[HSF] Calcified Homograft

Wed Mar 19 15:25:30 EDT 2008

Hal,

I was going to have Dr. Brown to help me with a case, but the lady got admitted with congestive heart failure while I am getting the paper works.

The LV cutting device makes a hole the same size as the connector. However, it become bigger as the heart contracts. Therefore, he endup with placing a lot of pleget sutures. Bleeding eventually stopped. He did this completely off pump. I wonder if it will be better to do this on pump. 

Z Zhou

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

Date: Wed, 19 Mar 2008 08:55:53 
To:OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Calcified Homograft

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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