From benjamin.bidstrup at bigpond.com Sun Nov 1 01:42:12 2009 From: benjamin.bidstrup at bigpond.com (Bidstrup Ben) Date: Sat Oct 31 11:42:53 2009 Subject: [HSF] Test In-Reply-To: <89c4ed2d0910310806x2279bdfbr48c796162b403fb9@mail.gmail.com> References: <89c4ed2d0910310806x2279bdfbr48c796162b403fb9@mail.gmail.com> Message-ID: <91F6D080-6EFB-499E-A6D4-4AF39B20910A@bigpond.com> Yes On 01/11/2009, at 1:06 AM, Prasanna Simha M wrote: > Testing.Jon is it getting delivered ? > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From prasannasimha at gmail.com Sun Nov 1 00:54:51 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 31 14:54:14 2009 Subject: [HSF] Pain in the neck OT In-Reply-To: <65603364-87FC-44CA-89C5-CF2D6DB1BFB8@med.miami.edu> References: <89c4ed2d0910310738w526d1d46gc7fa4f7e6c02588d@mail.gmail.com> <231048E3-3CA9-4E91-8846-A3581C54E495@mac.com> <65603364-87FC-44CA-89C5-CF2D6DB1BFB8@med.miami.edu> Message-ID: <89c4ed2d0910311124s6b759e70ucb45dd9b79aae5e5@mail.gmail.com> Who manufactures them ? Prasanna On Sat, Oct 31, 2009 at 11:50 PM, Salerno, Tomas wrote: > There are loops that allow the surgeon to keep neck straight while > doing the anastomoses > > Ts > > Sent from my iPhone > > On Oct 31, 2009, at 2:08 PM, "Giuseppe Rescigno" > wrote: > >> Prasanna, >> >> it is worse my actual feeling about my position in Ancona... I feel a >> pain in the back! >> >> Giuseppe >> >> >> Il giorno 31/ott/09, alle ore 15:38, Prasanna Simha M ha scritto: >> >>> I often get a pain in the neck of late when I do a CABG - horrible >>> crick in >>> the neck after the surgery is over. It doesnt happen when I use >>> loupes when >>> I do congenital surgery so I am not sure wearing loupes is the >>> cause (I >>> thought initially that it may be the cause because of ?the fixed >>> focal >>> length) . I dont harvest the IMA nowadays as usually my Asst Prof >>> or a >>> Resident does it (Victor Aldrete had mentioned about that once.) >>> So any tips /tricks to avoid this ? I thought it was accentuated >>> today as I >>> had the table a bit low while doing ?a Ramus and OM ?during an >>> OPCABG but >>> that is a suspicion.-- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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 > ----------------------------------------- > -- Prasanna Simha M From benjamin.bidstrup at bigpond.com Sun Nov 1 07:56:49 2009 From: benjamin.bidstrup at bigpond.com (Bidstrup Ben) Date: Sat Oct 31 17:57:15 2009 Subject: [HSF] Pain in the neck OT In-Reply-To: <89c4ed2d0910311124s6b759e70ucb45dd9b79aae5e5@mail.gmail.com> References: <89c4ed2d0910310738w526d1d46gc7fa4f7e6c02588d@mail.gmail.com> <231048E3-3CA9-4E91-8846-A3581C54E495@mac.com> <65603364-87FC-44CA-89C5-CF2D6DB1BFB8@med.miami.edu> <89c4ed2d0910311124s6b759e70ucb45dd9b79aae5e5@mail.gmail.com> Message-ID: <64DFBCF6-CA01-4D6E-93D9-5878080C487D@bigpond.com> Designs for Vision. They can adjust the focal length to allow you to stand up. Maybe also your assistant will have to adjust as to where you need the table. On 01/11/2009, at 4:24 AM, Prasanna Simha M wrote: > Who manufactures them ? > Prasanna > > On Sat, Oct 31, 2009 at 11:50 PM, Salerno, Tomas > wrote: >> There are loops that allow the surgeon to keep neck straight while >> doing the anastomoses >> >> Ts >> >> Sent from my iPhone >> >> On Oct 31, 2009, at 2:08 PM, "Giuseppe Rescigno" >> wrote: >> >>> Prasanna, >>> >>> it is worse my actual feeling about my position in Ancona... I >>> feel a >>> pain in the back! >>> >>> Giuseppe >>> >>> >>> Il giorno 31/ott/09, alle ore 15:38, Prasanna Simha M ha scritto: >>> >>>> I often get a pain in the neck of late when I do a CABG - horrible >>>> crick in >>>> the neck after the surgery is over. It doesnt happen when I use >>>> loupes when >>>> I do congenital surgery so I am not sure wearing loupes is the >>>> cause (I >>>> thought initially that it may be the cause because of the fixed >>>> focal >>>> length) . I dont harvest the IMA nowadays as usually my Asst Prof >>>> or a >>>> Resident does it (Victor Aldrete had mentioned about that once.) >>>> So any tips /tricks to avoid this ? I thought it was accentuated >>>> today as I >>>> had the table a bit low while doing a Ramus and OM during an >>>> OPCABG but >>>> that is a suspicion.-- >>>> Prasanna Simha M >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From rudi at kbd.hr Sun Nov 1 00:31:00 2009 From: rudi at kbd.hr (Igor Rudez) Date: Sat Oct 31 18:31:32 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: <8CC8CAE0-C686-4BC5-854F-8EB04752ACD8@pol.net> Message-ID: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr> Zhou, I partially agree with you! Of course we have to master those (new) skills as well, but do not be afraid we are going to lose patients! I can remember many of our colleagues were convinced that we're going to be out of job because of drug eluting stents! And what happened? So, OK, yes, master the skills but no, we are still far, far in front of them! And when they make a hole pushing some device, stent, whatever in the heart, aorta, wherever, who do you think they are going to call? Igor -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Zhandong Zhou Sent: Saturday, October 31, 2009 7:02 PM To: OpenHeart-L@lists.hsforum.com Subject: [HSF] Changing field in Our specialty To all, I am in DC for a endovascular course for thoracic aneurysm. Only 25% are CV surgeons. Others are vascular, radiology, cardiologist. We need to catch up, without these skills, we are going to lose the percutaneous valve. Any thoughts? Z Zhou _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Sun Nov 1 08:25:18 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Oct 31 22:55:56 2009 Subject: [HSF] Pain in the neck In-Reply-To: References: <89c4ed2d0910310738w526d1d46gc7fa4f7e6c02588d@mail.gmail.com> <7EDD4730-4E09-471D-A201-BAC44BA4CB23@mac.com> Message-ID: <89c4ed2d0910311955p59ec921bp601fa3bcb9162571@mail.gmail.com> Frankly bilateral IMA's are better - one less proximal to do !! Prasanna On Sun, Nov 1, 2009 at 8:17 AM, Michael Firstenberg wrote: > Is this y > > > > On Sat, Oct 31, 2009 at 2:01 PM, Giuseppe Rescigno wrote: > >> Prasanna, >> >> you should do more physical activity. Just try to move your head up and >> down, left to right and all around just when you wake up. >> >> Giuseppe >> >> >> Il giorno 31/ott/09, alle ore 15:38, Prasanna Simha M ha scritto: >> >> >> I often get a pain in the neck of late when I do a CABG - horrible crick in >>> the neck after the surgery is over. It doesnt happen when I use loupes >>> when >>> I do congenital surgery so I am not sure wearing loupes is the cause (I >>> thought initially that it may be the cause because of ?the fixed focal >>> length) . I dont harvest the IMA nowadays as usually my Asst Prof or a >>> Resident does it (Victor Aldrete had mentioned about that once.) >>> So any tips /tricks to avoid this ? I thought it was accentuated today as >>> I >>> had the table a bit low while doing ?a Ramus and OM ?during an OPCABG but >>> that is a suspicion.-- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> ?OpenHeart-L@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@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 >> anddisclaimers posted at: >> >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From hgrmd at aol.com Sun Nov 1 02:58:06 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Sat Oct 31 23:00:44 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr><8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com> Message-ID: <1690977052-1257044352-cardhu_decombobulator_blackberry.rim.net-70919428-@bda735.bisx.prod.on.blackberry> 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bCBtZXNzYWdlcyB0cmFuc21pdHRlZCBieSB0aGUgT3BlbkhlYXJ0LUwgYXJlIHN1YmplY3QgdG8g dGhlIHBvbGljaWVzIGFuZA0KPiBkaXNjbGFpbWVycyBwb3N0ZWQgYXQ6DQo+IGh0dHA6Ly93d3cu aHNmb3J1bS5jb20vbGlzdGRpc2NsYWltDQo+IC0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0t LS0tLS0tLS0tLS0tDQo+DQpfX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19f X19fX19fXw0KT3BlbkhlYXJ0LUwgbWFpbGluZyBsaXN0DQoNClNlbmQgcG9zdGluZ3MgdG86DQog T3BlbkhlYXJ0LUxAbGlzdHMuaHNmb3J1bS5jb20NCg0KVG8gVU5TVUJTQ1JJQkUsIHRvIENIQU5H RSBlbWFpbCBhZGRyZXNzLCBvciB0byB2aWV3IGFyY2hpdmVzOg0KaHR0cDovL21tcC5janAuY29t L21haWxtYW4vbGlzdGluZm8vb3BlbmhlYXJ0LWwNCg0KQWxsIG1lc3NhZ2VzIHRyYW5zbWl0dGVk IGJ5IHRoZSBPcGVuSGVhcnQtTCBhcmUgc3ViamVjdCB0byB0aGUgcG9saWNpZXMgYW5kIA0KZGlz Y2xhaW1lcnMgcG9zdGVkIGF0Og0KaHR0cDovL3d3dy5oc2ZvcnVtLmNvbS9saXN0ZGlzY2xhaW0N Ci0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tDQo= From msfirst at gmail.com Sun Nov 1 00:32:15 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sat Oct 31 23:40:39 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: <777638700-1257044845-cardhu_decombobulator_blackberry.rim.net-1712052426-@bda735.bisx.prod.on.blackberry> References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr><8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com><1690977052-1257044352-cardhu_decombobulator_blackberry.rim.net-70919428-@bda735.bisx.prod.on.blackberry> <777638700-1257044845-cardhu_decombobulator_blackberry.rim.net-1712052426-@bda735.bisx.prod.on.blackberry> Message-ID: <22DA4729-09A8-4926-BB1A-9557A2437A98@gmail.com> 10hrs on bypass? Regardless in my experience many of these patient have no doctors. They are always coming into the ED with chest pain poorly controlled hypertension whatever. Since the have descending pathology regardless of what else we always get called and no one else wants to claim ownership. Sure if you have a nice little boutique practice and get finely tuned patients sent to you then I am sure stenting can be fun. -michael/iPhone On Oct 31, 2009, at 11:06 PM, hgrmd@aol.com wrote: > Michael, > Sorry, just read your previous post. Now I understand why you are > a bit cranky. Sounds like you had a terrible case. > > Hal > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: hgrmd@aol.com > Date: Sun, 1 Nov 2009 02:58:06 > To: > Subject: Re: [HSF] Changing field in Our specialty-get on board or > be left out > > Michael, > Other than monitoring the result by CT and making sure the pt is on > the proper antihypertensive, doing a TEVAR doesn't make the surgeon > the pt's primary. Certainly, I don't take that role with my cases. > Didn't get enough candy trick or treating tonight? > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Michael Firstenberg > Date: Sat, 31 Oct 2009 22:44:26 > To: > Subject: Re: [HSF] Changing field in Our specialty-get on board or > be left out > > I have no problem giving up the descending stent graft work PROVIDED > whoever > does it takes care of these patients afterwards. I find many of this > patients have horrible comorbidities, poorly controlled hypertension, > diabetes, etc that no one wants to deal with. Many have not seen a > doctors > in years - if ever and rarely do they have insurance (not that I > care about > that). If a Radiologist wants to put a stent graft in, then he/she > can take > responsibility for all of the patients other medical, social, > economic problems. Knock yourselves out and good luck........ > > Everyone wants to put the stent(s) in whatever vessel and walk away > - sorry, > doesnt work that way......... > > -michael > > On Sat, Oct 31, 2009 at 7:06 PM, wrote: > >> >> My humble prediction >> Open descending and/or thoracoabdominal aortic aneurysm surgery is >> destined >> to the same fate as open gastric surgery or open gallbladder >> surgery within >> the next 10 yrs and those who don't get on board with endovascular >> methods >> will be left out. >> >> Tom Martin >> U of Florida >> Gainesville >> >> -----Original Message----- >> From: Igor Rudez >> To: OpenHeart-L@lists.hsforum.com >> Sent: Sat, Oct 31, 2009 6:31 pm >> Subject: RE: [HSF] Changing field in Our specialty >> >> >> >> Zhou, >> partially agree with you! Of course we have to master those (new) >> skills >> s well, but do not be afraid we are going to lose patients! >> can remember many of our colleagues were convinced that we're going >> to be >> ut of job because of drug eluting stents! And what happened? >> o, OK, yes, master the skills but no, we are still far, far in >> front of >> hem! And when they make a hole pushing some device, stent, whatever >> in the >> eart, aorta, wherever, who do you think they are going to call? >> Igor >> -----Original Message----- >> rom: openheart-l-bounces@lists.hsforum.com >> mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Zhandong >> Zhou >> ent: Saturday, October 31, 2009 7:02 PM >> o: OpenHeart-L@lists.hsforum.com >> ubject: [HSF] Changing field in Our specialty >> >> o all, >> I am in DC for a endovascular course for thoracic aneurysm. Only 25% >> re CV surgeons. Others are vascular, radiology, cardiologist. >> We need to catch up, without these skills, we are going to lose the >> ercutaneous valve. >> Any thoughts? >> Z Zhou >> >> ______________________________________________ >> penHeart-L mailing list >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> isclaimers posted at: >> ttp://www.hsforum.com/listdisclaim >> ---------------------------------------- >> _______________________________________________ >> penHeart-L mailing list >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> isclaimers posted at: >> ttp://www.hsforum.com/listdisclaim >> ---------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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@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 > ----------------------------------------- From drdharris at yahoo.co.uk Sun Nov 1 10:19:10 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Sun Nov 1 05:20:40 2009 Subject: [HSF] Pain in the neck OT In-Reply-To: <64DFBCF6-CA01-4D6E-93D9-5878080C487D@bigpond.com> Message-ID: <666112.56015.qm@web24704.mail.ird.yahoo.com> I had same problem which resolved after changing to a Heine headband which has headlamp and Loupe incorporated. The magnif is only 2.5 but this appeard to be ok for me. More even distribution of weight so no more neck spasms postop. Dave Bidstrup Ben wrote: > Designs for Vision. They can adjust the focal length to allow you to stand up. Maybe also your assistant will have to adjust as to where you need the table. > On 01/11/2009, at 4:24 AM, Prasanna Simha M wrote: >> Who manufactures them ? >> Prasanna >> >> On Sat, Oct 31, 2009 at 11:50 PM, Salerno, Tomas wrote: >>> There are loops that allow the surgeon to keep neck straight while >>> doing the anastomoses >>> >>> Ts >>> >>> Sent from my iPhone >>> >>> On Oct 31, 2009, at 2:08 PM, "Giuseppe Rescigno" >>> wrote: >>> >>>> Prasanna, >>>> >>>> it is worse my actual feeling about my position in Ancona... I feel a >>>> pain in the back! >>>> >>>> Giuseppe >>>> >>>> >>>> Il giorno 31/ott/09, alle ore 15:38, Prasanna Simha M ha scritto: >>>> >>>>> I often get a pain in the neck of late when I do a CABG - horrible >>>>> crick in >>>>> the neck after the surgery is over. It doesnt happen when I use >>>>> loupes when >>>>> I do congenital surgery so I am not sure wearing loupes is the >>>>> cause (I >>>>> thought initially that it may be the cause because of the fixed >>>>> focal >>>>> length) . I dont harvest the IMA nowadays as usually my Asst Prof >>>>> or a >>>>> Resident does it (Victor Aldrete had mentioned about that once.) >>>>> So any tips /tricks to avoid this ? I thought it was accentuated >>>>> today as I >>>>> had the table a bit low while doing a Ramus and OM during an >>>>> OPCABG but >>>>> that is a suspicion.-- >>>>> Prasanna Simha M >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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@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@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 >>> ----------------------------------------- >>> >> >> >> >> --Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From msfirst at gmail.com Sun Nov 1 05:30:10 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Nov 1 05:30:44 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr><8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com><1690977052-1257044352-cardhu_decombobulator_blackberry.rim.net-70919428-@bda735.bisx.prod.on.blackberry> <777638700-1257044845-cardhu_decombobulator_blackberry.rim.net-1712052426-@bda735.bisx.prod.on.blackberry> Message-ID: <1D76955B-44A5-407B-96E9-5A1F78A9C201@gmail.com> Which one? The disaster endocarditis or the disaster thoracic pathology - or both the problems that no one wants because it is too much work? -michael/iPhone On Nov 1, 2009, at 1:09 AM, Dwight Hand wrote: > > Michael, > Typical case in our region. > Dwight > >> From: msfirst@gmail.com >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Changing field in Our specialty-get on board or >> be left out >> Date: Sat, 31 Oct 2009 23:32:15 -0400 >> CC: >> >> 10hrs on bypass? >> Regardless in my experience many of these patient have no doctors. >> They are always coming into the ED with chest pain poorly controlled >> hypertension whatever. Since the have descending pathology regardless >> of what else we always get called and no one else wants to claim >> ownership. >> >> Sure if you have a nice little boutique practice and get finely tuned >> patients sent to you then I am sure stenting can be fun. >> >> -michael/iPhone >> >> On Oct 31, 2009, at 11:06 PM, hgrmd@aol.com wrote: >> >>> Michael, >>> Sorry, just read your previous post. Now I understand why you are >>> a bit cranky. Sounds like you had a terrible case. >>> >>> Hal >>> >>> Hal >>> Sent from my Verizon Wireless BlackBerry >>> >>> -----Original Message----- >>> From: hgrmd@aol.com >>> Date: Sun, 1 Nov 2009 02:58:06 >>> To: >>> Subject: Re: [HSF] Changing field in Our specialty-get on board or >>> be left out >>> >>> Michael, >>> Other than monitoring the result by CT and making sure the pt is on >>> the proper antihypertensive, doing a TEVAR doesn't make the surgeon >>> the pt's primary. Certainly, I don't take that role with my cases. >>> Didn't get enough candy trick or treating tonight? >>> >>> Hal >>> Sent from my Verizon Wireless BlackBerry >>> >>> -----Original Message----- >>> From: Michael Firstenberg >>> Date: Sat, 31 Oct 2009 22:44:26 >>> To: >>> Subject: Re: [HSF] Changing field in Our specialty-get on board or >>> be left out >>> >>> I have no problem giving up the descending stent graft work PROVIDED >>> whoever >>> does it takes care of these patients afterwards. I find many of >>> this >>> patients have horrible comorbidities, poorly controlled >>> hypertension, >>> diabetes, etc that no one wants to deal with. Many have not seen a >>> doctors >>> in years - if ever and rarely do they have insurance (not that I >>> care about >>> that). If a Radiologist wants to put a stent graft in, then he/she >>> can take >>> responsibility for all of the patients other medical, social, >>> economic problems. Knock yourselves out and good luck........ >>> >>> Everyone wants to put the stent(s) in whatever vessel and walk away >>> - sorry, >>> doesnt work that way......... >>> >>> -michael >>> >>> On Sat, Oct 31, 2009 at 7:06 PM, wrote: >>> >>>> >>>> My humble prediction >>>> Open descending and/or thoracoabdominal aortic aneurysm surgery is >>>> destined >>>> to the same fate as open gastric surgery or open gallbladder >>>> surgery within >>>> the next 10 yrs and those who don't get on board with endovascular >>>> methods >>>> will be left out. >>>> >>>> Tom Martin >>>> U of Florida >>>> Gainesville >>>> >>>> -----Original Message----- >>>> From: Igor Rudez >>>> To: OpenHeart-L@lists.hsforum.com >>>> Sent: Sat, Oct 31, 2009 6:31 pm >>>> Subject: RE: [HSF] Changing field in Our specialty >>>> >>>> >>>> >>>> Zhou, >>>> partially agree with you! Of course we have to master those (new) >>>> skills >>>> s well, but do not be afraid we are going to lose patients! >>>> can remember many of our colleagues were convinced that we're going >>>> to be >>>> ut of job because of drug eluting stents! And what happened? >>>> o, OK, yes, master the skills but no, we are still far, far in >>>> front of >>>> hem! And when they make a hole pushing some device, stent, whatever >>>> in the >>>> eart, aorta, wherever, who do you think they are going to call? >>>> Igor >>>> -----Original Message----- >>>> rom: openheart-l-bounces@lists.hsforum.com >>>> mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Zhandong >>>> Zhou >>>> ent: Saturday, October 31, 2009 7:02 PM >>>> o: OpenHeart-L@lists.hsforum.com >>>> ubject: [HSF] Changing field in Our specialty >>>> >>>> o all, >>>> I am in DC for a endovascular course for thoracic aneurysm. Only >>>> 25% >>>> re CV surgeons. Others are vascular, radiology, cardiologist. >>>> We need to catch up, without these skills, we are going to lose the >>>> ercutaneous valve. >>>> Any thoughts? >>>> Z Zhou >>>> >>>> ______________________________________________ >>>> penHeart-L mailing list >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >>>> All messages transmitted by the OpenHeart-L are subject to the >>>> policies and >>>> isclaimers posted at: >>>> ttp://www.hsforum.com/listdisclaim >>>> ---------------------------------------- >>>> _______________________________________________ >>>> penHeart-L mailing list >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >>>> All messages transmitted by the OpenHeart-L are subject to the >>>> policies and >>>> isclaimers posted at: >>>> ttp://www.hsforum.com/listdisclaim >>>> ---------------------------------------- >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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@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@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@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 > ----------------------------------------- From drdharris at yahoo.co.uk Sun Nov 1 10:38:35 2009 From: drdharris at yahoo.co.uk (David Harris) Date: Sun Nov 1 05:39:04 2009 Subject: [HSF] Is the 3F Aortic Valve a Good Alternative? In-Reply-To: Message-ID: <871601.52929.qm@web24712.mail.ird.yahoo.com> Hal, that data was presented in Vienna. I will get the reference. Your criticism is welcome. It was titled '20 year follow up of mitroflo...' But the timespan to me looked vagua as from what I could tell it looked more like 12 years. Dave Hgrmd@aol.com wrote: > Dave, > Which "Edwards 23" are you referring? Maybe the old Perimount, but I > highly doubt a Mitroflow 19 is equivalent to an Edwards Magna Ease 23. In > addition, I doubt that Mitroflow has the kind of durability data. If so, > please provide references. > > Hal > > > In a message dated 10/31/2009 4:45:34 A.M. Eastern Daylight Time, > drdharris@yahoo.co.uk writes: > I would personally only use that valve if there are distinct technical > advantages - like the Mitroflow (good long term results reported at EACTS). > Mitroflow 19 also reported to be equiv to Edwards 23. If I was at a high > volume academic centre I would use it, with good follow up...there is always > potential for better results long term-which may become irrelevant with the > new transcatheter valves. Dave > Giuseppe Rescigno wrote: >> Hal, >> I have implanted three 3F aortic valves. They are quite easy to implant > and there is a theretical benefit in tubular prostheses. You should, as for > every stentless, be horizontal with the stitches without following the > annulus. It is therefore quite easy to put the commisures at the right > positions thanks to the holder. Aortotomy should be horizontal and above the STJ. > They works pretty well