[HSF] Ao Wraping

Fri Mar 30 11:00:17 EDT 2007

Sounds like a great plan

On 3/30/07, Igor Rudez <rudi at kbd.hr> wrote:
>
> Michael,
> What about aorta-no-touch technique? One could use both IMAs and a radial
> artery attached to either of IMAs at any fashion desired (T graft, Y
> graft...). That would cover coronary issue without
> catheter-PCI-BMS-DES-etc
> procedures at all.
> Time will tell!
>
> Igor
>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Michael
> Firstenberg
> Sent: Friday, March 30, 2007 3:06 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Ao Wraping
>
>
> Nice answer - gee why dont we all just role over a play dead. Yes, there
> will be a role for catheter based interventions and all sorts of mini
> access
> stuff, but standard operations give standard results and until someone
> "proves" otherwise.  IMHO and I think the data supports that operative
> approaches to his problem will, and should be the standard of care for a
> very long time.
>
> John, you can have a community cath jockey knock off your left main with a
> perc valve........
>
>
> -michael
>
>
> On 3/30/07, John Schor <johnschor at mac.com> wrote:
> >
> > At 19 yrs of age with bicuspid AoV, I think your choice is very
> > reasonable. Besides, if the patient needs more surgery in the future,
> > it will be catheter-based (sorry, I couldn't resist). John
> >
> > John Schor, MD
> > PO Box 4445
> > Cottonwood, AZ 86326
> >
> >
> > On Mar 30, 2007, at 3:50 AM, Igor Rudez wrote:
> >
> > > I think his Ajit's rationale was intention to prevent late
> > > dilatation of the aorta which happens quite often in bicuspid
> > > patients. Although patient's
> > > aorta did not reach the treshold mentioned by Prasanna (4,5 cm but
> > > for the
> > > age below 60yrs, I keep treshold of 4,0 cm) and it might seem a bit
> > > of too
> > > much surgery for the moment, the decision of wrapping the aorta
> > > looks quite
> > > appealing to me and surely a better choice than preventive
> > > replacment of it.
> > >
> > > Igor (from Zagreb, Croatia as well)
> > > ;-)
> > >
> > >
> > >
> > > -----Original Message-----
> > > From: openheart-l-bounces at lists.hsforum.com
> > > [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Prasanna
> > > Simha M
> > > Sent: Friday, March 30, 2007 11:29 AM
> > > To: OpenHeart-L at lists.hsforum.com
> > > Subject: Re: [HSF] Ao Wraping
> > >
> > >
> > > One question  w<s that true aneurysamal dilatation or just post
> > > stenotic dilatation ? Does a post stenotic dilatation really require
> > > any such extensive procedure  like aortic replacement especially
> > > since it is less
> > > than 4.5 cms. Isn,t that strategy a little bit aggresive Prasanna
> > > from
> > > Zagreb
> > >
> > > On 3/30/07, Shahid Malik <smmalik at brain.net.pk> wrote:
> > >>
> > >> Ajit,
> > >> Probably difficult to argue your choice of procedure except the
> > >> comment that he took a 27mm aortic valve.I cannot recall the last
> > >> time I used this size valve. Seven yrs ago,I replaced a root in a
> > >> 22yrs old
> > >> Marfans(member of a diagnosed-documented family)C.T clearly showed
> > >> the
> > >> rest of the arterial tree to be normal,and aneurysm limited to the
> > >> ascending aorta.Event free surgery and post op course.Post op
> > >> followed
> > >> by referring.Three and half yrs later I was told that she suddenly
> > >> collapsed and died.Survillence by yourself for life is right.
> > >> Shahid Malik
> > >>
> > >> On Friday, March 30, 2007 at 08:10:41 AM, OpenHeart-
> > >>
> > >> @lists.hsforum.com wrote:
> > >>
> > >>> Ajit,
> > >>> I would have done the same and your patient will do well! Just
> > >>> echo him
> > >> on 6
> > >>> months, and then again every year for follow-up purposes! I am
> > >>> aware
> > >> that
> > >>> there might be some other approaches and comments but...."Every
> > >>> road
> > >> leads
> > >>> to Rome" and "There are many ways to skin a cat"!
> > >>> A year ago I posted some pictures of aorta wrapping.
> > >>> Good job.
> > >>>
> > >>> Igor
> > >>>
> > >>> -----Original Message-----
> > >>> From: openheart-l-bounces at lists.hsforum.com
> > >>> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Ajit
> > >>> Damle
> > >>> Sent: Friday, March 30, 2007 7:24 AM
> > >>> To: OpenHeart-L at lists.hsforum.com
> > >>> Cc: 'Manoj Pradhan'
> > >>> Subject: [HSF] Ao Wraping
> > >>>
> > >>>
> > >>> I operated on a 19 year old last week to replace his aortic valve.
> > >>> (What
> > >> a
> > >>> treat! A change from my usual 84 yr old dialysis dependent valves
> > >>> and
> > >>> CABGs!)
> > >>>
> > >>> He was known to have a bicuspid valve. In the past few months, he
> > >> started to
> > >>> become symptomatic (with LV dilatation) so this was a good time to
> > >> replace
> > >>> his valve. He looked Marphanoid, so I had a pre-op CT. That
> > >>> showed, a
> > >> smooth
> > >>> fusiform aneurysm starting in the distal ascending aorta, from 1cm
> > >>> below
> > >> the
> > >>> brachiocephalic takeoff to proximal arch. The diameter was 3.8cms.
> > >>> For comparison, the proximal ascending aorta was 2..6 cms and the
> > >>> descending Aorta was 2.3 cms. The patient is 6' tall and a BSA of
> > >>> 2.3. I was
> > >> prepared
> > >>> to replace his arch. I am very confident and comfortable replacing
> > >> aortic
> > >>> arches, and touch wood, very lucky. But I had some nagging doubts
> > >> regarding
> > >>> the risk/reward ratio in this man.
> > >>>
> > >>> At surgery, to I found that his aortic tissue strength was quite
> > >>> good. I
> > >> did
> > >>> cannulate the undersurface of aortic arch, instead the femoral
> > >> cannulation I
> > >>> had planned (I had the fem artery exposed). I replaced the
> > >>> bi-cuspid
> > >> valve
> > >>> with a 27 Carbomedics. I used a 28 Hemashield graft to externally
> > >>> wrap
> > >> the
> > >>> aorta and sutured it to to the aortic adventitia meticulously,
> > >>> with substantial dissection,  from just above the coronary ostia
> > >>> to the
> > >> take-off
> > >>> of brachio-cephalic laterally and well past it medially, past my
> > >>> aortic input site.
> > >>>
> > >>> Before I did the wrapping,  I may point out  that the aortotomy
> > >>> suture
> > >> line,
> > >>> the cardioplegia and aortic cannula input site, none required any
> > >> additional
> > >>> sutures, indicating that the aortic tissue quality  was good.
> > >>>
> > >>> Did I do the right thing? I will have this man under CT
> > >>> surveillance for ever, but still.................
> > >>>
> > >>>
> > >>> Ajit Damle
> > >>> Fargo ND
> > >>>
> > >>> _______________________________________________
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> > >>
> > >> e-mail: smmalik at brain.net.pk
> > >>
> > >>
> > >> --
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> > >>
> > >>
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> > >
> > > --
> > > Prasanna Simha M _______________________________________________
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