[HSF] Calcified Homograft

[hgrmd at aol.com]

Zhandong,
? Thanks for your personal observations on this device.? Dr. Brown is certainly the leader with the procedure.? I suspect Dr. Gammie is 2nd.? I know Gammie is working on a device to streamline construction of the apical hole, but we are currently left with using a "cork borer".? The person I plan to do the procedure is a guy with severe a.s. and 2 previous CABG's.

Hal


-----Original Message-----
From: zzhoumd at pol.net
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 19 Mar 2008 7:30 am
Subject: Re: AW: [HSF] Calcified Homograft




I went to see Dr. Brown (who has the largest series of this kind case) a few 
months ago for apical conduit case which is a little nerve racking. Make sure 
that you have level one infuser available. The problem is no good device for 
making the hole on the LV. 

I do not know how well a mechanic valve will perform in such conduit.

Z Zhou



Sent via BlackBerry by AT&T

-----Original Message-----
From: Hgrmd at aol.com

Date: Wed, 19 Mar 2008 06:20:08 
To:OpenHeart-L at lists.hsforum.com
Subject: Re: AW: [HSF] Calcified Homograft


Roberto,
  I would vote for an anatomic solution at this woman's young  age.  Though I 
don't have an extensive experience (fortunately) with these  types of cases, 
I distinctly remember doing a failing homograft a few years  ago.  It was one 
of 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 
suturable, then grafting the RCA, CX, and LAD may be  necessary.  I would not be 
in 
favor 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 
fact, I plan to do my first such case  next month with Jim Gammie proctoring the 

case.
 
Hal



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