[HSF] Redo root replacement

[erdinç naseri]

Don,
This patient had  LC ostial cannulation and continous cold hyperkalemic blood cardioplegia throughout the case.Theoretically there was unobstructed supply down the coronaries.Following declamping the heart started beating in sinus rythm and I consider this as a sign of good protectionin such a long cross clamp time..The previous case was that of an operated CABG with acute dissection involving RCA ostium and preop MI and low EF.We have to review our protocol for very long X clamps.
erdinc
> From: donross at bigpond.com> Subject: Re: [HSF] Redo root replacement > Date: Tue, 22 May 2007 16:40:10 +1000> To: OpenHeart-L at lists.hsforum.com> CC: > > erdinc,> Doing cardiac surgery is the pits sometime!> I do feel that there is something wring with your protection because > this patient shouldn't have perished after such masterly surgery.> I think you had another death after a longish Xclamp recently?> These clamp times should not be such a problem with good protection.> Do you ever use retrograde as well as antigrade?> I think most folk (Thomas excepted) use both and deliver > intermittently either blood or crystalloid 'plegia every 15-20 minutes.> Commiserations,> Don> On 22/05/2007, at 3:57 PM, erdinç naseri wrote:> > >> > 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 > > bradyca> > rdia unresponsive to pacing at postop 6.th hour.Open the wound and > > massage.Unfortunately couldn't make it.> > erdinc> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the > > policies and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------