[HSF] RCA osteal lesion-osteal reconstruction

[Edward Bender]

Ani:
I don't know where this impression comes from.  I often change course,  
even before the operation starts, if I don't like what I see or am  
unhappy with catheter placement, etc.  I have rarely converted to a  
full sternotomy, but have extended a small incision to a larger one  
quite a few times.  Doing the best repair or replacement trumps small  
incisions.

Ed Bender, MD


On Apr 30, 2008, at 10:47 PM, Ani Anyanwu wrote:

>> Chest approach should not compromise the technique. If it is, than  
>> conversion should be done.> > Z Zhou
>
>
> Z
>
> Unfortunately this is easier said than done and in reality surgeons  
> rarely will convert from a mini approach to a sternotomy. What  
> usually results in such cases (where a compromise in technique is  
> forced) is that we do not convert but either struggle, accept  
> inferior result or accept inferior technique. This as i have said  
> previously is well documented in the literature as a higher valve  
> replacement rate in the majority of reports on min-invasive mitral  
> valve surgery. Looking through most series, one will also note that  
> conversions, although talked about, are rare in practice.
>
> There is an understandable reluctance to give a patient a second  
> scar or a larger scar.
>
> Ani
>
>
>
>
>
>> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] RCA osteal  
>> lesion-osteal reconstruction> From: zzhoumd at pol.net> Date: Wed, 30  
>> Apr 2008 23:05:38 +0000> CC: > > > Hal, > > Agreed, whether you can  
>> do a good job with valve repair has lot to do with your  
>> understanding of the valve. > > Chest approach should not  
>> compromise the technique. If it is, than conversion should be  
>> done.> > Z Zhou> > Sent via BlackBerry by AT&T> > -----Original  
>> Message-----> From: Hgrmd at aol.com> > Date: Wed, 30 Apr 2008  
>> 07:45:15 > To:OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] RCA  
>> osteal lesion-osteal reconstruction> > > "Animal",> Actually, I'm  
>> more than OK with your stance. An old cowboy on TV once > said, "a  
>> man's got to understand his limitations." In our zeal to advance >  
>> surgical frontiers, we must not force those of us not comfortable  
>> or ready for the > challenge. For instance, there may be misguided  
>> surgeons wishing to create > a robotic mitral practice, who, in  
>> reality, have no significant mitral repair > experience done via  
>> sternotomy. Certainly, it would be a mistake for such > surgeons to  
>> think they will become safe robotic surgeons when they aren't even  
>> > comfortable doing complex open repairs.> > Hal> > > >  
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