[HSF] Post CABG dissection

Sun Mar 1 19:25:15 EST 2009

yes

-----Original Message-----
From: Roberto Battellini <robertobattellini at hotmail.com>
To: lists HSF <openheart-l at lists.hsforum.com>
Sent: Sun, 1 Mar 2009 4:26 am
Subject: RE: [HSF] Post CABG dissection

In a type "arch first"?

Roberto

> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Post CABG dissection
> Date: Sat, 28 Feb 2009 22:52:39 -0500
> From: tdmartin2000 at aol.com
> CC: 
> 
> bifurcated graft to innom and carotid and occasionally to l subclavian taken 
off the prox ascending graft
> 
> Tom
> 
> 
> -----Original Message-----
> From: Michael Firstenberg <msfirst at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Thu, 26 Feb 2009 3:23 pm
> Subject: Re: [HSF] Post CABG dissection
> 
> 
> 
> can you describe your "prophylactic debranching?"
> 
> -m
> 
> On Thu, Feb 26, 2009 at 9:42 AM, <tdmartin2000 at aol.com> wrote:
> 
> > Prasanna
> > Not sure if I have a real "strategy" as each one is a little different. We
> > use felt strips inside and out on the aorta proximally and distally. We have
> > gotten away from routinely using bioglue between the layers and just use?a
> > thin layer of bioglue on the dacron needle holes. If you use too much glue
> > it makes identifying the location of leaks difficult at times and I think
> > may set you up for pseudoaneurysms in the future. We cool to 18 on all and
> > replace at least up to the innominate. If they are young we might consider
> > some type of debranching (grafts to innom and carotid) to set them up for
> > possible stent grafting in the future if needed. If the hct is good we take
> > 1 to3 units of blood off before going on pump to keep their plts etc and
> > give this back after coming off. We also try to salvage as many valves as is
> > safe to do. I use direct aortic cannulation if at all possible but don't
> > hesitate to use the femorals. I am not an axillary fan but several o my
> > partners are.
> >
> > Tom
> >
> >
> > -----Original Message-----
> > From: Prasanna Simha M <prasannasimha at gmail.com>
> > To: OpenHeart-L at lists.hsforum.com
> > Sent: Wed, 25 Feb 2009 7:46 am
> > Subject: Re: [HSF] Post CABG dissection
> >
> >
> >
> > What is your dissection strategy and how do you manage bleeding /suture
> > lines in these cases (Obviously the
 word is good technique 0but what do you
> > do - tips and tricks
> > Prasanna
> >
> > On Wed, Feb 25, 2009 at 5:42 PM, <hgrmd at aol.com> wrote:
> >
> > > Great job, Tom. That is why you are my "go to guy" when cases like this
> > > arise.
> > >
> > > Hal
> > > Sent from my Verizon Wireless BlackBerry
> > >
> > > -----Original Message-----
> > > From: tdmartin2000 at aol.com
> > >
> > > Date: Tue, 24 Feb 2009 20:12:55
> > > To: <OpenHeart-L at lists.hsforum.com>
> > > Subject: Re: [HSF] Post CABG dissection
> > >
> > >
> > > Follow up
> > > I actually posted the case shortly after my resident called me and told
> > me
> > > abou
> t the pt. On review of the CT it was quite different. What he had was
> > > consolidation of his lung but he also had rupture of his aorta just above
> > > the valve posteriorly with a pseudoaneurysm that compressed his RPA and
> > part
> > > of the MPA as it extended over to the left. He also had quite a
> > compression
> > > of his right atrium with fluid. I operated on him last night - he was
> > > actually 6 wks out and as you might expect it was really stuck. He was
> > quite
> > > hypoxic (sats in 70's0 goin into the OR. Fem- fem (Hal would be proud)
> > > opened chest, spent at least 1.5 - 2 hrs digging things out safely.
> > Cooled,
> > > replaced the ascending and prox arch, resuspended the valve, and
> > reimplanted
> > > 3 vein grafts. Moderate coagulopathy but is doing well today.
> > >
> > > Tom
> > >
> > >
> > > -----Original Message-----
> > > From: Hgrmd at aol.com
> > > To: OpenHeart-L at lists.hsforum.com
> > > Sent: Mon, 23 Feb 2009 5:59 am
> > > Subject: Re: [HSF] Post CABG dissection
> > >
> > >
> > >
> > > Tom,
> > > My guess is the dissection has been present for one month. I would
> > favor
> > > waiting until the pneumonia begins to clear up (at least until he is
> > > afebrile, nonbacteremic, no leukocytosis). Obviously, TEE or CT's every
> > > couple
> > > of
> > > days until you are sure the dimensions of the aorta are stable. If
> > > uncontrolled CHF, will have to inter
vene sooner. Tough case.
> > >
> > > Hal
> > >
> > >
> > > In a message dated 2/23/2009 5:42:56 A.M. Eastern Standard Time,
> > > tdmartin200
> > 0 at aol.com writes:
> > >
> > > 50 yo 1 mo s/p CABG at another institution. Presented with CHF symptoms,
> > > vague chest pain, cough, SOB. TEE- type 1 dissection, 2-3+ AI.
> > Transfered
> > > to
> > > UF.
> > > Intubated for hypoxia shortly after admission. CXR and CT show
> > > consolidated
> > > LLL pneumonia. No pericardial effusion.
> > > Treatment plan? When do you operate?
> > >
> > > Tom Martin
> > > U of Florida
> > > Gainesville
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> > --
> > Prasanna Simha M
> > _____________________________________________
> __
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