[HSF] yikes..... post aortic dissection distal pseudoaneurysm

[Tea Acuff]

His now 100% mobidity from his first operation, when combined with his 10% mortality for the next one equals in Mike math, 110%.

But , Tom, straight up. What do you think the likelyhood, knowing only the present data, that his chest pain is due to his aorta or an easier end point that he will become acutely symptomatic within the next 12 mouths? 
Wouldn't a followup in 3-6 months have prognostic value?  What are the odds that his current SOB is related to 1-2+ AI?  

This is a rock from a glass house. I have operated myself, probably often enough, where there are criteria but after a poor outcome I wonder whether there were strong enough. And unlike Ani's refusal of the rabies shot our therapy is not only painful, but lethal.


tea


----- Original Message ----
From: "tdmartin2000 at aol.com" <tdmartin2000 at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, March 25, 2008 9:54:28 PM
Subject: Re: [HSF] yikes..... post aortic dissection distal pseudoaneurysm


Michael

Sounds like one of our usual patients. I would really need to see the films, but from what you describe what this guy needs is a reop with removal of his previous graft, AVR or possible root or maybe a valve sparing procedure depending on the root and valve anatomy, and either an elephant trunk or a arch debranching with bypass grafts to the innom and carotid, creating a landing zone for a future stent graft for the descending. If he has no available landing zone near his celiac then an thoracoabdominal resection/repair would most likely be in his future. At 62, as long as he doesn't have any horrible comorbidities, his in hospital survival will be in the 90% range.

Good luck.



Tom Martin

U of Florida

Gainesville


-----Original Message-----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tue, 25 Mar 2008 3:36 pm
Subject: [HSF] yikes..... post aortic dissection distal pseudoaneurysm




I admitted a symptomatic (chest pain and SOB) 62 year/old who had an Type I
repair done in 2002.  Per the patient, he had a very prolonged
post-operative course - including a CVA which left him with a significant
right sided weakness..  At the time, he had a tube graft with resuspension
of the aortic valve, a RCA bypass, and a beveled graft to under the arch.
He now has a moderate size pseudoaneurysm at the isthmus of the underside of
the arch where the graft is attached to the native aorta.  In the OP note
the surgeon describes using a bunch of bioglue in that area to get the
dissected layers back together.  The remainder of his aorta is gently
dilated (~5-6 cm) with a chronic hematoma all the way down to his
bifurcation.

On an echo he has mild to moderate AI with a good EF.

We are currently thinking a stent graft, but not sure there is an
appriopriate landing zone as this is right under the head vessels and there
is not much room between the LCC and LSC.

Unfortunately, none of the open operations/approaches sound good for this
guy.

(left heart bypass, hypothermia - poss circ arrest, TAAA?)


any thoughts or pearls which are not associated with an 110% M&M?


-michael

(one of our experiences vascular surgeons suggested lots of beta-blockers
and a good bottle of scotch)
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