[HSF] ASD with LAD Disease

[Donald Ross]

Mark Levinson could have done both via a subxyphoid incision.
Nowhere near an intercostal nerve or a robot.
Don
On 31/12/2007, at 11:26 PM, Zhandong Zhou wrote:

> In this day of age, just talking about survival for open heart  
> surgery or coronary artery disease is not enough. PCI has never  
> matched CABG in terms of survival or MACE (major adverse cardiac  
> event). PCI is gaining ground every year. We have to do our part as  
> well. Here is the case I did today.
>
> 65 year old active patient has 1 year history of increasing SOB.  
> TEE show large ASD not candidate for closure device. Cath show 70%  
> LAD take off lesion. left to right shunt 2.5:1. PA pressure about  
> 60mmHg with resistance about 3 woods unit. (I can not remember  
> exact number, if someone interested, I can find it) Patient's  
> cardiologist ask me if I can do it with minimal invasive approach  
> as the patient wanted go back to normal life in short period time  
> without restrictions.
>
> Although it is general rule that I do not do CABG for mini-valve or  
> ASD, I decided to give a try. I used robot to take down LIMA, then  
> went to the right chest with 2.5 inch incision. Fem-fem cannulation  
> and clamp the aorta with modified heart-port technique. Fix the ASD  
> with a 3cm autologus pericardial patch. With aorta still clamped, I  
> made a second incision in left chest about 2 inch size and suture  
> the LIMA to LAD. It took me a little over 5 hours to do the  
> surgery, patient is doing well, already wake and will be extubated  
> tonight. Alternative, I could have done the whole thing with a  
> sternotomy in less than 3 hours.
>
> In summery, patient end up with two mini-thoracotomy incision, one  
> is 2.5 inches in the right chest, one is 2 inches in the left  
> chest. He also has a small incision for femoral cannulation. The  
> advantage, no sternotomy, no rib cutting, he can go back to normal  
> acrivities in 2 weeks with no restrictions. Disadvantage, longer  
> surgery time and a little more work for the surgeon.
>
> Any comments?
>
> Z Zhou
>
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