[HSF] Calcified Homograft

[hgrmd at aol.com]

Roberto,

  The risk of anatomic reconstruction in a 3rd time redo is substantial.  However, AVI isn't a great long term solution for such a young patient.  I know the Leipzig short term results are excellent, especially considering the preop condition (average Euroscore around 25% I believe).  Nevertheless, the long term performance of this valve is completely unknown, and this patient is quite young.  BTW, Lars Svennsohn's results of transapical AVI, presented at the last STS, weren't nearly as favorable as what Leipzig reports.



Hal


-----Original Message-----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 19 Mar 2008 5:47 am
Subject: AW: AW: [HSF] Calcified Homograft




Hal,
ow high ist he risk with anatomic reconstruction?
ith Transapical in patients over 80 and multimorbide problems is 10%, for
his case would be 5%...so...may be ...
f they perform anatomic reconstruction, I agree to canulate the axillary
rtery, may be they have to go on hypothermia if the aorta is damaged. May
e wise to cool down before clamping the aorta.
oberto
-----Ursprüngliche Nachricht-----
on: openheart-l-bounces at lists.hsforum.com
mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Hgrmd at aol.com
esendet: Mittwoch, 19. März 2008 11:20
n: OpenHeart-L at lists.hsforum.com
etreff: Re: AW: [HSF] Calcified Homograft
Roberto,
 I would vote for an anatomic solution at this woman's young  age.  Though
 
on't have an extensive experience (fortunately) with these  types of cases,
I distinctly remember doing a failing homograft a few years  ago.  It was
ne 
f the hardest cases I can recall.  The old graft had  to be hacked out with
Mayo scissors.  If the coronary ostia are also  heavily calcified and not 
uturable, then grafting the RCA, CX, and LAD may be  necessary.  I would
ot be in 
avor of an AVI since the patient is so  young.  Another option would be the
aortic valve bypass, which is the LV  apical-descending aorta conduit.  In 
act, I plan to do my first such case  next month with Jim Gammie proctoring
he 
ase.

al

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