[HSF] Thoracic Pseudoaneurym

[Tea Acuff]

Translation for Michael.
1)If you don't have LVAD, one's results are limited to certain strategies.
2)If you don't have a blood bank, one's results are limited to certain strategies. 
3)Using all posssible strategies is a messy solution to lack of planning for rules 1) and 2).
tea



----- Original Message ----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, May 27, 2008 9:22:42 PM
Subject: Re: [HSF] Thoracic Pseudoaneurym

come on - you need to be more specific.


On 5/27/08, Prasanna Simha M <prasannasimha at gmail.com> wrote:
> It is a question of practice. If you treat every patient as a "potential
> Jehovah's" , doing a Jehovah will then become effortless as it will be a
> routine then.Blood conservation has to be right from the word go.
> Prasanna
>
> On Wed, May 28, 2008 at 7:37 AM, Michael Firstenberg <msfirst at gmail.com>
> wrote:
>
>> i also have associated bloodless complex heart surgery as an oxymoron.
>>  maybe those who practice it routiely can shed some light on their
>> system - obvously more than just being good surgeons.
>>
>> On 5/27/08, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>> > Michael
>> >
>> > At 74 and with two prior, and gracious, gifts of bloodless cardiac
>> surgery,
>> > I think this patient needs a compelling reason, and a compelling
>> > surgeon,
>> to
>> > earn himself a third.
>> >
>> > I wonder given that he is asymptomatic how this was diagnosed: 7.8 cm
>> might
>> > sound dreadful but if we had another CT from 18 months ago, or one 12
>> months
>> > from now, that also showed 7.8 we might be a bit more relaxed. As
>> surgeons
>> > we always feel a need to fix things but it is not clear in my humble
>> opinion
>> > that his life expectancy with surgery is necessarily better than his
>> > life
>> > expectancy without surgery. Certainly his surest way of being alive in
>> three
>> > or six, or even likely twelve, months is not to have surgery, and his
>> surest
>> > way to be dead in a month is to have surgery today. Although Dr Martin's
>> > group does have phenomenal success in these patients, I suspect that in
>> most
>> > hands, embarking on such a surgery will transform to physician assisted
>> > death. Many groups have not even been able to perform routine
>> > hypothermic
>> > arrest cases without blood products.
>> >
>> > I think some things are mutually exclusive - in the same way a
>> cardiologist
>> > would not place a drug eluting stent in someone who will not take
>> > antiplatelet agents, we should not embark on such major reoperative
>> surgery
>> > in a (relatively) anemic elderly patient who will not have a blood
>> > transfusion. Blood transfusion is as integral a part of therapy for his
>> > disease as is antiplatelet therapy for coronary stenting.
>> >
>> > Ani
>> >
>> >
>> >
>> >
>> >> From: cardsurg at bellsouth.net> To: OpenHeart-L at lists.hsforum.com> Date:
>> >> Tue, 27 May 2008 16:10:03 -0400> CC: > Subject: [HSF] Thoracic
>> >> Pseudoaneurym> > I have a 74 yo Jehovah witness two years out from a
>> redo
>> >> AVR with a 7.8 cm> pseudoaneurysm adjacent to the ascending aorta. The
>> CTA
>> >> suggest a small> communication, at the level of the aortic suture line.
>> >> The Pseudoaneurysm> abuts the sternum. His hemoglobin is 12.6. He is
>> >> presently asymptomatic> with no fever or chills but occasionally gets
>> >> "pressure in his chest". He> is the sole care giver for his bedridden
>> >> wife.> > I have proposed extracorporeal circulation, hypothermic
>> >> circulatory arrest> and repair with a conduit if his hemoglobin were
>> >> higher. With the current> limitations regarding erythropoietin use I
>> would
>> >> welcome input on management> suggestions.> > Michael Vincent Smith, MD>
>> >
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>
> --
> Prasanna Simha M
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