[HSF] (no subject)

[David Harris]

Hal,

That is a very unfortunate and sad story. Half of the problem is when the patient encounters us on our learning curve. Maybe the crux of the matter is that we should not be doing these cases without supervision if we have not yet gained enough experience.

In my earlier days I repaired a mitral in a 10 year old. In retrospect the repair would have been OK, there was a central jet and I was unhappy so went onto replacement. Clamp time was 90 minutes, and heart was protected as well as possible. The patient was sent to ICU in a stable condition after coming off pump easily, but after 3 hours had an arrest and unsuccessful resuscitation....I was told later by the paediatrician that we should not be attempting valve repairs as this prolongs the clamp time too much and is therefore hazardous.

Dave



--- On Sun, 31/8/08, Hgrmd at aol.com <Hgrmd at aol.com> wrote:

> From: Hgrmd at aol.com <Hgrmd at aol.com>
> Subject: Re: [HSF] (no subject)
> To: OpenHeart-L at lists.hsforum.com
> Date: Sunday, 31 August, 2008, 8:35 PM
> Ani,
>   As usual, your analysis of Ross results reflects my
> conclusions as  well.  
> Unless they are scrupulously followed up, the results are
> probably  not quite 
> as good as reflected in the literature.  At the last
> Society of  Heart Valve 
> Disease, the Ross surgeon on your faculty gave a
> particularly  glowing account 
> of his results.  I was skeptical then; I'm skeptical 
> now.  The major problem 
> for me is that the Ross requires replacing a  usually
> normal root (This is the 
> same criticism I have of stentless miniroots  for aortic
> stenosis.).  In 
> addition, it converts single valve into double  valve
> disease.  
>   Finally, the Ross is inherently more risky.  I know the
> surgeon  who did 
> the Ross on my patient back in 1999.  This surgeon has and
> deserves  an 
> excellent reputation.  However, I'll always remember
> how he asked me to  review a case 
> in which he was being sued.  The patient was a 24 yo single
>  mother of 3 that 
> he did a Ross for AI.  The patient died shortly after 
> surgery of a massive 
> anteroseptal MI.  Though it was never proved, I'm sure 
> the fatality was due to 
> injury of the 1st septal while harvesting the  autograft. 
> If the lady had 
> just had a garden variety mechanical AVR, I'm  sure
> there would be 3 less 
> orphans in my community.
>  
> Hal
> 
> 
> 
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