[HSF] 4th rime reop mitral valve

[Hgrmd at aol.com]

Chuck,
  Has he had any type of assessment of his hepatic reserve?  Is  there any 
contribution of severe TR to the picture?  Other than  catastrophic reentry, the 
thing that would most likely kill him would be postop  hepatorenal syndrome.  
I don't envy you, my friend.  If you do decide  to operate, I would either 
split the sternum on CPB or approach the valve(s)  from the right side.  Another 
reasonable option would be to tell the  patient he is out of luck.
 
Hal



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