[HSF] Percutaneous AVR

[Roberto Battellini]

The truth is that there are some AI.
I am going to have the information soon.
In the cases when it was AI II he put a valve in a valve.
Better results as Corevalve´s
 
Roberto> From: benjamin.bidstrup at bigpond.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Percutaneous AVR> Date: Mon, 9 Feb 2009 06:30:14 +1000> CC: > > One wonders in some of these cases, whether they will turn up a bit > later needing an AVR for the endo leak. What data have you got, > Roberto? Is this 'simply' handled by another perc AVR?> > Patients will trade off the issues of early M&M for long term outcomes.> > As someone said they heard Gruntzig state many years ago re CAD; " I > can fix this with just a little prick in the groin."> Ben Bidstrup FRACS FRCSEd FEBCTS> Cardiothoracic Surgeon> > > > On 09/02/2009, at 3:02 AM, Michael Firstenberg wrote:> > > I foresee a lot of perc. valves in relatively low risk redo's in > > which people will be happy with sub-par results rather than deal > > with the headaches of redo's (fyi - I dont mind redo's as I am still > > young enough to like interesting problems - at least sometimes).> >> > or maybe that train has already left the station.> >> > -michael> >> >> >> > On Feb 8, 2009, at 11:13 AM, Roberto Battellini wrote:> >> >>> >> Good question, Ani.> >> Only in patients older than 75 years, they shift to transapical, > >> but is NOT an indication for> >> inoperability!, just a trend of work.> >> When Tommy is in your country in Meetings, we do it > >> conventionally.May be we should make some statistks to> >> see the differences, could be a good paper.-> >>> >> Roberto> From: anianyanwu at hotmail.com> To: openheart-l at lists.hsforum.com > >> > Subject: RE: [HSF] severed LIMAS in redos> Date: Sun, 8 Feb 2009 > >> 12:10:34 +0000> > > I did 10 AVR in cases with pervious bypasses, > >> on the beating heart,never touched the LIMA.> Then Tommy began with > >> his transapical and did the rest.> > Roberto> Surely in Leipzig, a > >> patent LIMA is not an indication of inoperability that shifts a > >> patient to transapical AVR?> > Ani> > > From: robertobattellini at hotmail.com > >> > To: openheart-l at lists.hsforum.com> Subject: RE: [HSF] severed > >> LIMAS in redos> Date: Sun, 8 Feb 2009 09:56:06 +0100> > > Ani,> I > >> had 2 cases.> One was a coro redo, I could fast anastomose a piece > >> of vein to the distal injured LIMA, and perfuse it with blood from > >> the cardioplegia line,> did ok.> The second was a redo after AVR > >> and LIMA-LAD, he had endocarditis and a valve 19.I did the same > >> with the injured LIMA,> and a re-AVR with pericardial patch and a > >> 21 valve.He died in low output under IABP.Long clamping time and > >> the > injured LIMA were responsible.> If the atrium is easy to > >> free, I always think in putting a retrograde cardioplegia catheter > >> and perfuse from the pump.> I had no other cases. I did 10 AVR in > >> cases with pervious bypasses, on the beating heart,never touched > >> the LIMA.> Then Tommy began with his transapical and did the rest.> > >> > Roberto> > From: mmlevinson at hsforum.com> To: OpenHeart-L at lists.hsforum.com > >> > Subject: Re: [HSF] Re-do AVR> Date: Sun, 8 Feb 2009 01:31:08 > >> -0600> CC: > > > On Feb 1, 2009, at 11:24 AM, Ani Anyanwu wrote:> > > >> >> > > > How many surgeons here have seen severed LIMAs in redos > >> and roughly > > how many of these patients did survive? I suspect > >> it is a much more > > fatal injury that we appreciate. I have been > >> involved in or know > > about maybe ten such injuries - some > >> occuring after institution of > > CPB - during my training and > >> after and I can recall only one > > survivor. It is certainly not > >> as benign as it sounds.> >> > A survey performed and published > >> years ago on the subject of > catastrophic sternal re-entry > >> reported a 50% mortality for a severed > graft.