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

Sun Jan 20 20:47:11 EST 2008

One of the modes of ventricular failure could be acute that is one
worry.That may give rise to persistent right heart failure or failure of RV
pressures to regress. Otherwise in stenotic mitral valve disease  PA
pressures should decrease unless there is hemosiderosis.
Prasanna

On Jan 20, 2008 8:40 PM, Macbook <grescigno at mac.com> wrote:

> Dear Ani and Prasanna,
>
> I support the idea of preserving the subvalvular apparatus but I do
> not believe that this was the reason of the problems. IMHO this may
> jeopardize the mid-term results with a progressive LV enlargement. In
> this particular case I am quite convinced of a right heart failure.
>
> Giuseppe
>
>
> Il giorno 20/gen/08, alle ore 16:01, Ani Anyanwu ha scritto:
>
> >> There is also no need to "excise" leaflets or more precisely
> >> disrupe the> annulopapillary contnuity .  In fact I may make an
> >> inflammatory comment that it is> unethical not to preserve
> >> annulopappillary continuity in modern day mitral> valve surgery
> >>> Prasanna
> > Yes Prasanna, I would say that is a rather inflammatory comment! As
> > you know this chordal sparing business was largely an invention of
> > Dr David in the 1980s. There is however a paper (in press) from
> > David's group questioning the validity of this technique. David et
> > al looked at all MVRs done over 15 years in their institution and
> > found no difference in patients who had chordal sparing (these
> > procedures largely done by David who is an ardent believer like
> > you) vs no chordal preservation (these largely done by his
> > colleagues). Of course one would have expected chordal sparing to
> > do better for two reasons - because the chords were spared and
> > because they were operated by one of the most talented surgeons of
> > the era...yet the data showed no difference.
> >
> > Ani
> >
> >
> >
> >> Date: Sun, 20 Jan 2008 19:35:01 +0530> From:
> >> prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com>
> >> Subject: Re: [HSF] Access to AV groove area post bypass
> >> Bioprosthesis choice> CC: > > Two things, I do not think a 27 size
> >> valve is stenotic in an average> patient especially the one with
> >> your weight and height - there must be some> other problem.> There
> >> is also no need to "excise" leaflets or more precisely disrupe
> >> the> annulopapillary contnuity . If you really need to do that
> >> then there are> alternatives like creating artificial neochordae
> >> and bivalving the PML. I> can say that I virtually do all cases
> >> with annulopappillary continuity> preservation in all mitrals (and
> >> have my fair share of calcified mitrals> with small LV's . In fact
> >> I may make an inflammatory comment that it is> unethical not to
> >> preserve annulopappillary continuity in modern day mitral> valve
> >> surgery since we can always construct neochordae (these can be>
> >> successfully be done with Ticron too - not necessarily Goretex)> I
> >> do not know the EOA for 27 Epic can anyone give me the data). The
> >> patients> BSA by Dubois formula is 1.659 m2.> What was done for
> >> her Afib ?> Prasanna> > > On Jan 20, 2008 7:14 PM, Macbook
> >> <grescigno at mac.com> wrote:> > > 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.> > > http://body.aol.com/fitness/winter-exercise?
> >> NCID=aolcmp00300000002489> > >
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-- 
Prasanna Simha M