[HSF] Redo root replacement

[erdinç naseri]

Dear everybody,
Follow up of the aortic root replacement in a previously operated AVR-Cryolife O'Brian (76 y/o male).
Yesterday I operated the patient:
Left femoral artery and vein cannulation and R femoral artery IABP cath.Opened sternum on full bypass(preop CT showed RV completely adhesed to sternum).Mild laceration of RV in the process, no need to do any thing.Cooled up to 26 and cross clamped.Opened Aorta: NCC torn from base,RCC torn from free edge to base.The whole root and ascending aortic specially  annulus  calicific like stone.took 30 minutes to come to a point where sutures can be put.Decalcification of NCC  lead to an opening in AML (sutured primarily since the leaflet was very redundant and pliable.Aortic root replaced with composit graft( NCC supraannular to the aortic wall), Lc ostium via a vein  to the graft,Rc directly to the graft.Myocardial protection : continous antegrade blood hypothermic and hyperkalemik blood Through LC ostium (RCA rudimentry on angio and intraop).X-Clamp:146min,CPB 257 minute,Weaning on high dose inotropes and IABP( very gradual).Everything O.K with decrease in inotropes .Suden bradycardia unresponsive to pacing at postop 6.th hour.Open the wound and massage.Unfortunately couldn't make it.
erdinc