[HSF] On pump beating heart

[David Harris]

Thanks Hal, I see your point.
Tomorrow I`m doing a similar case that was done at `St
Elsewhere` 3  years ago. She needs the mitral done for
moderate regurgitation, and a graft to third marginal.
The referring cardiologist says he sees them coming
back a lot if the valve is not done

--- Hgrmd at aol.com wrote:

> 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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Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite A2                                
Tygerberg Hospital, 7505       
Cape Town, South Africa.            
Tel +27-21-9762347             
Fax +27-21-9761157      Mobile +27-83-3309587