[HSF] On pump beating heart

[Hgrmd at aol.com]

Dave,
  That's what makes HSF such a good tool for education.   Unfortunately, the 
Elefteriades data that you cite has largely been refuted by  others.  The fact 
that he states that his Yale grafts uniformly suffice in  treating ischemic 
MR has not been the experience of me and others.  Though  I haven't yet seen 
him disavow those recommendations, I do know that he recently  was on the "PRO" 
side of a debate at some meeting that I didn't attend. Perhaps  he's finally 
seen the light. You want to live to fight another day to have  your ischemic MR 
repaired via right thoracotomy, if necessary?  Welcome to  the pain, expense, 
and risk of another major operation.  I would dare say  that the mortality 
alone in such instances would be around 10%.  Mind you,  this would be in a 
heart that has suffered even longer the ravages of ischemic  MR.  Even moderate MR 
adversely impacts the long term survival of patients  as has been amply 
documented by Serrano at Mayo.  The case I'm doing in the  morning is just such a 
case.  This 69 yo lady had CABG around 4 years  ago.  She's been in and out of 
the hospital with CHF.  Her creatinine  is 2.2.  The LIMA and the PDA grafts 
are OK.  She has severe MR, TR,  and also needs a graft to a large ramus.  Her 
EF is 25%.  CABG alone  screwed her.  She now faces another operation in the 
morning that probably  carries a 10-15% risk.  This is not an isolated case, 
trust me.  Just  because you revascularize a heart does not ensure that all the 
previous adverse  remodeling is going to occur.  Why take the chance?  I can 
easily add  a ring to a CABG case in less than 35-40 minutes, which includes 
the extra time  to double cannulate.
Hal
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