but trans gradient are not so low as company says. I > implanted it in over 80 yo people and this should be the ideal population > for a limited follow-up valve. Sorin Fredom Solo is probably more friendly > and the number of implants is significantly greater (at least in Italy). > Nevertheless during last year I came to the conclusion that stented valves > warrant the best reproducible result and I stopped using either 3F and Solo. >> Giuseppe >> Il giorno 26/ott/09, alle ore 00:57, Hgrmd@aol.com ha scritto: >>> Members, >>> Lately, I've gotten a lot of heat from the ATS rep trying to > convince me >>> to use the 3F aortic valve. Having been in this profession long > enough to >>> see valves come and go, I'd like to hear thoughts from other members, >>> especially the users. >>> >>> Hal >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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 > anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- From prasannasimha at gmail.com Sun Nov 1 09:15:24 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 05:58:42 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: <22DA4729-09A8-4926-BB1A-9557A2437A98@gmail.com> References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr> <8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com> <1690977052-1257044352-cardhu_decombobulator_blackberry.rim.net-70919428-@bda735.bisx.prod.on.blackberry> <777638700-1257044845-cardhu_decombobulator_blackberry.rim.net-1712052426-@bda735.bisx.prod.on.blackberry> <22DA4729-09A8-4926-BB1A-9557A2437A98@gmail.com> Message-ID: <89c4ed2d0910312045q3e80069cu627cea26b9a5e44@mail.gmail.com> Why the 10 hours ? Inability to wean ? Prasanna On Sun, Nov 1, 2009 at 9:02 AM, Michael Firstenberg wrote: > 10hrs on bypass? > Regardless in my experience many of these patient have no doctors. They are > always coming into the ED with chest pain poorly controlled hypertension > whatever. Since the have descending pathology regardless of what else we > always get called and no one else wants to claim ownership. > > Sure if you have a nice little boutique practice and get finely tuned > patients sent to you then I am sure stenting can be fun. > > -michael/iPhone > > On Oct 31, 2009, at 11:06 PM, hgrmd@aol.com wrote: > >> Michael, >> ?Sorry, just read your previous post. ?Now I understand why you are a bit >> cranky. ?Sounds like you had a terrible case. >> >> Hal >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: hgrmd@aol.com >> Date: Sun, 1 Nov 2009 02:58:06 >> To: >> Subject: Re: [HSF] Changing field in Our specialty-get on board or be left >> out >> >> Michael, >> ?Other than monitoring the result by CT and making sure the pt is on the >> proper antihypertensive, doing a TEVAR doesn't make the surgeon the pt's >> primary. ?Certainly, I don't take that role with my cases. ?Didn't get >> enough candy trick or treating tonight? >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: Michael Firstenberg >> Date: Sat, 31 Oct 2009 22:44:26 >> To: >> Subject: Re: [HSF] Changing field in Our specialty-get on board or be left >> out >> >> I have no problem giving up the descending stent graft work PROVIDED >> whoever >> does it takes care of these patients afterwards. ?I find many of this >> patients have horrible comorbidities, poorly controlled hypertension, >> diabetes, etc that no one wants to deal with. ?Many have not seen a >> doctors >> in years - if ever and rarely do they have insurance (not that I care >> about >> that). ?If a Radiologist wants to put a stent graft in, then he/she can >> take >> responsibility for all of the patients other medical, social, >> economic problems. ?Knock yourselves out and good luck........ >> >> Everyone wants to put the stent(s) in whatever vessel and walk away - >> sorry, >> doesnt work that way......... >> >> -michael >> >> On Sat, Oct 31, 2009 at 7:06 PM, wrote: >> >>> >>> My humble prediction >>> Open descending and/or thoracoabdominal aortic aneurysm surgery is >>> destined >>> to the same fate as open gastric surgery or open gallbladder surgery >>> within >>> the next 10 yrs and those who don't get on board with endovascular >>> methods >>> will be left out. >>> >>> Tom Martin >>> U of Florida >>> Gainesville >>> >>> -----Original Message----- >>> From: Igor Rudez >>> To: OpenHeart-L@lists.hsforum.com >>> Sent: Sat, Oct 31, 2009 6:31 pm >>> Subject: RE: [HSF] Changing field in Our specialty >>> >>> >>> >>> Zhou, >>> partially agree with you! Of course we have to master those (new) skills >>> s well, but do not be afraid we are going to lose patients! >>> can remember many of our colleagues were convinced that we're going to be >>> ut of job because of drug eluting stents! And what happened? >>> o, OK, yes, master the skills but no, we are still far, far in front of >>> hem! And when they make a hole pushing some device, stent, whatever in >>> the >>> eart, aorta, wherever, who do you think they are going to call? >>> Igor >>> -----Original Message----- >>> rom: openheart-l-bounces@lists.hsforum.com >>> mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Zhandong Zhou >>> ent: Saturday, October 31, 2009 7:02 PM >>> o: OpenHeart-L@lists.hsforum.com >>> ubject: [HSF] Changing field in Our specialty >>> >>> o all, >>> I am in DC for a endovascular course for thoracic aneurysm. Only 25% >>> re CV surgeons. Others are vascular, radiology, cardiologist. >>> We need to catch up, without these skills, we are going to lose the >>> ercutaneous valve. >>> Any thoughts? >>> Z Zhou >>> >>> ______________________________________________ >>> penHeart-L mailing list >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >>> All messages transmitted by the OpenHeart-L are subject to the policies >>> and >>> isclaimers posted at: >>> ttp://www.hsforum.com/listdisclaim >>> ---------------------------------------- >>> _______________________________________________ >>> penHeart-L mailing list >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >>> All messages transmitted by the OpenHeart-L are subject to the policies >>> and >>> isclaimers posted at: >>> ttp://www.hsforum.com/listdisclaim >>> ---------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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@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 > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Nov 1 16:32:47 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 06:03:26 2009 Subject: [HSF] Pain in the neck OT In-Reply-To: <666112.56015.qm@web24704.mail.ird.yahoo.com> References: <64DFBCF6-CA01-4D6E-93D9-5878080C487D@bigpond.com> <666112.56015.qm@web24704.mail.ird.yahoo.com> Message-ID: <89c4ed2d0911010302u5c74e7c7t79039bc081e9b961@mail.gmail.com> My loup is also Heine 2.5. Prasanna On Sun, Nov 1, 2009 at 3:49 PM, David Harris wrote: > I had same problem which resolved after changing to a Heine headband which has headlamp and Loupe incorporated. The magnif is only 2.5 but this appeard to be ok for me. More even distribution of weight so no more neck spasms postop. Dave > > Bidstrup Ben wrote: >> Designs for Vision. They can adjust the focal ?length to allow you to stand up. Maybe also your assistant will have to adjust as to where you need the table. >> On 01/11/2009, at 4:24 AM, Prasanna Simha M wrote: >>> Who manufactures them ? >>> Prasanna >>> >>> On Sat, Oct 31, 2009 at 11:50 PM, Salerno, Tomas wrote: >>>> There are loops that allow the surgeon to keep neck straight while >>>> doing the anastomoses >>>> >>>> Ts >>>> >>>> Sent from my iPhone >>>> >>>> On Oct 31, 2009, at 2:08 PM, "Giuseppe Rescigno" >>>> wrote: >>>> >>>>> Prasanna, >>>>> >>>>> it is worse my actual feeling about my position in Ancona... I feel a >>>>> pain in the back! >>>>> >>>>> Giuseppe >>>>> >>>>> >>>>> Il giorno 31/ott/09, alle ore 15:38, Prasanna Simha M ha scritto: >>>>> >>>>>> I often get a pain in the neck of late when I do a CABG - horrible >>>>>> crick in >>>>>> the neck after the surgery is over. It doesnt happen when I use >>>>>> loupes when >>>>>> I do congenital surgery so I am not sure wearing loupes is the >>>>>> cause (I >>>>>> thought initially that it may be the cause because of ?the fixed >>>>>> focal >>>>>> length) . I dont harvest the IMA nowadays as usually my Asst Prof >>>>>> or a >>>>>> Resident does it (Victor Aldrete had mentioned about that once.) >>>>>> So any tips /tricks to avoid this ? I thought it was accentuated >>>>>> today as I >>>>>> had the table a bit low while doing ?a Ramus and OM ?during an >>>>>> OPCABG but >>>>>> that is a suspicion.-- >>>>>> Prasanna Simha M >>>>>> _______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@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@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@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 >>>> ----------------------------------------- >>>> >>> >>> >>> >>> --Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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 anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Nov 1 16:33:44 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 06:04:21 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: <1D76955B-44A5-407B-96E9-5A1F78A9C201@gmail.com> References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr> <8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com> <1690977052-1257044352-cardhu_decombobulator_blackberry.rim.net-70919428-@bda735.bisx.prod.on.blackberry> <777638700-1257044845-cardhu_decombobulator_blackberry.rim.net-1712052426-@bda735.bisx.prod.on.blackberry> <1D76955B-44A5-407B-96E9-5A1F78A9C201@gmail.com> Message-ID: <89c4ed2d0911010303o37b353acl3772cb2fb151a6d2@mail.gmail.com> The one which you were on CPB for 10 hours.Tell us more about it. Prasanna On Sun, Nov 1, 2009 at 4:00 PM, Michael Firstenberg wrote: > Which one? > The disaster endocarditis or the disaster thoracic pathology - or both the > problems that no one wants because it is too much work? > > -michael/iPhone > > On Nov 1, 2009, at 1:09 AM, Dwight Hand wrote: > >> >> Michael, >> Typical case in our region. >> Dwight >> >>> From: msfirst@gmail.com >>> To: OpenHeart-L@lists.hsforum.com >>> Subject: Re: [HSF] Changing field in Our specialty-get on board or be >>> left out >>> Date: Sat, 31 Oct 2009 23:32:15 -0400 >>> CC: >>> >>> 10hrs on bypass? >>> Regardless in my experience many of these patient have no doctors. >>> They are always coming into the ED with chest pain poorly controlled >>> hypertension whatever. Since the have descending pathology regardless >>> of what else we always get called and no one else wants to claim >>> ownership. >>> >>> Sure if you have a nice little boutique practice and get finely tuned >>> patients sent to you then I am sure stenting can be fun. >>> >>> -michael/iPhone >>> >>> On Oct 31, 2009, at 11:06 PM, hgrmd@aol.com wrote: >>> >>>> Michael, >>>> Sorry, just read your previous post. ?Now I understand why you are >>>> a bit cranky. ?Sounds like you had a terrible case. >>>> >>>> Hal >>>> >>>> Hal >>>> Sent from my Verizon Wireless BlackBerry >>>> >>>> -----Original Message----- >>>> From: hgrmd@aol.com >>>> Date: Sun, 1 Nov 2009 02:58:06 >>>> To: >>>> Subject: Re: [HSF] Changing field in Our specialty-get on board or >>>> be left out >>>> >>>> Michael, >>>> Other than monitoring the result by CT and making sure the pt is on >>>> the proper antihypertensive, doing a TEVAR doesn't make the surgeon >>>> the pt's primary. ?Certainly, I don't take that role with my cases. >>>> Didn't get enough candy trick or treating tonight? >>>> >>>> Hal >>>> Sent from my Verizon Wireless BlackBerry >>>> >>>> -----Original Message----- >>>> From: Michael Firstenberg >>>> Date: Sat, 31 Oct 2009 22:44:26 >>>> To: >>>> Subject: Re: [HSF] Changing field in Our specialty-get on board or >>>> be left out >>>> >>>> I have no problem giving up the descending stent graft work PROVIDED >>>> whoever >>>> does it takes care of these patients afterwards. ?I find many of this >>>> patients have horrible comorbidities, poorly controlled hypertension, >>>> diabetes, etc that no one wants to deal with. ?Many have not seen a >>>> doctors >>>> in years - if ever and rarely do they have insurance (not that I >>>> care about >>>> that). ?If a Radiologist wants to put a stent graft in, then he/she >>>> can take >>>> responsibility for all of the patients other medical, social, >>>> economic problems. ?Knock yourselves out and good luck........ >>>> >>>> Everyone wants to put the stent(s) in whatever vessel and walk away >>>> - sorry, >>>> doesnt work that way......... >>>> >>>> -michael >>>> >>>> On Sat, Oct 31, 2009 at 7:06 PM, wrote: >>>> >>>>> >>>>> My humble prediction >>>>> Open descending and/or thoracoabdominal aortic aneurysm surgery is >>>>> destined >>>>> to the same fate as open gastric surgery or open gallbladder >>>>> surgery within >>>>> the next 10 yrs and those who don't get on board with endovascular >>>>> methods >>>>> will be left out. >>>>> >>>>> Tom Martin >>>>> U of Florida >>>>> Gainesville >>>>> >>>>> -----Original Message----- >>>>> From: Igor Rudez >>>>> To: OpenHeart-L@lists.hsforum.com >>>>> Sent: Sat, Oct 31, 2009 6:31 pm >>>>> Subject: RE: [HSF] Changing field in Our specialty >>>>> >>>>> >>>>> >>>>> Zhou, >>>>> partially agree with you! Of course we have to master those (new) >>>>> skills >>>>> s well, but do not be afraid we are going to lose patients! >>>>> can remember many of our colleagues were convinced that we're going >>>>> to be >>>>> ut of job because of drug eluting stents! And what happened? >>>>> o, OK, yes, master the skills but no, we are still far, far in >>>>> front of >>>>> hem! And when they make a hole pushing some device, stent, whatever >>>>> in the >>>>> eart, aorta, wherever, who do you think they are going to call? >>>>> Igor >>>>> -----Original Message----- >>>>> rom: openheart-l-bounces@lists.hsforum.com >>>>> mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Zhandong >>>>> Zhou >>>>> ent: Saturday, October 31, 2009 7:02 PM >>>>> o: OpenHeart-L@lists.hsforum.com >>>>> ubject: [HSF] Changing field in Our specialty >>>>> >>>>> o all, >>>>> I am in DC for a endovascular course for thoracic aneurysm. Only 25% >>>>> re CV surgeons. Others are vascular, radiology, cardiologist. >>>>> We need to catch up, without these skills, we are going to lose the >>>>> ercutaneous valve. >>>>> Any thoughts? >>>>> Z Zhou >>>>> >>>>> ______________________________________________ >>>>> penHeart-L mailing list >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >>>>> All messages transmitted by the OpenHeart-L are subject to the >>>>> policies and >>>>> isclaimers posted at: >>>>> ttp://www.hsforum.com/listdisclaim >>>>> ---------------------------------------- >>>>> _______________________________________________ >>>>> penHeart-L mailing list >>>>> Send postings to: >>>>> OpenHeart-L@lists.hsforum.com >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>>> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >>>>> All messages transmitted by the OpenHeart-L are subject to the >>>>> policies and >>>>> isclaimers posted at: >>>>> ttp://www.hsforum.com/listdisclaim >>>>> ---------------------------------------- >>>>> >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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@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@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@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@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@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 > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Nov 1 16:40:28 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 06:11:06 2009 Subject: [HSF] Is the 3F Aortic Valve a Good Alternative? In-Reply-To: References: Message-ID: <89c4ed2d0911010310q5eb82b2buaec8dc31494189c4@mail.gmail.com> Hal , how long is the Magna around ? We have been using it in India for a few years (frightfully expensive here). I am not sure how many years follow up is there for the Magna . Remember that even changes in these valves do not equate to similar results though the name may be the same.I doubt that Magna has a follow up equal to that of even teh mitroflow.Any one has literature ? I think the earliest reports were that of Totaro et al in 2003 or 2005 Prasanna On Sat, Oct 31, 2009 at 5:44 PM, wrote: > Dave, > ?Which "Edwards 23" are you referring? ?Maybe the old Perimount, ?but I > highly doubt a Mitroflow 19 is equivalent to an Edwards Magna Ease ?23. ?In > addition, I doubt that Mitroflow has the kind of durability ?data. ?If so, > please provide references. > > Hal > > > In a message dated 10/31/2009 4:45:34 A.M. Eastern Daylight Time, > drdharris@yahoo.co.uk writes: > > I would ?personally only use that valve if there are distinct technical > advantages - ?like the Mitroflow (good long term results reported at EACTS). > Mitroflow 19 ?also reported to be equiv to Edwards 23. If I was at a high > volume academic ?centre I would use it, with good follow up...there is always > potential for ?better results long term-which may become irrelevant with the > new ?transcatheter valves. Dave > > Giuseppe Rescigno wrote: >> ?Hal, >> I have implanted three 3F aortic valves. They are quite easy to ?implant > and there is a theretical benefit in tubular prostheses. You should, ?as for > every stentless, be horizontal with the stitches without following the > annulus. It is therefore quite easy to put the commisures at the right > positions thanks to the holder. Aortotomy should be horizontal and above the ?STJ. > They works pretty well but trans gradient are not so low as company says. ?I > implanted it in over 80 yo people and this should be the ideal population > for a limited follow-up valve. Sorin Fredom Solo is probably more friendly > and ?the number of implants is significantly greater (at least in Italy). > Nevertheless during last year I came to the conclusion that stented valves > warrant the best reproducible result and I stopped using either 3F and ?Solo. >> Giuseppe >> Il giorno 26/ott/09, alle ore 00:57, ?Hgrmd@aol.com ha scritto: >>> Members, >>> ? Lately, ?I've gotten a lot of heat from the ATS rep trying to > convince ?me >>> to use the 3F aortic valve. ?Having been in this ?profession ?long > enough to >>> see valves come and go, I'd like ?to hear thoughts from other ?members, >>> especially the ?users. >>> >>> Hal >>> ?_______________________________________________ >>> OpenHeart-L ?mailing list >>> >>> Send postings to: >>> ? OpenHeart-L@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@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 > anddisclaimers ?posted at: >> http://www.hsforum.com/listdisclaim >> ?----------------------------------------- > > _______________________________________________ > OpenHeart-L ?mailing list > > Send postings ?to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From donross at bigpond.com Sun Nov 1 22:35:17 2009 From: donross at bigpond.com (Donald Ross) Date: Sun Nov 1 06:37:09 2009 Subject: [HSF] Pain in the neck In-Reply-To: <89c4ed2d0910310738w526d1d46gc7fa4f7e6c02588d@mail.gmail.com> References: <89c4ed2d0910310738w526d1d46gc7fa4f7e6c02588d@mail.gmail.com> Message-ID: <9CD7CD1F-D339-414A-AC0D-00E6E1DDEF9C@bigpond.com> After the chest is split, so you have something to grab, drag the patient over to your side of the table. Don PS warn the anaesthetist to check his stuff is still connected after you do it. On 01/11/2009, at 1:38 AM, Prasanna Simha M wrote: > I often get a pain in the neck of late when I do a CABG - horrible > crick in > the neck after the surgery is over. It doesnt happen when I use > loupes when > I do congenital surgery so I am not sure wearing loupes is the cause > (I > thought initially that it may be the cause because of the fixed focal > length) . I dont harvest the IMA nowadays as usually my Asst Prof or a > Resident does it (Victor Aldrete had mentioned about that once.) > So any tips /tricks to avoid this ? I thought it was accentuated > today as I > had the table a bit low while doing a Ramus and OM during an > OPCABG but > that is a suspicion.-- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From hgrmd at aol.com Sun Nov 1 11:37:40 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Sun Nov 1 06:39:08 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: References: <886062.42502.qm@web81604.mail.mud.yahoo.com><8CC8CAE0-C686-4BC5-854F-8EB04752ACD8@pol.net><7BD195DF-4D3A-41A1-A94A-D4496CF12A9C@mac.com> Message-ID: 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DQpPcGVuSGVhcnQtTCBtYWlsaW5nIGxpc3QNCg0KU2VuZCBwb3N0aW5ncyB0bzoNCiBPcGVuSGVh cnQtTEBsaXN0cy5oc2ZvcnVtLmNvbQ0KDQpUbyBVTlNVQlNDUklCRSwgdG8gQ0hBTkdFIGVtYWls IGFkZHJlc3MsIG9yIHRvIHZpZXcgYXJjaGl2ZXM6DQpodHRwOi8vbW1wLmNqcC5jb20vbWFpbG1h bi9saXN0aW5mby9vcGVuaGVhcnQtbA0KDQpBbGwgbWVzc2FnZXMgdHJhbnNtaXR0ZWQgYnkgdGhl IE9wZW5IZWFydC1MIGFyZSBzdWJqZWN0IHRvIHRoZSBwb2xpY2llcyBhbmQgDQpkaXNjbGFpbWVy cyBwb3N0ZWQgYXQ6DQpodHRwOi8vd3d3LmhzZm9ydW0uY29tL2xpc3RkaXNjbGFpbQ0KLS0tLS0t LS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0NCg== From hgrmd at aol.com Sun Nov 1 11:48:29 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Sun Nov 1 06:49:59 2009 Subject: [HSF] Is the 3F Aortic Valve a Good Alternative? In-Reply-To: <89c4ed2d0911010310q5eb82b2buaec8dc31494189c4@mail.gmail.com> References: <89c4ed2d0911010310q5eb82b2buaec8dc31494189c4@mail.gmail.com> Message-ID: <1261356619-1257076169-cardhu_decombobulator_blackberry.rim.net-304367925-@bda735.bisx.prod.on.blackberry> Prasanna, Not sure of the Magna data either, but it is made with Edwards pericardial leaflets for which I have 19 years of experience in private practice. The number of senescent Edwards pericardial valves I've replaced I could count on one hand, and I've never replaced one I inserted. Not a scientific paper, but strong empiric personal experience, IMHO. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: Prasanna Simha M Date: Sun, 1 Nov 2009 16:40:28 To: Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? Hal , how long is the Magna around ? We have been using it in India for a few years (frightfully expensive here). I am not sure how many years follow up is there for the Magna . Remember that even changes in these valves do not equate to similar results though the name may be the same.I doubt that Magna has a follow up equal to that of even teh mitroflow.Any one has literature ? I think the earliest reports were that of Totaro et al in 2003 or 2005 Prasanna On Sat, Oct 31, 2009 at 5:44 PM, wrote: > Dave, > ?Which "Edwards 23" are you referring? ?Maybe the old Perimount, ?but I > highly doubt a Mitroflow 19 is equivalent to an Edwards Magna Ease ?23. ?In > addition, I doubt that Mitroflow has the kind of durability ?data. ?If so, > please provide references. > > Hal > > > In a message dated 10/31/2009 4:45:34 A.M. Eastern Daylight Time, > drdharris@yahoo.co.uk writes: > > I would ?personally only use that valve if there are distinct technical > advantages - ?like the Mitroflow (good long term results reported at EACTS). > Mitroflow 19 ?also reported to be equiv to Edwards 23. If I was at a high > volume academic ?centre I would use it, with good follow up...there is always > potential for ?better results long term-which may become irrelevant with the > new ?transcatheter valves. Dave > > Giuseppe Rescigno wrote: >> ?Hal, >> I have implanted three 3F aortic valves. They are quite easy to ?implant > and there is a theretical benefit in tubular prostheses. You should, ?as for > every stentless, be horizontal with the stitches without following the > annulus. It is therefore quite easy to put the commisures at the right > positions thanks to the holder. Aortotomy should be horizontal and above the ?STJ. > They works pretty well but trans gradient are not so low as company says. ?I > implanted it in over 80 yo people and this should be the ideal population > for a limited follow-up valve. Sorin Fredom Solo is probably more friendly > and ?the number of implants is significantly greater (at least in Italy). > Nevertheless during last year I came to the conclusion that stented valves > warrant the best reproducible result and I stopped using either 3F and ?Solo. >> Giuseppe >> Il giorno 26/ott/09, alle ore 00:57, ?Hgrmd@aol.com ha scritto: >>> Members, >>> ? Lately, ?I've gotten a lot of heat from the ATS rep trying to > convince ?me >>> to use the 3F aortic valve. ?Having been in this ?profession ?long > enough to >>> see valves come and go, I'd like ?to hear thoughts from other ?members, >>> especially the ?users. >>> >>> Hal >>> ?