[HSF] Tissue Valve+Graft

[Ani Anyanwu]

Dr Zhou
 
No that is not he case. Even if the valve is placed between the annulus and the dacron, the valve alone can be easily rereplaced without doing another Bentall. 
 
Dr Griepp describes a simple way of doing it. Just make an oblique incision in old dacron and then incise the cloth vey close to the stent of the valve, the stent dislocates easily and you take out the valve leaving the sewing ring intact. A new valve is sewn in with a running prolene suture. He has done several this way - a tissue valve in dacron tube has been his preferred method of biological root replacement since late 1980s so quite a few have failed now.
 
Ani



> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Tissue Valve+Graft> From: zzhoumd at pol.net> Date: Thu, 22 Nov 2007 17:12:29 +0000> CC: > > > My concern is redo. If the valve is placed between annulus and the dacron graft, you may need another Bentall instead of simple valve replacement.> > Z Zhou> > Sent via BlackBerry by AT&T> > -----Original Message-----> From: "Ajit Damle" <damle at cableone.net>> > Date: Thu, 22 Nov 2007 10:52:03 > To:<OpenHeart-L at lists.hsforum.com>> Subject: RE: [HSF] Tissue Valve+Graft> > > Yes, if anticoagulation is contra-indicated. But I have not re-operated on> any of these patients, so I do not know.> > Ajit> > -----Original Message-----> From: openheart-l-bounces at lists.hsforum.com> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of zzhoumd at pol.net> Sent: Thursday, November 22, 2007 10:46 AM> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Tissue Valve+Graft> > Dear Ajit,> > Thanks for the detailed description. Just wonder if you will use the same> technique in a younger patient.> > Z Zhou> > Sent via BlackBerry by AT&T> > -----Original Message-----> From: "Ajit Damle" <damle at cableone.net>> > Date: Thu, 22 Nov 2007 10:00:19 > To:<OpenHeart-L at lists.hsforum.com>> Subject: [HSF] Tissue Valve+Graft> > > Dear Dr. Zhou,> > > > I have no experience in the Ross procedure, but I have done quite a few> Perimount valve and Valsalva graft combinations. It is my favorite technique> for root replacement in older patients.> > > > I have highlighted my points:> > > > 1. For a Perimount valve, the size of the Valsalva graft should be 5 sizes> higher. So if you implant a 23 mm valve, choose a 28 mm conduit. This may be> different for other valves, as the Perimounts do have larger OD. The other> day I confirmed that the OD for a 23 mm Sorin Mitroflow is between a 19 and> 21 Magna. Call your tissue valve rep ahead of time. Intra-op, before> putting sutures, make sure it is the correct fit.> > > > 2. Depending on the location of coronary ostia, trim appropriately the lower> margin of the graft. I then pre-load the Valsalva graft on to the valve> holder and advance it so that the valve sewing ring and the lower margin of> the graft match. I then insert pledgeted sub-annular sutures first through> the valve, and then immediately through the graft margin. The valve is then> parachuted down on the annulus. Before tying the sutures, look inside the> graft and make sure the sutures are OK (in one instance one of my> commissural sutures was riding on a post, narrowly avoided a disaster).> > > > Also, after the annular sutures are tied, I test the suture line for leaks> with cardioplegia through the graft, and confirming no surgical leaks, seal> the suture line with a topical sealant (Co-Seal). I repeat the testing and> sealing for the coronary ostia implantation as well. I have had virtually no> leaks from these, and have gotten away without blood transfusions in many,> particularly elective, patients. Use of topical sealant is a class IIb> indication.> > > > Ajit Damle> > > > > > > > > > > > > > > > > > > > > > -----Original Message-----> From: openheart-l-bounces at lists.hsforum.com> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of zzhoumd at pol.net> Sent: Thursday, November 22, 2007 6:42 AM> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Tissue valve in a young patient> > > > Tom, thanks for your detailed description. My partner tried the first> technique you described. He had difficulty for hemostasis if the suture line> bleeds. I really like the second technique. > > > > Just wonder how do you choose the size of the graft and valve. Do you always> choose 5mm larger graft for your mosiac valve? Do you prefer valve salvage> than a composite bioprothesis graft?> > > > I have been using full root Freestyle in the past for older patients or> patients who do not want to take coumadin. Recently, a few people told me> they have seen aneurysmal dilation in young patients. Redo can also be> difficult.> > > > Z Zhou> > > > > > Sent via BlackBerry by AT&T> > > > -----Original Message-----> > From: tdmartin2000 at aol.com> > > > Date: Thu, 22 Nov 2007 00:19:26 > > To:OpenHeart-L at lists.hsforum.com> > 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> > > > > > Sent via BlackBerry by AT&T> > _______________________________________________> > 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> > -----------------------------------------> > > > > > ________________________________________________________________________> > More new features than ever. Check out the new AOL Mail ! -> http://o.aolcdn.com/cdn.webmail.aol.com/mailtour/aol/en-us/text.htm?ncid=aol> cmp00050000000003> > _______________________________________________> > 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> -----------------------------------------
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