[HSF] On pump beating heart

[Tea Acuff]

There is a world of difference of a patient with a good LV and mild MR and a myopathic ventricle with moderate MR. Likewise there is likely different treatments for a large variety of this problems. This one of the problems with our so called best evidence, the "large randomized clinical trial". Include everything and nothing is clear when it comes out. Hard to call that an experiment except for the form.
tea


----- Original Message ----
From: David Harris <drdharris at yahoo.co.uk>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, March 5, 2007 3:08:30 PM
Subject: Re: [HSF] On pump beating heart


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
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