_______________________________________________ >>> OpenHeart-L ?mailing list >>> >>> Send postings to: >>> ? OpenHeart-L@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@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 > anddisclaimers ?posted at: >> http://www.hsforum.com/listdisclaim >> ?----------------------------------------- > >_______________________________________________ > OpenHeart-L ?mailing list > > Send postings ?to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Sun Nov 1 17:13:34 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 06:52:04 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: <1631739193-1257075519-cardhu_decombobulator_blackberry.rim.net-901706-@bda735.bisx.prod.on.blackberry> References: <886062.42502.qm@web81604.mail.mud.yahoo.com> <8CC8CAE0-C686-4BC5-854F-8EB04752ACD8@pol.net> <7BD195DF-4D3A-41A1-A94A-D4496CF12A9C@mac.com> <1631739193-1257075519-cardhu_decombobulator_blackberry.rim.net-901706-@bda735.bisx.prod.on.blackberry> Message-ID: <89c4ed2d0911010343u452143d6xff93307ada246f90@mail.gmail.com> Hal, with people looking at cost containment you will see a jarring reality check for many of those procedures.There are patients now clamoring for a LIMA to LAD after stents have failed them. Prasanna On Sun, Nov 1, 2009 at 5:07 PM, wrote: > John, > ?Agree it will be a "scary ride", mainly for the patients as some of those technqies you describe give them clearly suboptimal results. ?I strongly suspect the doc at TCT doing the ostial LM stenting with a "perfect" result would be getting conventional LIMA to LAD if he had the same anatomy. ?I won't even begin to tell you my thoughts of an E Valve clip and a c.s. Screwing up the anatomy of a repairable valve. > > > > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: John Schor > Date: Sat, 31 Oct 2009 21:18:51 > To: > Subject: Re: [HSF] Changing field in Our specialty > > In thoracic cases, the same size criteria is used for stent grafting > as for open surgery. > > I have believed for the past 9 yrs that "open surgery" would be > relegated to history books. As doctors( not just as CV surgeons), we > should be prepared for ?1. repairs (of all organ systems) rather than > replacements 2. Avoidance of incisions--or increased use of scopes-- > whenever possible 3. Natural Orifice access surgery 4. Medication > rather than surgery. > > The aorta, from the sinotubular junction to the bifurcation, will be > "fixed" with endovascular techniques. (probably in less than 10 yrs) > Agree with Tom. Even in my small community hospital working alone in > the OR (no PA or first assistants), I have been able to fix 10cm > ruptured AAA with stent grafting. > > You should all attend a Cardiology meeting such as the TCT. You will > be amazed to see such things as L Main stenting for 95% ostial lesion-- > with PERFECT result. Transfemoral and transapical AVR's done safely. > MV repairs with clips and then reinforced with coronary sinus > rings........ > > Hold on to your hats. It's gonna be a scary ride. > > John > > John Schor, MD > Thoracic and Cardiovascular Surgery > Heart and Vascular Center of > Northern Arizona > Flagstaff, Sedona, and > Cottonwood, AZ > Tel: 928-649-2584 > > On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: > >> What is your threshold for intervention, i mean the size for >> descending aorta. >> >> Zhandong Zhou, MD >> St. Joseph Hospital >> Syracuse, New York >> Tel: 315 423 7192 >> >> On Oct 31, 2009, at 5:30 PM, John Schor wrote: >> >>> Agree. >>> See many of my previous posts. >>> John >>> John Schor, MD >>> Thoracic and Cardiovascular Surgery >>> Heart and Vascular Center of >>> Northern Arizona >>> Flagstaff, Sedona, and >>> Cottonwood, AZ >>> Tel: 928-649-2584 >>> >>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>> >>>> To all, >>>> >>>> I am in DC for a endovascular course for thoracic aneurysm. Only >>>> 25% are CV surgeons. Others are vascular, radiology, cardiologist. >>>> >>>> We need to catch up, without these skills, we are going to lose >>>> the percutaneous valve. >>>> >>>> Any thoughts? >>>> >>>> Z Zhou_______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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 anddisclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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 anddisclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From rudi at kbd.hr Sun Nov 1 12:56:16 2009 From: rudi at kbd.hr (Igor Rudez) Date: Sun Nov 1 06:56:47 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: <1631739193-1257075519-cardhu_decombobulator_blackberry.rim.net-901706-@bda735.bisx.prod.on.blackberry> Message-ID: <000501ca5aea$51927400$1d23a8c0@kbd.hr> Hal, my friend, I couldn't agree more! I can remember when first transfemoral aortic valves have been deployed, standing ovations from the crowd, cardiologists celebrating how they have conquered yet another field, and nobody even bothered about paravalvular leaks ("it's OK for this type of procedure"), occluded coronary ostia ("well, you know, there is much of calcium there"), migrating valves in both ways (downstream aorta, or upstream into the LV). Marketing is a hell! I'm not afraid that we're going to lose our jobs! If it happens in The States, you can spend the rest of your working days here, in Croatia! I can guarantee you will have enough patients! Igor -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of hgrmd@aol.com Sent: Sunday, November 01, 2009 12:38 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Changing field in Our specialty John, Agree it will be a "scary ride", mainly for the patients as some of those technqies you describe give them clearly suboptimal results. I strongly suspect the doc at TCT doing the ostial LM stenting with a "perfect" result would be getting conventional LIMA to LAD if he had the same anatomy. I won't even begin to tell you my thoughts of an E Valve clip and a c.s. Screwing up the anatomy of a repairable valve. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: John Schor Date: Sat, 31 Oct 2009 21:18:51 To: Subject: Re: [HSF] Changing field in Our specialty In thoracic cases, the same size criteria is used for stent grafting as for open surgery. I have believed for the past 9 yrs that "open surgery" would be relegated to history books. As doctors( not just as CV surgeons), we should be prepared for 1. repairs (of all organ systems) rather than replacements 2. Avoidance of incisions--or increased use of scopes-- whenever possible 3. Natural Orifice access surgery 4. Medication rather than surgery. The aorta, from the sinotubular junction to the bifurcation, will be "fixed" with endovascular techniques. (probably in less than 10 yrs) Agree with Tom. Even in my small community hospital working alone in the OR (no PA or first assistants), I have been able to fix 10cm ruptured AAA with stent grafting. You should all attend a Cardiology meeting such as the TCT. You will be amazed to see such things as L Main stenting for 95% ostial lesion-- with PERFECT result. Transfemoral and transapical AVR's done safely. MV repairs with clips and then reinforced with coronary sinus rings........ Hold on to your hats. It's gonna be a scary ride. John John Schor, MD Thoracic and Cardiovascular Surgery Heart and Vascular Center of Northern Arizona Flagstaff, Sedona, and Cottonwood, AZ Tel: 928-649-2584 On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: > What is your threshold for intervention, i mean the size for > descending aorta. > > Zhandong Zhou, MD > St. Joseph Hospital > Syracuse, New York > Tel: 315 423 7192 > > On Oct 31, 2009, at 5:30 PM, John Schor wrote: > >> Agree. >> See many of my previous posts. >> John >> John Schor, MD >> Thoracic and Cardiovascular Surgery >> Heart and Vascular Center of >> Northern Arizona >> Flagstaff, Sedona, and >> Cottonwood, AZ >> Tel: 928-649-2584 >> >> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >> >>> To all, >>> >>> I am in DC for a endovascular course for thoracic aneurysm. Only >>> 25% are CV surgeons. Others are vascular, radiology, cardiologist. >>> >>> We need to catch up, without these skills, we are going to lose >>> the percutaneous valve. >>> >>> Any thoughts? >>> >>> Z Zhou_______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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 anddisclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From Hgrmd at aol.com Sun Nov 1 06:57:57 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Nov 1 06:59:07 2009 Subject: [HSF] Changing field in Our specialty Message-ID: Prasanna, Agreed. You also have to realize there are a lot of docs "showing out" at conferences doing stuff that they rarely do in their own practice. Last week, I visited a hybrid suite and spoke with the doc inserting transcatheter valves. I asked him about the need for modalities such an dyna CT and even 3D TEE as adjuncts to fluoro for positioning the valve. Mind you, I've seen all of these modalities presented in valve meetings as useful for transcatheter valve procedures. He said he relied only on monoplane fluoro, and was pleased with is results. Hal In a message dated 11/1/2009 6:53:19 A.M. Eastern Standard Time, prasannasimha@gmail.com writes: Hal, with people looking at cost containment you will see a jarring reality check for many of those procedures.There are patients now clamoring for a LIMA to LAD after stents have failed them. Prasanna On Sun, Nov 1, 2009 at 5:07 PM, wrote: > John, > Agree it will be a "scary ride", mainly for the patients as some of those technqies you describe give them clearly suboptimal results. I strongly suspect the doc at TCT doing the ostial LM stenting with a "perfect" result would be getting conventional LIMA to LAD if he had the same anatomy. I won't even begin to tell you my thoughts of an E Valve clip and a c.s. Screwing up the anatomy of a repairable valve. > > > > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: John Schor > Date: Sat, 31 Oct 2009 21:18:51 > To: > Subject: Re: [HSF] Changing field in Our specialty > > In thoracic cases, the same size criteria is used for stent grafting > as for open surgery. > > I have believed for the past 9 yrs that "open surgery" would be > relegated to history books. As doctors( not just as CV surgeons), we > should be prepared for 1. repairs (of all organ systems) rather than > replacements 2. Avoidance of incisions--or increased use of scopes-- > whenever possible 3. Natural Orifice access surgery 4. Medication > rather than surgery. > > The aorta, from the sinotubular junction to the bifurcation, will be > "fixed" with endovascular techniques. (probably in less than 10 yrs) > Agree with Tom. Even in my small community hospital working alone in > the OR (no PA or first assistants), I have been able to fix 10cm > ruptured AAA with stent grafting. > > You should all attend a Cardiology meeting such as the TCT. You will > be amazed to see such things as L Main stenting for 95% ostial lesion-- > with PERFECT result. Transfemoral and transapical AVR's done safely. > MV repairs with clips and then reinforced with coronary sinus > rings........ > > Hold on to your hats. It's gonna be a scary ride. > > John > > John Schor, MD > Thoracic and Cardiovascular Surgery > Heart and Vascular Center of > Northern Arizona > Flagstaff, Sedona, and > Cottonwood, AZ > Tel: 928-649-2584 > > On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: > >> What is your threshold for intervention, i mean the size for >> descending aorta. >> >> Zhandong Zhou, MD >> St. Joseph Hospital >> Syracuse, New York >> Tel: 315 423 7192 >> >> On Oct 31, 2009, at 5:30 PM, John Schor wrote: >> >>> Agree. >>> See many of my previous posts. >>> John >>> John Schor, MD >>> Thoracic and Cardiovascular Surgery >>> Heart and Vascular Center of >>> Northern Arizona >>> Flagstaff, Sedona, and >>> Cottonwood, AZ >>> Tel: 928-649-2584 >>> >>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>> >>>> To all, >>>> >>>> I am in DC for a endovascular course for thoracic aneurysm. Only >>>> 25% are CV surgeons. Others are vascular, radiology, cardiologist. >>>> >>>> We need to catch up, without these skills, we are going to lose >>>> the percutaneous valve. >>>> >>>> Any thoughts? >>>> >>>> Z Zhou_______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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 anddisclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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 anddisclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Sun Nov 1 17:30:34 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 07:06:13 2009 Subject: [HSF] Is the 3F Aortic Valve a Good Alternative? In-Reply-To: <1261356619-1257076169-cardhu_decombobulator_blackberry.rim.net-304367925-@bda735.bisx.prod.on.blackberry> References: <89c4ed2d0911010310q5eb82b2buaec8dc31494189c4@mail.gmail.com> <1261356619-1257076169-cardhu_decombobulator_blackberry.rim.net-304367925-@bda735.bisx.prod.on.blackberry> Message-ID: <89c4ed2d0911010400t55711ca0ka2655b6dffcb0a11@mail.gmail.com> Yes, the only thing I wanted to high light is that while one may be good when some changes are made the efficacy may not always be translated to the new product. Incidentally my patients with the autopericardial valves came for follow up. I have done 5 implants as a preliminary trial pilot. One patient who had a perfect function @ 6 weeks came with viral pneumonitis @ 2 months (2 weeks after the follow up echo) and died of respiratory failure (patient came in extremis and died before deep swabs for PCR were sent.I have a suspicion of pH1N1. We had an echo showing good valve function at that time). The other 4 are OK and functioning well. Prasanna On Sun, Nov 1, 2009 at 5:18 PM, wrote: > Prasanna, > ?Not sure of the Magna data either, but it is made with Edwards pericardial leaflets for which I have 19 years of experience in private practice. ?The number of senescent Edwards pericardial valves I've replaced I could count on one hand, and I've never replaced one I inserted. ?Not a scientific paper, but strong empiric personal experience, IMHO. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Prasanna Simha M > Date: Sun, 1 Nov 2009 16:40:28 > To: > Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? > > Hal , how long is the Magna around ? We have been using it in India > for a few years (frightfully expensive here). I am not sure how many > years follow up is there for the Magna . Remember that even ?changes > in these valves do not equate to similar results though the name may > be the same.I doubt that Magna has a follow up equal to that of even > teh mitroflow.Any one has literature ? I think the earliest reports > were that of Totaro et al in 2003 or 2005 > Prasanna > > On Sat, Oct 31, 2009 at 5:44 PM, ? wrote: >> Dave, >> ?Which "Edwards 23" are you referring? ?Maybe the old Perimount, ?but I >> highly doubt a Mitroflow 19 is equivalent to an Edwards Magna Ease ?23. ?In >> addition, I doubt that Mitroflow has the kind of durability ?data. ?If so, >> please provide references. >> >> Hal >> >> >> In a message dated 10/31/2009 4:45:34 A.M. Eastern Daylight Time, >> drdharris@yahoo.co.uk writes: >> >> I would ?personally only use that valve if there are distinct technical >> advantages - ?like the Mitroflow (good long term results reported at EACTS). >> Mitroflow 19 ?also reported to be equiv to Edwards 23. If I was at a high >> volume academic ?centre I would use it, with good follow up...there is always >> potential for ?better results long term-which may become irrelevant with the >> new ?transcatheter valves. Dave >> >> Giuseppe Rescigno wrote: >>> ?Hal, >>> I have implanted three 3F aortic valves. They are quite easy to ?implant >> and there is a theretical benefit in tubular prostheses. You should, ?as for >> every stentless, be horizontal with the stitches without following the >> annulus. It is therefore quite easy to put the commisures at the right >> positions thanks to the holder. Aortotomy should be horizontal and above the ?STJ. >> They works pretty well but trans gradient are not so low as company says. ?I >> implanted it in over 80 yo people and this should be the ideal population >> for a limited follow-up valve. Sorin Fredom Solo is probably more friendly >> and ?the number of implants is significantly greater (at least in Italy). >> Nevertheless during last year I came to the conclusion that stented valves >> warrant the best reproducible result and I stopped using either 3F and ?Solo. >>> Giuseppe >>> Il giorno 26/ott/09, alle ore 00:57, ?Hgrmd@aol.com ha scritto: >>>> Members, >>>> ? Lately, ?I've gotten a lot of heat from the ATS rep trying to >> convince ?me >>>> to use the 3F aortic valve. ?Having been in this ?profession ?long >> enough to >>>> see valves come and go, I'd like ?to hear thoughts from other ?members, >>>> especially the ?users. >>>> >>>> Hal >>>> ?_______________________________________________ >>>> OpenHeart-L ?mailing list >>>> >>>> Send postings to: >>>> ? OpenHeart-L@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@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 >> anddisclaimers ?posted at: >>> http://www.hsforum.com/listdisclaim >>> ?----------------------------------------- >> >>_______________________________________________ >> OpenHeart-L ?mailing list >> >> Send postings ?to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From hgrmd at aol.com Sun Nov 1 12:05:10 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Sun Nov 1 07:06:42 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: <000501ca5aea$51927400$1d23a8c0@kbd.hr> References: 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LS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0NCg== From prasannasimha at gmail.com Sun Nov 1 17:33:41 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 07:09:25 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: References: Message-ID: <89c4ed2d0911010403v7e58dd5bu1733de22dcffbb01@mail.gmail.com> Cribrier came and demonstrated it with monoplane fluoro too !! One thing is the blessed thing is so expensive that it has not got a foot hold here. Prasanna On Sun, Nov 1, 2009 at 5:27 PM, wrote: > Prasanna, > ?Agreed. ?You also have to realize there are a lot of docs ?"showing out" > at conferences doing stuff that they rarely do in their own ?practice. ?Last > week, I visited a hybrid suite and spoke with the doc ?inserting > transcatheter valves. ?I asked him about the need for modalities ?such an dyna CT and > even 3D TEE as adjuncts to fluoro for positioning the ?valve. ?Mind you, > I've seen all of these modalities presented in valve ?meetings as useful for > transcatheter valve procedures. ?He said he relied ?only on monoplane fluoro, > and was pleased with is results. > > Hal > > > In a message dated 11/1/2009 6:53:19 A.M. Eastern Standard Time, > prasannasimha@gmail.com writes: > > Hal, ?with people looking at cost containment you will see a jarring > reality ?check ?for many of those procedures.There are patients now > clamoring ?for a LIMA to LAD after stents have failed them. > Prasanna > On Sun, Nov 1, ?2009 at 5:07 PM, ? wrote: >> John, >> ?Agree it will be a "scary ride", mainly for the patients as some of > those technqies you describe give them clearly suboptimal results. ?I ?strongly > suspect the doc at TCT doing the ostial LM stenting with a "perfect" > result would be getting conventional LIMA to LAD if he had the same anatomy. ?I > won't even begin to tell you my thoughts of an E Valve clip and a c.s. > Screwing up the anatomy of a repairable ?valve. >> >> >> >> >> Hal >> Sent from my ?Verizon Wireless BlackBerry >> >> -----Original Message----- >> ?From: John Schor >> Date: Sat, 31 Oct 2009 ?21:18:51 >> To: >> Subject: ?Re: [HSF] Changing field in Our specialty >> >> In thoracic cases, ?the same size criteria is used for stent grafting >> as for open ?surgery. >> >> I have believed for the past 9 yrs that "open ?surgery" would be >> relegated to history books. As doctors( not just as ?CV surgeons), we >> should be prepared for ?1. repairs (of all organ ?systems) rather than >> replacements 2. Avoidance of incisions--or ?increased use of scopes-- >> whenever possible 3. Natural Orifice access ?surgery 4. Medication >> rather than surgery. >> >> The aorta, ?from the sinotubular junction to the bifurcation, will be >> "fixed" with ?endovascular techniques. (probably in less than 10 yrs) >> Agree with ?Tom. Even in my small community hospital working alone in >> the OR (no ?PA or first assistants), I have been able to fix 10cm >> ruptured AAA ?with stent grafting. >> >> You should all attend a Cardiology ?meeting such as the TCT. You will >> be amazed to see such things as L ?Main stenting for 95% ostial lesion-- >> with PERFECT result. ?Transfemoral and transapical AVR's done safely. >> MV repairs with clips ?and then reinforced with coronary sinus >> rings........ >> >> ?Hold on to your hats. It's gonna be a scary ride. >> >> ?John >> >> John Schor, MD >> Thoracic and Cardiovascular ?Surgery >> Heart and Vascular Center of >> Northern Arizona >> ?Flagstaff, Sedona, and >> Cottonwood, AZ >> Tel: ?928-649-2584 >> >> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou ?wrote: >> >>> What is your threshold for intervention, i mean the ?size for >>> descending aorta. >>> >>> Zhandong Zhou, ?MD >>> St. Joseph Hospital >>> Syracuse, New York >>> ?Tel: 315 423 7192 >>> >>> On Oct 31, 2009, at 5:30 PM, John ?Schor wrote: >>> >>>> ?Agree. >>>> See many of my previous posts. >>>> ?John >>>> John Schor, MD >>>> Thoracic and ?Cardiovascular Surgery >>>> Heart and Vascular Center ?of >>>> Northern Arizona >>>> Flagstaff, Sedona, ?and >>>> Cottonwood, AZ >>>> Tel: ?928-649-2584 >>>> >>>> On Oct 31, 2009, at 11:02 AM, ?Zhandong Zhou wrote: >>>> >>>>> To ?all, >>>>> >>>>> I am in DC for a endovascular ?course for thoracic aneurysm. Only >>>>> 25% are CV surgeons. ?Others are vascular, radiology, ?cardiologist. >>>>> >>>>> We need to catch up, ?without these skills, we are going to lose >>>>> the ?percutaneous valve. >>>>> >>>>> Any ?thoughts? >>>>> >>>>> Z ?Zhou_______________________________________________ >>>>> ?OpenHeart-L mailing list >>>>> >>>>> Send postings ?to: >>>>> ?OpenHeart-L@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 anddisclaimers posted at: >>>>> ?http://www.hsforum.com/listdisclaim >>>>> ?