[HSF] TVR with liver failure

[Prasanna Simha M]

Hepatic failure Childs C would be at least 30 -40 % Mortality.
Prasanna

On Sun, Mar 2, 2008 at 9:26 PM, Michael Firstenberg <msfirst at gmail.com> wrote:
> I also use tissue valves in the tricuspid position (and put on perm
>  epicardial wires!).  I recently saw a patient with a mechanical MVR/TVR who
>  needed a perm pacer for a junctional rate in the 30's.
>
>  I thought showing our liver transplant surgeon what real pain is..... doing
>  a liver transplant on a patient who requires coumadin to keep the INR in the
>  3-4 range!
>  (I may never get another consult from the solid organ transplant team
>  again..... wait, is that a bad thing?)
>
>  I agree - but is there anyway to tell how much of her liver is from the TS?
>  My understanding is that these patients do not get cirrhosis?
>
>  Should I insist on a biopsy?
>
>  of course, according to the STS risk database this case has about a 2-5%
>  mortality (redo valve)
>
>  -m
>
>
>
>
>  On 3/2/08, Hgrmd at aol.com <Hgrmd at aol.com> wrote:
>  >
>  > Michael,
>  > I probably wouldn't operate since the patient has advanced primary  liver
>  > disease.  If it was secondary to tricuspid disease, that might be
>  > a  different
>  > story.  However, I'd have to eyeball her before I could  definitely tell
>  > you
>  > not to operate.  If you do offer surgery, the bleeding  will be
>  > predictably
>  > horrendous.  First, I would do a maze.  The  patient would definitely
>  > benefit
>  > from eventually getting off Coumadin.  Do the tricuspid part with the
>  > heart warm
>  > and beating.  Do a  replacement with a bioprosthesis.  I would favor an
>  > Edwards  Perimount.  You may ask why, since I invariably castigate the
>  > hell out of
>  > that valve for its propensity to savage the lateral wall with its sharp
>  > struts.  However, in the tricuspid position, I wouldn't be worried about
>  > AV
>  > rupture, as long as the RV was ample.  Don't use a mechanical.  They  have
>  > a higher
>  > thrombosis rate, even with Coumadin.
>  >
>  > Hal
>  >
>  >
>  >
>  > **************Ideas to please picky eaters. Watch video on AOL Living.
>  > (
>  > http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/
>  > 2050827?NCID=aolcmp00300000002598)
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-- 
Prasanna Simha M