[HSF] Calcified Homograft

[Prasanna Simha M]

>From experience from making holes at the LV apex (CMV's etc. Always
have a purse string to deflect the radial tension when the heart
contracts or else it will and shall expand.. I have seen an
apicoaorticconduit being placed years back and the thing that was done
was an initial purse string , suture placement ,  and the placement of
a the sutures through the graft , boring of the hole with a cutter
that was provided and the  graft was pulled down and tied. The aortic
anastomiosis was done with a side clamp.
Prasanna

On Wed, Mar 19, 2008 at 7:55 PM,  <zzhoumd at pol.net> wrote:
>
>  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
>
>
>  Sent via BlackBerry by AT&T
>
>  -----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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-- 
Prasanna Simha M