----------------------------------------- >>>> >>>> ?_______________________________________________ >>>> OpenHeart-L ?mailing list >>>> >>>> Send postings to: >>>> ?OpenHeart-L@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 anddisclaimers posted at: >>>> ?http://www.hsforum.com/listdisclaim >>>> ?----------------------------------------- >>> ?_______________________________________________ >>> OpenHeart-L ?mailing list >>> >>> Send postings to: >>> ?OpenHeart-L@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 anddisclaimers posted at: >>> ?http://www.hsforum.com/listdisclaim >>> ?----------------------------------------- >> >> ?_______________________________________________ >> OpenHeart-L mailing ?list >> >> Send postings to: >> ?OpenHeart-L@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@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 >> ?----------------------------------------- >> > > > > -- > Prasanna Simha ?M > _______________________________________________ > OpenHeart-L mailing ?list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From hgrmd at aol.com Sun Nov 1 12:09:40 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Sun Nov 1 07:12:11 2009 Subject: [HSF] Is the 3F Aortic Valve a Good Alternative? In-Reply-To: <89c4ed2d0911010400t55711ca0ka2655b6dffcb0a11@mail.gmail.com> References: <89c4ed2d0911010310q5eb82b2buaec8dc31494189c4@mail.gmail.com> <1261356619-1257076169-cardhu_decombobulator_blackberry.rim.net-304367925-@bda735.bisx.prod.on.blackberry><89c4ed2d0911010400t55711ca0ka2655b6dffcb0a11@mail.gmail.com> Message-ID: <215969449-1257077442-cardhu_decombobulator_blackberry.rim.net-327658898-@bda735.bisx.prod.on.blackberry> Prasanna, I agree, but I will take me chances on a valve made by a company I trust. Be assured, I will be vigilant for any early failures. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: Prasanna Simha M Date: Sun, 1 Nov 2009 17:30:34 To: Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? Yes, the only thing I wanted to high light is that while one may be good when some changes are made the efficacy may not always be translated to the new product. Incidentally my patients with the autopericardial valves came for follow up. I have done 5 implants as a preliminary trial pilot. One patient who had a perfect function @ 6 weeks came with viral pneumonitis @ 2 months (2 weeks after the follow up echo) and died of respiratory failure (patient came in extremis and died before deep swabs for PCR were sent.I have a suspicion of pH1N1. We had an echo showing good valve function at that time). The other 4 are OK and functioning well. Prasanna On Sun, Nov 1, 2009 at 5:18 PM, wrote: > Prasanna, > ?Not sure of the Magna data either, but it is made with Edwards pericardial leaflets for which I have 19 years of experience in private practice. ?The number of senescent Edwards pericardial valves I've replaced I could count on one hand, and I've never replaced one I inserted. ?Not a scientific paper, but strong empiric personal experience, IMHO. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Prasanna Simha M > Date: Sun, 1 Nov 2009 16:40:28 > To: > Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? > > Hal , how long is the Magna around ? We have been using it in India > for a few years (frightfully expensive here). I am not sure how many > years follow up is there for the Magna . Remember that even ?changes > in these valves do not equate to similar results though the name may > be the same.I doubt that Magna has a follow up equal to that of even > teh mitroflow.Any one has literature ? I think the earliest reports > were that of Totaro et al in 2003 or 2005 > Prasanna > > On Sat, Oct 31, 2009 at 5:44 PM, ? wrote: >> Dave, >> ?Which "Edwards 23" are you referring? ?Maybe the old Perimount, ?but I >> highly doubt a Mitroflow 19 is equivalent to an Edwards Magna Ease ?23. ?In >> addition, I doubt that Mitroflow has the kind of durability ?data. ?If so, >> please provide references. >> >> Hal >> >> >> In a message dated 10/31/2009 4:45:34 A.M. Eastern Daylight Time, >> drdharris@yahoo.co.uk writes: >> >> I would ?personally only use that valve if there are distinct technical >> advantages - ?like the Mitroflow (good long term results reported at EACTS). >> Mitroflow 19 ?also reported to be equiv to Edwards 23. If I was at a high >> volume academic ?centre I would use it, with good follow up...there is always >> potential for ?better results long term-which may become irrelevant with the >> new ?transcatheter valves. Dave >> >> Giuseppe Rescigno wrote: >>> ?Hal, >>> I have implanted three 3F aortic valves. They are quite easy to ?implant >> and there is a theretical benefit in tubular prostheses. You should, ?as for >> every stentless, be horizontal with the stitches without following the >> annulus. It is therefore quite easy to put the commisures at the right >> positions thanks to the holder. Aortotomy should be horizontal and above the ?STJ. >> They works pretty well but trans gradient are not so low as company says. ?I >> implanted it in over 80 yo people and this should be the ideal population >> for a limited follow-up valve. Sorin Fredom Solo is probably more friendly >> and ?the number of implants is significantly greater (at least in Italy). >> Nevertheless during last year I came to the conclusion that stented valves >> warrant the best reproducible result and I stopped using either 3F and ?Solo. >>> Giuseppe >>> Il giorno 26/ott/09, alle ore 00:57, ?Hgrmd@aol.com ha scritto: >>>> Members, >>>> ? Lately, ?I've gotten a lot of heat from the ATS rep trying to >> convince ?me >>>> to use the 3F aortic valve. ?Having been in this ?profession ?long >> enough to >>>> see valves come and go, I'd like ?to hear thoughts from other ?members, >>>> especially the ?users. >>>> >>>> Hal >>>> ?_______________________________________________ >>>> OpenHeart-L ?mailing list >>>> >>>> Send postings to: >>>> ? OpenHeart-L@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@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 >> anddisclaimers ?posted at: >>> http://www.hsforum.com/listdisclaim >>> ?----------------------------------------- >> >>_______________________________________________ >> OpenHeart-L ?mailing list >> >> Send postings ?to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From anianyanwu at hotmail.com Sun Nov 1 12:20:03 2009 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun Nov 1 07:20:31 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr> <8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com> Message-ID: > Everyone wants to put the stent(s) in whatever vessel and walk away - sorry, > doesnt work that way......... > > -michael Unfortunately, it will work that way and even if surgeon does not put them in he will still be burdened with dealing with complications and post-op issues. In one way or the other the patient willl be connected to a surgeon. Many patients will get to the 'stenter' through a surgeon. Some patients will have 'debranching' procedures which have to be done by a surgeon, or stenter will ask surgeon to help with vascular access. Whichever way there will be some surgeon attached to the case in that way the 'stenter' can run 100 miles after 24 hours and leave you to pick the pieces. One patient recently spent 2 months in our ICU and then died after descending stent and I never saw the stenters after the first week (in this case stenters were vascular surgeons) another was paraplegic and spent weeks, also died, again stenters nowhere to be seen. Unless you have aortic surgeons (who also do/did the open surgical equivalents) doing these I think you will find we will still be left to pick up the pieces left by stent cowboys in our various localities. The morbidity of these procedures and post-op care required is not trivial and requires as intense detail and care as for patients having surgical repair. Minimally invasive surgery etc is a misnomer and gives patients and physicians the false security that the treatment is no big deal. However, looking aat TAVI or TEVAR data, it is clear the procedures are very invasive indeed and patients are still subject to the whole gamut of complications (or some new ones) and mortality as patients having the conventional procedures. Ani > Date: Sat, 31 Oct 2009 22:44:26 -0400 > Subject: Re: [HSF] Changing field in Our specialty-get on board or be left out > From: msfirst@gmail.com > To: OpenHeart-L@lists.hsforum.com > CC: > > I have no problem giving up the descending stent graft work PROVIDED whoever > does it takes care of these patients afterwards. I find many of this > patients have horrible comorbidities, poorly controlled hypertension, > diabetes, etc that no one wants to deal with. Many have not seen a doctors > in years - if ever and rarely do they have insurance (not that I care about > that). If a Radiologist wants to put a stent graft in, then he/she can take > responsibility for all of the patients other medical, social, > economic problems. Knock yourselves out and good luck........ > > Everyone wants to put the stent(s) in whatever vessel and walk away - sorry, > doesnt work that way......... > > -michael > > On Sat, Oct 31, 2009 at 7:06 PM, wrote: > > > > > My humble prediction > > Open descending and/or thoracoabdominal aortic aneurysm surgery is destined > > to the same fate as open gastric surgery or open gallbladder surgery within > > the next 10 yrs and those who don't get on board with endovascular methods > > will be left out. > > > > Tom Martin > > U of Florida > > Gainesville > > > > -----Original Message----- > > From: Igor Rudez > > To: OpenHeart-L@lists.hsforum.com > > Sent: Sat, Oct 31, 2009 6:31 pm > > Subject: RE: [HSF] Changing field in Our specialty > > > > > > > > Zhou, > > partially agree with you! Of course we have to master those (new) skills > > s well, but do not be afraid we are going to lose patients! > > can remember many of our colleagues were convinced that we're going to be > > ut of job because of drug eluting stents! And what happened? > > o, OK, yes, master the skills but no, we are still far, far in front of > > hem! And when they make a hole pushing some device, stent, whatever in the > > eart, aorta, wherever, who do you think they are going to call? > > Igor > > -----Original Message----- > > rom: openheart-l-bounces@lists.hsforum.com > > mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Zhandong Zhou > > ent: Saturday, October 31, 2009 7:02 PM > > o: OpenHeart-L@lists.hsforum.com > > ubject: [HSF] Changing field in Our specialty > > > > o all, > > I am in DC for a endovascular course for thoracic aneurysm. Only 25% > > re CV surgeons. Others are vascular, radiology, cardiologist. > > We need to catch up, without these skills, we are going to lose the > > ercutaneous valve. > > Any thoughts? > > Z Zhou > > > > ______________________________________________ > > penHeart-L mailing list > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > ttp://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > > isclaimers posted at: > > ttp://www.hsforum.com/listdisclaim > > ---------------------------------------- > > _______________________________________________ > > penHeart-L mailing list > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > ttp://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > > isclaimers posted at: > > ttp://www.hsforum.com/listdisclaim > > ---------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@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@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 > ----------------------------------------- _________________________________________________________________ Download Messenger onto your mobile for free