[HSF] TVR with liver failure

[Prasanna Simha M]

That wa my line of reasoning too since each cannot live without the
opther (Putting it  in the Koan way !!
Prasanna

On Sun, Mar 2, 2008 at 10:22 PM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
> > 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?
>  > > -m
>  But what does it matter? This patient already has cirrhosis. The aim of surgery here is not to improve liver dysfunction (which has been assumed to be irreversible if listed for a transplant) but to make the liver transplant safer from the cardiac perspective and to protect the new liver from high venous pressure.
>
>  If a tissue valve you can consider balloon dilatation.
>
>  Suggest to the liver surgeons that you do a combined procedure - you will rereplace the valve at time of liver transplant. That way both operations become survivable. I bet you they will run a mile. That way you see how committed they are to this patient rather than seeking an excuse not to do the transplant. If you operate now, I bet you will find the patient die on your hands of liver failure and be told post-operatively by liver team (who you were doing a favor) that the patient is too sick to transplant.
>
>  Ani
>
>
>
>
>
>  > Date: Sun, 2 Mar 2008 10:56:34 -0500> From: msfirst at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] TVR with liver failure> CC: > > 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> -----------------------------------------
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-- 
Prasanna Simha M