[HSF] 4th rime reop mitral valve

[Douville, Chuck]

Consult for the members from yesterday. 50 yr old male, former IV drug abuser with hepatitis C but none for 4 years, current alcohol user and smoker. History dates back to 2004 when he had a homograft root AVR for endocarditis; returned to OR for bleeding and IABP but made it through. In 2005 presents with severe MR and CHF; undergoes transsternal Mitral repair with quadrangular resection and physio ring. Six months later (now 2006) undergoes redo transternal MVR with a St. Jude biocor valve for  severe Mitral insufficiency. He now presents to our institution for the first time with CHF and has a 23 mm mean gradient across his bioprosthetic mitral valve (effective orifice area 1.03) and CHF. EF is 50% with mild Aortic insufficiency in the homograft root. He is cirrhotic with an INR of 1.3, Transaminases are 3X normal and his serum albumin is 2.7 (nl is 3.5 in our institution).Serum creatinine is normal but his platelet count is 50K.  No ascites on ultrasound, No varices on esophagoscopy. HIs blood cultures are negative.
 
His three sternotomies in 4 years have not worked out particularly well. Who wants to operate?