[HSF] ASD with LAD Disease

[Goldman, Scott]

Agreed, we do heart ports on many sick patients. MV repairs on pretranplants, endocardis, acute ruptured cords ect.  I feel that the lower amount of trauma with minimally invasive surgery contributes to a suvival advantage.

Scott Goldman MD

Chairman 
Department of Surgery
MLH

-----Original Message-----

From:  "zzhoumd at pol.net" <zzhoumd at pol.net>
Subj:  Re: [HSF] ASD with LAD Disease
Date:  Tue Jan 1, 2008 8:14 am
Size:  5K
To:  "OpenHeart-L at lists.hsforum.com" <OpenHeart-L at lists.hsforum.com>

Michael, 
 
Happy new year! 
 
I just saw him and he is up in the chair. One of the advantages of mini thoracotomy is less bleeding. Total chest tube drainage is less than 200ml. Hct is 37 (39 pre-op). 
 
You brought up an important point. Mini invasive surgery is more for less sick patients, although I did robotic MIDCAB in some sick patients. I have also done heart port mitral valve replacement in a third time redo patient when she had endocarditis and in septic shock. Again, it is not a silver bullet. There should be different solutions for sicker patients like yours.  
 
OPCAB was developed as a first step to compete with PCI, but it is not the solution. We have to do better. 
 
For me, This is the last day on call for a five day long weekend. 
 
Z Zhou 
 
 
 
Sent via BlackBerry by AT&T 
 
-----Original Message----- 
From: "Michael Firstenberg" <msfirst at gmail.com> 
 
Date: Tue, 1 Jan 2008 08:40:27  
To:OpenHeart-L at lists.hsforum.com 
Subject: Re: [HSF] ASD with LAD Disease 
 
 
Z - 
I am not picking on you - I am am glad that you see my points.  Just has we 
are operating on "less sick" patients such as yours (though it is suprising 
that with that big of an ASD that he did not have more problems) we are also 
operating on very sick patients and what concerns me is all of this 
enthusiasm for high technology and cosmetic cardiac surgery in patients with 
very little room for error. 
 
I assume your patient is extubated and doing ok? 
 
-m 
 
 
On 1/1/08, zzhoumd at pol.net <zzhoumd at pol.net> wrote: 
> 
> 
> Murtaza, thanks for your comments. I think the same principle can be used 
> in mini valve cases if the patient has 1-2 vessel CAD. 
> 
> Z Zhou 
> 
> 
> Sent via BlackBerry by AT&T 
> 
> -----Original Message----- 
> From: murtaza chishti <cmurtaza at hotmail.com> 
> 
> Date: Tue, 1 Jan 2008 07:47:54 
> To:<openheart-l at lists.hsforum.com> 
> Subject: RE: [HSF] ASD with LAD Disease 
> 
> 
> 
> 
> 
> if the surgeon has the will, the patience, the skills  and 
> the  infra-structure and can  achieve the same surgical   objective via a 
> less traumatic and less disruptive approach, has the wisdom to select the 
> appropriate candidate for a relatively unfamiliar operation and the 
> foresight to anticipate trouble and the ability to forestall potential 
> disasters, he/she should, without doubt , go ahead and do it; or else , how 
> does the art and science of surgery advance? 
> 
> great work Dr Zhou 
> 
> murtaza 
> 
> 
> > From: zzhoumd at pol.net 
> > To: OpenHeart-L at lists.hsforum.com 
> > Subject: Re: [HSF] ASD with LAD Disease 
> > Date: Tue, 1 Jan 2008 00:36:26 +0800 
> 
> > CC: 
> > 
> > Michael, 
> > 
> > Thanks for all the comments. Mini invasive surgery dose not change the 
> basics of open heart surgery. It is done with the same principle, but 
> different approach with different instruments. I do not see the 
> contra-indications for surgery have ever changed for sicker patients. But I 
> did see patients with less of disease become more acceptable for surgery. 
> For example, single vessel disease such as we discussed earlier. Like Ani 
> suggested, some cardiologists will manage single vessel disease medically. 
> But I do have growing number of cases that cardiologists will send to me for 
> single graft to OM or RCA as patient is symptomatic. I have one patient has 
> chronically occluded RCA for many years. After I grafted the distal RCA with 
> a mini incision and Robotic RIMA takedown, he told me that he felt 20 years 
> younger and full of energy. 
> > 
> > Now come back to your question about bad lungs or obese patients. If 
> just graft the LAD, the surgery can be down without bypass or sternotomy. I 
> have done many of them and they do well. Patients with severe COPD, usually 
> tolerate single lung ventilation well as I learned from my thoracic surgery 
> experience. Obese patients can be challange, but I have done patients up to 
> 300 pounds. For Mitral or ASD, with videoscope assistance or robot, it can 
> be done as well. I think Hal can tell you more. 
> > 
> > Most patients can tolerate some degree of hypoxia. However, if I see 
> sats below 90, I just let the anesthesiologist ventilate both lungs then 
> find out the problem. LIMA takedown can be performed with both lung 
> ventilation by increasing CO2 pressue in the left chest to creat enough 
> space. I never hesitate to convert someone to regular sternotomy. For ASD or 
> mitral valve, just go on bypass with femoral cannulation then drop both 
> lungs. 
> > 
> > Regarding heart-port, I just use the femoral cannulation part and their 
> instruments. I never used their endo balloon. To avoid femoral cannulation 
> complications, just ask anesthesia to check the descending aorta make sure 
> no dissection. Most common complication is seroma, it can be avoided by less 
> of dissection and using Seldinger technique. One of my partner's patients 
> did have compartment sydrome from DVT. 
> > 
> > There is no doubt that the surgery can be done much quicker with 
> standard sternotomy. It is a little more work to do mini incisions. 
> Therefore, the ar