[HSF] Ao Wraping, One more question!

[erdinç naseri]

Ajit,
I always ask myself whether we should  extensively operate patients with EF 
of lower than 35.Is there any study evaluating 5,10 and 15 years survival of 
these patients without any associated cardiac pathologies .
erdinc



>From: "murtaza chishti" <cmurtaza at hotmail.com>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: RE: [HSF] Ao Wraping, One more question!
>Date: Sat, 31 Mar 2007 11:51:02 +0000
>
>ajit damle
>
>in absence of a connective tissue disorder, AVR would be unnecessary.
>
>murtaza chishti
>
>
>>From: "Ajit Damle" <damle at cableone.net>
>>Reply-To: OpenHeart-L at lists.hsforum.com
>>To: <OpenHeart-L at lists.hsforum.com>
>>Subject: RE: [HSF] Ao Wraping, One more question!
>>Date: Fri, 30 Mar 2007 09:44:21 -0500
>>
>>
>>Thank you Igor, Michael, Prasanna, Hal, Ed and Manoj for your thoughtful
>>replies.
>>
>>I do not know what to make of the diameter as a threshold for an 
>>operation.
>>Is it 4.0, as Igor recommends? In a 19 year old, who has plenty of time to
>>plot against us, my threshold would be lower still. But replacing the
>>ascending aorta without (or a brief) circulatory arrest is a different 
>>deal
>>than replacing the arch with a longer circ arrest. I must admit, though,
>>that I am astonished every time that patients wake up without a detectable
>>neurological deficit!
>>
>>Part of the reason is the relative ease and absolute success rate of arch
>>replacements in low risk patients. I did lose a patient some years ago, 
>>who
>>I treated with a Cabrol shunt for coronary ostial implantation. I could 
>>not
>>prove it, but I do think that the shunt somehow (twisted or compressed)
>>induced coronary insufficiency. Since then,  I have switched to the 
>>Valsalva
>>graft and direct coronary implantation, and have been just giddy with
>>success.
>>
>>I had never considered wrapping to be a serious option, but there was a
>>recent paper that showed external wrapping was a viable option, and that 
>>got
>>me thinking.
>>
>>BTW, I have yet another aortic aneurysm coming up. 52 yr man, non-ischemic
>>cardiomyopathy, QRS 110 ms, EF 25-30%, NYHA II, PAP 55/20, new onset 
>>A.Fib.
>>MR 2+, AI 1+, tricuspid aortic valve, no coronary angiogram yet, Asc Ao 
>>6.1
>>cms.(not arch, I think I can do him without, or a brief, circ arrest). My
>>plan is to replace the asc aorta, repair mitral, do a maze, excise the LA
>>appendage, and CABG if needed. I wonder if I should replace his aortic 
>>valve
>>as well, because he may be on coumadin anyway and, with his cardiomyopathy 
>>I
>>may not have the luxury to bring him back in 5-10 years.
>>
>>What do you think? Too much an operation for this man? Should I replace 
>>his
>>aortic valve?
>>
>>Ajit Damle
>>Fargo ND
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
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