[HSF] TVR with liver failure

[Michael Firstenberg]

agreed - but would YOU go after this - you probably see a lot more TS than
we (I?) do

-michael


On 3/2/08, Prasanna Simha M <prasannasimha at gmail.com> wrote:
>
> 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)
> >  > _______________________________________________
> >  > OpenHeart-L mailing list
> >  >
> >  > Send postings to:
> >  > OpenHeart-L at lists.hsforum.com
> >  >
> >  > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> >  > http://mmp.cjp.com/mailman/listinfo/openheart-l
> >  >
> >  > All messages transmitted by the OpenHeart-L are subject to the
> policies
> >  > and
> >  > disclaimers posted at:
> >  > http://www.hsforum.com/listdisclaim
> >  > -----------------------------------------
> >  >
> >  _______________________________________________
> >  OpenHeart-L mailing list
> >
> >  Send postings to:
> >   OpenHeart-L at lists.hsforum.com
> >
> >  To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> >  http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> >  All messages transmitted by the OpenHeart-L are subject to the policies
> and
> >  disclaimers posted at:
> >  http://www.hsforum.com/listdisclaim
> >  -----------------------------------------
> >
>
>
>
> --
> Prasanna Simha M
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies
> and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>