[HSF] TVR with liver failure

[Prasanna Simha M]

Any chance doing it combined with a hepatic transplant since they may
need support during the anhepatic phase anyway ?
Prasanna

On Sun, Mar 2, 2008 at 9:17 PM,  <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