AW: AW: AW: [HSF] aortic root reimplantation and Rv dysfx-Late answer to Erdinc

[Dr. Roberto Battellini]

Erdinc,

shumway had a refrigerator with 80 bottles of cold saline in the OR, he
poured from one side and sucked from the other side of the pericardial
cavity. This is sometimes impossible to controle in mitral cases, but good
for coronary cases. The all the surgeons used slush, I used to perform the
LAD with all the heart under ice. The protection of the RV was ok, but we
had many phrenic paralysis, once I had a double phrenic paralysis and then
abandoned the slush. (we used a rubber piece, or a neoprene piece  to
protect the phrenic nerve. Bob, John Flege and others can talk about this
era, it was called "the ice era", then came Tomas Salerno and Gerald
Buckberg and we changed the techniques.
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von erdinç naseri
Gesendet: Freitag, 7. September 2007 12:37
An: openheart-l at lists.hsforum.com
Betreff: RE: AW: AW: [HSF] aortic root reimplantation and Rv dysfx


>Dear Robertto,
> as an old surgeon, I remember the old times ort he "ice era", we covered
the> heart with ice and the protection of the right heart was excellent.
Also I> remember being 10 days at Stanford in 1982: Dr Shumway did not
perform> cardioplegia, but made a bath of very cold saline the whole time,
in the> pericardial sac, with excellent clinical results. I saw him
personally.Add> this to your armamentarium for those cases.
 
1.In retrospect I even thought that I should have cooled down to 18 degrees
and used a lot of 4 degree saline .Must it be cold slush or does  cold
saline suffice?
> Considering retrograde cardioplegia, if you have a two stage cannula you
are> not 100% sure that the cannula is just exactly at the coronary sinus
ostium,> but if you use double cannulation, then yes. Did you begin with
double stage> and changed?
 
2.I started with 2 stage single cannulae  as is the routine for aortic cases
( I didn't want to repair TR) and then converted to double venous cannulae.I
check the tip of the CS cannulae and pay attention that it be at the very
prx. partof the CS.
> And for Tric insuf only grade one I would not have considered it the
cause> of the problem.> Was the core of the endarterectomy complete? Was the
distal anastomosis on> the descending posterior?
 
3.I started arteriotomy at the last 2 cm of RCA but because of unsmooth tail
I continued distally and finally ended  quiet far in PDA.
erdinc
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