http://clk.atdmt.com/UKM/go/174426567/direct/01/ From guilherme at succi.com.br Sun Nov 1 12:24:10 2009 From: guilherme at succi.com.br (guilherme@succi.com.br) Date: Sun Nov 1 07:25:09 2009 Subject: Res: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? In-Reply-To: <1261356619-1257076169-cardhu_decombobulator_blackberry.rim.net-304367925-@bda735.bisx.prod.on.blackberry> References: <89c4ed2d0911010310q5eb82b2buaec8dc31494189c4@mail.gmail.com><1261356619-1257076169-cardhu_decombobulator_blackberry.rim.net-304367925-@bda735.bisx.prod.on.blackberry> Message-ID: <2023387091-1257078277-cardhu_decombobulator_blackberry.rim.net-1803764212-@bda122.bisx.produk.on.blackberry> Dear members, I work in Brazil and I can tell you the things were worse down here 5 years ago. I think cardiologists have realized their patients had not done so well with that lot of coronary stenting. Our number of referred patients have grown in the past few years since the stents - proclaimed to be "never occluding" ones started to kill young people with left main or LAD disease. The aortic stenting is a reality and if one don't stop his practice for a six month period or so to get trained in this field he would never be able to compete in the head of the market. I believe there are going to be patients for everyone. And I can't stop my practice for six months to learn endovascular. Guilherme Succi Sao Paulo Brazil Enviado do meu BlackBerry? da TIM -----Original Message----- From: hgrmd@aol.com Date: Sun, 1 Nov 2009 11:48:29 To: Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? Prasanna, Not sure of the Magna data either, but it is made with Edwards pericardial leaflets for which I have 19 years of experience in private practice. The number of senescent Edwards pericardial valves I've replaced I could count on one hand, and I've never replaced one I inserted. Not a scientific paper, but strong empiric personal experience, IMHO. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: Prasanna Simha M Date: Sun, 1 Nov 2009 16:40:28 To: Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? Hal , how long is the Magna around ? We have been using it in India for a few years (frightfully expensive here). I am not sure how many years follow up is there for the Magna . Remember that even changes in these valves do not equate to similar results though the name may be the same.I doubt that Magna has a follow up equal to that of even teh mitroflow.Any one has literature ? I think the earliest reports were that of Totaro et al in 2003 or 2005 Prasanna On Sat, Oct 31, 2009 at 5:44 PM, wrote: > Dave, > ?Which "Edwards 23" are you referring? ?Maybe the old Perimount, ?but I > highly doubt a Mitroflow 19 is equivalent to an Edwards Magna Ease ?23. ?In > addition, I doubt that Mitroflow has the kind of durability ?data. ?If so, > please provide references. > > Hal > > > In a message dated 10/31/2009 4:45:34 A.M. Eastern Daylight Time, > drdharris@yahoo.co.uk writes: > > I would ?personally only use that valve if there are distinct technical > advantages - ?like the Mitroflow (good long term results reported at EACTS). > Mitroflow 19 ?also reported to be equiv to Edwards 23. If I was at a high > volume academic ?centre I would use it, with good follow up...there is always > potential for ?better results long term-which may become irrelevant with the > new ?transcatheter valves. Dave > > Giuseppe Rescigno wrote: >> ?Hal, >> I have implanted three 3F aortic valves. They are quite easy to ?implant > and there is a theretical benefit in tubular prostheses. You should, ?as for > every stentless, be horizontal with the stitches without following the > annulus. It is therefore quite easy to put the commisures at the right > positions thanks to the holder. Aortotomy should be horizontal and above the ?STJ. > They works pretty well but trans gradient are not so low as company says. ?I > implanted it in over 80 yo people and this should be the ideal population > for a limited follow-up valve. Sorin Fredom Solo is probably more friendly > and ?the number of implants is significantly greater (at least in Italy). > Nevertheless during last year I came to the conclusion that stented valves > warrant the best reproducible result and I stopped using either 3F and ?Solo. >> Giuseppe >> Il giorno 26/ott/09, alle ore 00:57, ?Hgrmd@aol.com ha scritto: >>> Members, >>> ? Lately, ?I've gotten a lot of heat from the ATS rep trying to > convince ?me >>> to use the 3F aortic valve. ?Having been in this ?profession ?long > enough to >>> see valves come and go, I'd like ?to hear thoughts from other ?members, >>> especially the ?users. >>> >>> Hal >>> ?_______________________________________________ >>> OpenHeart-L ?mailing list >>> >>> Send postings to: >>> ? OpenHeart-L@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@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 > anddisclaimers ?posted at: >> http://www.hsforum.com/listdisclaim >> ?----------------------------------------- > >_______________________________________________ > OpenHeart-L ?mailing list > > Send postings ?to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From guilherme at succi.com.br Sun Nov 1 12:23:16 2009 From: guilherme at succi.com.br (guilherme@succi.com.br) Date: Sun Nov 1 07:25:59 2009 Subject: Res: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? In-Reply-To: <1261356619-1257076169-cardhu_decombobulator_blackberry.rim.net-304367925-@bda735.bisx.prod.on.blackberry> References: <89c4ed2d0911010310q5eb82b2buaec8dc31494189c4@mail.gmail.com><1261356619-1257076169-cardhu_decombobulator_blackberry.rim.net-304367925-@bda735.bisx.prod.on.blackberry> Message-ID: <2023387091-1257078266-cardhu_decombobulator_blackberry.rim.net-1736010117-@bda122.bisx.produk.on.blackberry> Dear members, I work in Brazil and I can tell you the things were worse down here 5 years ago. I think cardiologists have realized their patients had not done so well with that lot of coronary stenting. Our number of referred patients have grown in the past few years since the stents - proclaimed to be "never occluding" ones started to kill young people with left main or LAD disease. The aortic stenting is a reality and if one don't stop his practice for a six month period or so to get trained in this field he would never be able to compete in the head of the market. I believe there are going to be patients for everyone. And I can't stop my practice for six months to learn endovascular. Guilherme Succi Sao Paulo Brazil Enviado do meu BlackBerry? da TIM -----Original Message----- From: hgrmd@aol.com Date: Sun, 1 Nov 2009 11:48:29 To: Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? Prasanna, Not sure of the Magna data either, but it is made with Edwards pericardial leaflets for which I have 19 years of experience in private practice. The number of senescent Edwards pericardial valves I've replaced I could count on one hand, and I've never replaced one I inserted. Not a scientific paper, but strong empiric personal experience, IMHO. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: Prasanna Simha M Date: Sun, 1 Nov 2009 16:40:28 To: Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? Hal , how long is the Magna around ? We have been using it in India for a few years (frightfully expensive here). I am not sure how many years follow up is there for the Magna . Remember that even changes in these valves do not equate to similar results though the name may be the same.I doubt that Magna has a follow up equal to that of even teh mitroflow.Any one has literature ? I think the earliest reports were that of Totaro et al in 2003 or 2005 Prasanna On Sat, Oct 31, 2009 at 5:44 PM, wrote: > Dave, > ?Which "Edwards 23" are you referring? ?Maybe the old Perimount, ?but I > highly doubt a Mitroflow 19 is equivalent to an Edwards Magna Ease ?23. ?In > addition, I doubt that Mitroflow has the kind of durability ?data. ?If so, > please provide references. > > Hal > > > In a message dated 10/31/2009 4:45:34 A.M. Eastern Daylight Time, > drdharris@yahoo.co.uk writes: > > I would ?personally only use that valve if there are distinct technical > advantages - ?like the Mitroflow (good long term results reported at EACTS). > Mitroflow 19 ?also reported to be equiv to Edwards 23. If I was at a high > volume academic ?centre I would use it, with good follow up...there is always > potential for ?better results long term-which may become irrelevant with the > new ?transcatheter valves. Dave > > Giuseppe Rescigno wrote: >> ?Hal, >> I have implanted three 3F aortic valves. They are quite easy to ?implant > and there is a theretical benefit in tubular prostheses. You should, ?as for > every stentless, be horizontal with the stitches without following the > annulus. It is therefore quite easy to put the commisures at the right > positions thanks to the holder. Aortotomy should be horizontal and above the ?STJ. > They works pretty well but trans gradient are not so low as company says. ?I > implanted it in over 80 yo people and this should be the ideal population > for a limited follow-up valve. Sorin Fredom Solo is probably more friendly > and ?the number of implants is significantly greater (at least in Italy). > Nevertheless during last year I came to the conclusion that stented valves > warrant the best reproducible result and I stopped using either 3F and ?Solo. >> Giuseppe >> Il giorno 26/ott/09, alle ore 00:57, ?Hgrmd@aol.com ha scritto: >>> Members, >>> ? Lately, ?I've gotten a lot of heat from the ATS rep trying to > convince ?me >>> to use the 3F aortic valve. ?Having been in this ?profession ?long > enough to >>> see valves come and go, I'd like ?to hear thoughts from other ?members, >>> especially the ?users. >>> >>> Hal >>> ?_______________________________________________ >>> OpenHeart-L ?mailing list >>> >>> Send postings to: >>> ? OpenHeart-L@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@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 > anddisclaimers ?posted at: >> http://www.hsforum.com/listdisclaim >> ?----------------------------------------- > >_______________________________________________ > OpenHeart-L ?mailing list > > Send postings ?to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Sun Nov 1 18:04:10 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 07:41:40 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr> <8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com> Message-ID: <89c4ed2d0911010434o205d064atc0f0c9afa070f595@mail.gmail.com> How many cardiologists are there after a complication requiring surgical intervention - normally zero. I have one cardiology Professor who insists that if there is a complication his unit member who has had the complication should hang around till we settle the case and get involved in periop echo etc etc. He was really wild when one balloon valvotomy tear occurred and no one was there when we were weaning the patient of CPB. I think that sort of commitment is needed from both sides to get patients up and running.I never hesitate when he calls us as I know he will be there to help us whereas some will dump the case like a hot potato. On Sun, Nov 1, 2009 at 5:50 PM, Ani Anyanwu wrote: > >> Everyone wants to put the stent(s) in whatever vessel and walk away - sorry, >> doesnt work that way......... >> >> -michael > > > > Unfortunately, it will work that way and even if surgeon does not put them in he will still be burdened with dealing with complications and post-op issues. In one way or the other the patient willl be connected to a surgeon. ?Many patients will get to the 'stenter' through a surgeon. Some patients will have 'debranching' procedures which have to be done by a surgeon, or stenter will ask surgeon to help with vascular access. