[HSF] Access to AV groove area post bypass

[Hgrmd at aol.com]

Dear Yadav,
  It's nice to hear a new voice on HSF.  I understand your  concern about 
lifting the heart to inspect the CX graft in the presence of a  mitral 
bioprosthesis.  Excellent suggestions have been given by Drs. Asai  and Flege.  In 
addition, I would suggest that you use the smallest, lowest  profile bioprosthesis 
available in order to lessen the likelihood of trauma to  the lateral wall 
from the struts of the valve.  That is why I've gone to  using the St. Jude 
Biocor.  The height of the Edwards porcine valve is  13mm, while the Biocor is 9 
mm.  This also reduces the likelihood of  important left ventricular outflow 
tract obstruction in small, hyperdynamic  hearts.  One valve I would specifically 
avoid is the Edwards  Perimount.  Years ago, I lost 2 patients from LV wall 
rupture while using  that valve.  The reason is its high profile as well as 
extremely sharp  struts.  
 
Hal



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