[HSF] On pump beating heart

[rowlesjohn at aol.com]

Roberto
 
Your operation for this elderly, high risk gentleman is a classic example of the less is more philosophy to facilitate an excellent outcome. Did the heart distend during the fibrillation and if so, how was it managed?
 
Thanks,
 
John Rowles
 
 
-----Original Message-----
From: battr at medizin.uni-leipzig.de
To: OpenHeart-L at hsforum.com
Sent: Thu, 15 Feb 2007 9:36 AM
Subject: AW: [HSF] On pump beating heart


Today I have done our N° 50 case of sever atherosclerotic aorta + 2-3 vessel
disease. The patient , 83 years old, was unstable, and with 3 vessel disease
+ left main, MI I grade. In TEE we recognized MI II grade. I canulated the
axyllary artery, as the whole aorta was calcified. Went on pump, did
LIMA-LAD and veins to obtuse marginal and RCA. The heart fibrillated by
doing the obtuse marginal, after which could be easily defibrillated. I
anastomosed the veins to the innominate artery (truncus) at 34 degrees.
Sorry, Hal, I did not touch the Mitral.

He came out of pump without drugs, he is now awake at ICU waiting to be
extubated.

 

I remembered that email from Tea, and want to know what is he doing in these
cases. Hal, would you have done aortic replacement on DHCA to just access to
the mitral?

 

We presented our experience last week with 49 cases in Hamburg.

Roberto

 

  _____  

Von: OpenHeart-L at hsforum.com [mailto:OpenHeart-L at hsforum.com] Im Auftrag von
Tea Acuff
Gesendet: Montag, 22. Juli 2002 15:23
An: OpenHeart-L
Betreff: Re: [HSF] On pump beating heart

 

Just a few clarifications.  I have experienced acute ischemia (or at least
what we attribute to be acute ischemia). My point is not that never occurs,
but it is that I am very poor at predicting when it will occur and have been
amazed at the cases it did not (since I violate most of the "rules").  If I
am suspicious, I will precondition as a test (which frequently passes), I
don't like to shunt. I pace the RCA if necessary. If I can't position an
important vessel, I will add RV support or CPB.  I think that a beating
heart techique "de-embolizes" the vessel much better than retrograde
cardioplegia for redo's and avoids a sometimes difficult cross clamp.  We
should think first beating heart and secondarily off pump unless there is a
specific reason to avoid the pump eg bad aorta, bad lungs, emergency on
anticoagulants,etc.
Tea Acuff

 

In a message dated 7/21/02 6:02:17 PM Central Daylight Time,
mkcd at comcast.net writes:






On pump and full Myocardial arrest although there are several surgeons who
advocate going on pump for hemodynamic support then doing beating heart
assisted. Anyone with this approach care to share your experience with us ?

Mercedes





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