[HSF] TVR with liver failure

[Michael Firstenberg]

oh yeah combined liver transplant, redo TVR (i actaully like the idea, but
we know we are crazy)

-m


On 3/2/08, Prasanna Simha M <prasannasimha at gmail.com> wrote:
>
> 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)> >
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> Prasanna Simha M
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