[HSF] Valve repair in an irradiated chest

[Mitch Lirtzman]

Greetings all.
Next week, I've scheduled MVR/TVR in a 48yo man who was treated for 
Hodgkin's three years ago. They managed to kill his kidneys with chemo and 
gave him "total body" irradiation. He now has severe MR and TR. Both should 
be amenable to repair. His coronaries are clean and EF~45%. The guy looks 
healthy as a horse but he can't walk more than 100 ft and can't lie flat.
Any caveats, pearls, or pitfalls I should be looking for?
Thanks in advance.
Mitch