[HSF] Access to AV groove area post bypass Bioprosthesis choice

[Macbook]

Dear Hal,

I agree 100% with you. However I recently operated on a very sick 76  
year-old woman who had undergone a previous open heart mitral  
commissurotomy for mitral stenosis. She had 80 mmHg systolic PAP and  
a severe tricuspid regurg (of course), giant left and right atria and  
continuous AFib. I put a 27 Epic prosthesis (the european equivalent  
of Biocor) and a n° 30 MC3 tricuspid ring. BTW I had to resect both  
leaflet in order to obtain this valve size.  She needed NO to be  
weaned from mechanical ventilation; subsequently she was transferred  
to the ward but she continued to show some degree of right heart  
failure (I should admit that she was not managed in a perfect way and  
I did not follow the patient strictly and personally as was probably  
needed....) After 20 days she was retransferred to our ICU and  
reintubated for severe hypercapnia (100 mmHg!). All the subsequent  
attempts to wean were unsuccessful and the patient eventually died  
from pneumonia. A collegue of mine said that the Epic valve was the  
possible cause because of its small orifice area (the lady was 165 cm  
and 60 Kgms). Honestly I am not sure about his conclusion but I  
should say that next time I will put a mechanical SJM (she was  
already anticoagulated). I will appreciate your toughts and those of  
all the members about the orifice areas of Biocor/Epic prostheses and  
the possibility to create a patient/prosthesis mismatch in mitral  
position.
Thank you


Giuseppe


Il giorno 20/gen/08, alle ore 13:14, Hgrmd at aol.com ha scritto:

> 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
>
>
>
> **************Start the year off right.  Easy ways to stay in shape.
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