[HSF] Calcified aortic stenosis

[Ani Anyanwu]

I recently listened to Dr Borger presenting the liepzig experience and such a patient would be a candidate for transapical valve. Her comorbidity (smoking, reop, unclampable aorta etc) makes her an ideal candidate.  

I however agree with what you infer that it seems difficult to justify the transapical approach if the surgery can be done open with 10% or less mortality. I think the main reason for doing transapical valves is to compete with the inevitable infringement of transfemoral AVRs by cardiologists. Whether it does the patient good is another question, but closed valve replacement will almost certainly be part of the future.

Ani

----- Original Message -----
From: tdmartin2000 at aol.com
Sent: Sunday, July 01, 2007 8:13 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Calcified aortic stenosis


Prasanna

A percutaneous valve for calcified aortic stenosis???? From a surgical standpoint, even if I were to replace her root ascending and arch with individual head vessel reimplantation I would say her survival is in the 90%?range with her greatest major morbidity coming from a stroke (5-7%). The question here, in my opinion, is how to deal with the pulm lesion and in what order.  
Someone on the forum must know the data on the perc valves so far, if so, speak up and educate us. I would think that a calcified aorta with calcific AS in a small female would be hard to do and would be at a significant risk of stroke- maybe more so than with an open procedure.

Tom Martin
U of Florida
Gainesville


-----Original Message-----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sat, 30 Jun 2007 10:33 pm
Subject: Re: [HSF] Calcified aortic stenosis



Smoker with ? lung Ca?
Is the valve replacement worth it ? if worth it then - probably would be a candidate for those percut valves. Why chop her up excessively ??
Prasanna?
tdmartin2000 at aol.com wrote:?
> Need a biopsy of lung lesion and then staging if pos for CA. If no carcinoma or something possibley cureable? and no AI, then an apical aortic conduit would be a consideration along with either a wedge resection or lobectomy. You certainly can replace the entire root, ascending?and arch with reasonable results as long as there is something to sew to either in the distal arch or the prox descending.?
>?
> Tom Martin?
> U of Florida?
> Gainesville?
>?
>?
> -----Original Message-----?
> From: Mitch Lirtzman <drmitch at cox.net>?
> To: OpenHeart-L at hsforum.com?
> Sent: Sat, 30 Jun 2007 7:48 pm?
> Subject: [HSF] Calcified aortic stenosis?
>?
>?
> To the forum. I know we've covered this type of problem in previous discussions, but...??
> ??
> An old patient of mine, 62yo petite diabetic female, unrepentant smoker 2ppd x 50yrs, had successful CABx3 in 2001- LIMA/ 2 veins. She's been complaining of increasing dyspnea for several months and referred her back to her cardiologist to investigate. The bottom line is she has critcal AS with AVA 0.3cms, normal EF, normal chambers, and all grafts are patent. She just had her left subclavian stent redone to improve LIMA flow. The problem is she is now totally calcified from valve through arch and LCCA is occluded just after the origin. Additionally, she now has a 1.5cm LUL nodule which lights up on PET. Surprisingly, her PFT is remarkably good but she always reminds me that she had a difficult post op course from a pulmonary standpoint.??
> Any thoughts besides the word NO???
> Thanks ahead of time.??
> Mitch Lirtzman??
> ??
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