> > One option to > >> prevent ischemic arrest is to place an intraluminal > shunt into > >> the severed ends of the graft. If you cut the Quest > Medical > >> silastic tubing, its hollow inside and can be fashioned at any > > >> length. We bend a sternal wire into a "Z" shape at one end and > > >> slide the shunt onto the wire, to act as a guide. This makes it > > >> easier to place into a vessel under arterial pressure. The shunt > > >> can protect the LAD territory from ischemia ... but its mainly a > > >> battle to get it into the severed graft before ischemic arrest. If > >> > the patient is already on CPB, one can drain the volume into the > >> pump > in order to see the transection site and then slide in the > >> shunt, go > back on CPB, and continue dissecting the heart and > >> proceed with the > remainder of the case, repairing the IMA at some > >> point later...> > We have found that a 6-0 Vicryl or silk is a nice > >> retension suture for > these shunts.> > Thanks to Don Ross for > >> suggesting the Quest Medical tubing as an > intracoronary shunt. I > >> have now used it in hundreds of distals > without a single known > >> problem..> > Mark> > > > Ani> >> >> >> From: damle at cableone.net> > >> To: OpenHeart-L at lists.hsforum.com> Date: > >> Sun, 1 Feb 2009 > >> 10:45:55 -0600> CC: > Subject: [HSF] Re-do AVR> > > >> It sometimes > >> seems that all my AVRs are re-dos after previous > >> CABGs. Here > >> is> the latest one:> > > > 76 M, severe COPD, FEV1 50% > >> of > >> predicted, LIMA-LAD, SVG to OM 1996,> Creatinine 1.6, Asc aorta > > >> >> 4.0. I saw him in 2006, Angio patent LIMA to a> 100% large LAD, > >> SVG > >> occluded, 99% Cx and RCA. AS, valve area 1.0 sq cms. EF> > >> 65%. 3D CT > >> 06 showed LIMA plastered to back of sternum and > >> coursing> medially. > >> His presentation was unstable angina. I > >> recommended surgery and> > >> patient refused.> > > > Now > >> increasing SOB, NYHA class III. EF now > >> 25%, AV area 0.6sq cms, > >> MR++,> wants surgery. PFTs unchanged. I am > >> planning CT, > >> coronary angio, PET scan> and perhaps a Dobutamine > >> ECHO. > >> Because of his coronary disease, he does not> qualify for the > >> > >> percuteneous trial.> > > > I have been doing my re-dos now after > > >> >> Hal's description: CPB and moderate> hypothermia before > >> sternotomy. > >> So although his LIMA has a high chance of> injury, > >> I will be able > >> to deal with it. But overall the problems are> > >> daunting. > > > > > >> Oh, and did I mention he is a Jehovah's > >> Witness?> > > > At STS > >> there was a presentation of AVR through > >> a right thoracotomy. If I > >> can> stent the Cx and RCA, that > >> might be the best option.> > > > > >> What do you think?> > > > > >> Ajit Damle> > > > > >> > >> _______________________________________________> OpenHeart-L > >> > >> mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >> > > All messages transmitted by the OpenHeart-L are subject > >> to the > >> policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim > >> > >> > -----------------------------------------> > > >> _________________________________________________________________> > >> > Check out the new and improved services from Windows Live. 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Check out the new services from Windows Live! > http://clk.atdmt.com/UKM/go/132630768/direct/01/_______________________________________________ > >> > OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com > >> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > > All messages transmitted by the OpenHeart-L are subject to the > >> policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim > >> > ----------------------------------------- > >> _______________________________________________> >> OpenHeart-L mailing list> >>> >> Send postings to:> >> OpenHeart-L at lists.hsforum.com> >>> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> >> http://mmp.cjp.com/mailman/listinfo/openheart-l> >>> >> All messages transmitted by the OpenHeart-L are subject to the > >> policies and> >> disclaimers posted at:> >> http://www.hsforum.com/listdisclaim> >> -----------------------------------------> >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the > > policies and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------