[HSF] On pump beating heart

[Edward Bender]

I echo Johns praise, Roberto.  In some of my patients where the aorta  
is heavily calcified, the is one spot somewhere on the aorta that is  
soft.  I use epi-aortic ultrasound, and, if no exophytic plaque, will  
use the heartstring device to sew on the top end (sorry for my  
acquired Aussie idiom).

Ed Bender, MD


On Feb 15, 2007, at 4:43 PM, rowlesjohn at aol.com wrote:

> 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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