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

Sun Jan 20 16:27:37 EST 2008

Pulmonary vascular resistance was fixed preoperatively....
Giuseppe

Il giorno 20/gen/08, alle ore 16:17, Prasanna Simha M ha scritto:

> 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> _______________________________________________>
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>
>
>
> -- 
> Prasanna Simha M
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