[HSF] Calcified Homograft

Thu Mar 20 01:14:22 EDT 2008

I have done several like this one and have used both techniques- redo root/MVR and apical aortic conduit/MVR. Either is a viable option, but all things considered I would probably go with a redo root with a mechanical valve conduit. If she has AS only as her aortic pathology I doubt she is infected. We have one pt out about 15 yrs or so that we had almost the same problem. He had a valve conduit that got infected with fungus, we replaced it with a homograft and then 10 yrs later he developed severe calcific AS. We redid his root with another mechanical valve conduit and he?is about 5 yrs out with no problems.
Either operation is technically demanding but the mortality should be under 10% for either. We have used mechanical valves, bioprostheses, freestyles and homografts with the apical aortic conduits and they all work well. If you do the? case on pump, which I would strongly suggest, then you don't need a rapid infuser.
Good luck!

Tom Martin
U of Florida
Gainesville

-----Original Message-----
From: hgrmd at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 19 Mar 2008 8:55 am
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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