[HSF] Tissue valve in a young patient

[Tea Acuff]

So the first is the Floridan "bikini root"?

Both are interesting ideas based, both I presume, on the next (ten year)step. Quite an insight, again presumably due to many second step encounters.

tea



----- Original Message ----
From: "tdmartin2000 at aol.com" <tdmartin2000 at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Wednesday, November 21, 2007 11:19:26 PM
Subject: Re: [HSF] Tissue valve in a young patient


If a valve salvage doesn't seem to be right ( but it probably will be if it is not bicuspid) then in this age group we have been using several techniques to place a bioprosthesis (Mosaic is my usual choice) like normal and then to sew a large dacron graft to a small rim of aorta at the base. The other techniqui is to take a relatively large graft (30 or 32), evert3 to 5 mm of graft at one end, then take a bioprosthesis, ie a 25 Magna ( in this cse a bovine pericardial is nice because the struts are shorter and fit into the? graft easier) and place the struts inside the graft at the everted end so that the sewing cuff is flush with the everted edge. Then sew the cuff to the everted edge with a 4-0 or 3-0 prolene. Then fold the everted edge of the graft back to normal. The bioprosthesis is now sewn into the graft with 3 to 5 mm of dacron graft as a sewing cuff. This is the sewn to the annulus however you want.

Now in 15 yrs when the valve needs to be replaced, the surgeon can open the graft, cut the prolene, remove the valve and drop another one in without having to replace the entire root. The same can be done with the first technique only you?take the valve out just like you would with any other redo valve.

Hope that made sense.



Tom Martin

U of Florida

Gainesville


-----Original Message-----
From: zzhoumd at pol.net
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 21 Nov 2007 10:36 pm
Subject: [HSF] Tissue valve in a young patient





To forum members,

I have a 48 yo patient who has a 6.5cm ascending aneurysm, severe AR. I told him 
I will try David procedure first. However, these valves are usually stretched so 
much, it may not be successful especially when there are thin with perforation 
in the leaflets. He dose not want take coumadin. Just wonder what kind the valve 
you will use if David procedure is not working..

Here are some of the options I am thinking:

1. Full root Freestyle, great hemodynamics. I have done many of them with great 
results. However, redo may be difficult. There are reports of later aneurysm 
dilation.

2. Suture a perimount valve inside hemoshield graft. Redo may be easier.

Any suggestions? I do not believe Ross in adult patients. No Mitroflow either.

Thanks!

Z Zhou


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