[HSF] Redo root replacement

[erdinç naseri]

Prasanna,
1.RCA was nondominant ( 2 mm probe didn2t go inside it)
2.No adenosine in Turkey( to my knowledge)
3.TEE probe still out of work.
4.Couldn' remember EF numerically but the patient was admitted toER in pulmonary pre edema days before the operation.
erdinc
> Date: Tue, 22 May 2007 15:00:54 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Redo root replacement> CC: > > Brady + arrest after bentall = RCA ostial problem till proved otherwise.> Using cold continuous is usually not a problem. I usually arrest with K and> maintain with plain cold blood unless there is activity. I also like to have> a retrograde on.> As I mentioned I use adenosine and Esmolol too to enhance protection.> This modification (especially added esmolol ) was a direct response to a> couple of AVR deaths I had some time back.> I also tryto follow the near hit miss strategy. If I need more than 5 mics> dopa + dobut in a case not in perop cardiogenic shock reassess and rule nout> a mechanical problem. Probably high inotropes + IABP was the first warning> of impending doom.> Was an Echo/ TEE done ?> Prasanna> > > On 5/22/07, erdinç naseri <enaseri at hotmail.com.tr> wrote:> >> >> > 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 st> > ernum 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 p> > acing at postop 6.th hour.Open the wound and > > massage.Unfortunatelycouldn'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>> > -----------------------------------------> > _______________________________________________> > 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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> 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> -----------------------------------------