time comes for selective perfusion, you simply clamp  the origin 
  of the innominate, and then place the retrograde cannula in the snare  left 
  common?  Sounds really simple.  I've got a Bentall, CABG, maze  Monday.  If it 
  looks like the distal has to be done open, I'll definitely  try it this way.
  Hal
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