AW: AW: [HSF] New crazy operations and solutions at HZL

[Tea Acuff]

Just like the concept "mininmally invasive" do we mean anything specifically (if so what?) by better operation? What kind of better operation does a 85 year with "pretty severe" dementia need?

tea



----- Original Message ----
From: "DukeB60 at aol.com" <DukeB60 at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, April 24, 2008 7:37:34 AM
Subject: Re: AW: AW: [HSF] New crazy operations and solutions at HZL

I was re-consulted yesterday on an 85 yo.  male with severe AS admitted with 
chest pain.  I had consulted on him a  year ago and thought him to be a poor 
surgical candidate because he had previous  CAB with Bilateral IMA's with the 
RIMA crossing the midline anterior to the  aorta, LIMA to the LAD and a couple 
of veins.  His EF is 30% - not  that bad.  He has, however, pretty severe 
dementia which played a  significant role in my decision not to operate then.  
Renal function is  okay.  
    I reconsidered doing him now because of my  experience with the 
apico-aortic conduit which I think would be much better  tolerated and safer than a 
traditional redo.  I would think it  has a high likelihood of giving this man 
symptomatic relief and keep him  out of the hospital for a while, but like AVI, 
maybe I am avoiding a tough redo  for the sake of an inferior but easier 
alternative.  The family has looked  into percutaneous valves.  
    In my mind the apico-aortic conduit makes a  non-operative case an 
operative one in this patient but perhaps it is not a  viable alternative and he 
should be done through a traditional sternotomy.  Any thoughts?

                                                                              
                      Ed

Edward P. Raines, M.D.
BryanLGH Cardiothoracic  Surgery
BryanLGH Medical Center East 
1600 South 48th Str.
Lincoln,  Nebraska 68506
Office: 402-481-8430
Cell: 402-730-9242
Fax:  402-481-8429



In a message dated 4/24/2008 5:20:10 A.M. Central Daylight Time,  
Hgrmd at aol.com writes:

Roberto,
Of course we are not better surgeons than the guys  at HZL!  As  you must 
know by now, HZL is widely considered one  of the top heart  programs in the 
world.  However, I do think  it's a fact that there is  little known about 
the long 
term  performance of transapical AVI, particularly  the durability of the  
prosthesis.  That is why I caution surgeons in  thinking that  most aortic 
valve 
cases should be done in this fashion.    Indeed, that may eventually be the 
case, 
but for now, we just don't  know.  The fact remains that most aortic valve 
cases can be  done conventionally with  excellent immediate and long term  
results.

Hal



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**************Need a new ride? Check out the largest site for U.S. used car 
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