[HSF] Possible infected Freestyle

[prasannasimha]

One of the worse mistakes to do is to try to shove too large a 
prosthesis into an aorta. This seems to be compounded in bioprosthesis 
with their struts. I think if you have had the misfortune of doing it 
,augmentation of the aortotomy needs to be doe to prevent the aorta 
tearing and also to prevent sleeving of the aorta over the bioprosthesis 
compromising coronary flow.
As far as pledgets on thin aortae, I think the best thing is to avoid 
bleeding in the first place by using a finer suture and closer bites and 
more importantly to "decompress" the aorta with CPB or SNP flushes and 
to take any subsequent bites on a non "pressurized" aorta.One more thing 
is to clear the aorta of adventitia or reverse flap the adventitia to 
act as an autopledget that seems to work well. (I think I sent the photo 
once some time back). I also prefer pericardial pledgets compared to 
Teflon as far as possible especially the U pledgets that act as both 
local tamponade in addition to pledgets.
http://ctsurgcomplications.wikia.com/wiki/Image:Hemostasis_aorta1.jpg
http://ctsurgcomplications.wikia.com/wiki/Complications_related_to_Arterial_cannulation
(Have to restart reediting the Wiki - having too much of Kitty 
(veterinary) problems of late with my kitten !!)
Prasanna
tdmartin2000 at aol.com wrote:
> Hal
> A 25 Mosaic will easily fit in the same annulus as a 23 magna. So, if he were to have tried to place a 23 magna the same problem would have occured. The question to John would be if he thought he oversized. If so he should have tried a 23 Mosaic to begin with. 
> What do you  think John?
> Tom 
>  
> -----Original Message-----
> From: Hgrmd at aol.com
> To: OpenHeart-L at lists.hsforum.com
> Sent: Tue, 1 May 2007 7:30 AM
> Subject: Re: [HSF] Possible infected Freestyle
>
>
> John,
>   Welcome to our club.  I hope one of the principles you learn  from this 
> case is that less is often more.  I don't know of many 80 yo  patients who would 
>
> truly benefit from the hassle of a 25 mm stented  prosthesis.  If you had 
> placed a 23 mm C-E Magna, you would have gotten the  same effective orifice 
> area, 
> and presumably not had this terrible  complication.  I'm not sure what Tea was 
> implying about the use of pledgets  on the aortotomy, but I recommend you use 
> them liberally.  Losing control  of an aortotomy is a very lonely feeling.
> Hal
>
>
>
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