[HSF] TVR with liver failure

[Michael Firstenberg]

I probably would have better luck doing it off pump than talking the Liver
team into a combined case.

I guess the underlying question is if her current liver reserve will
tolerate a redo?

-m


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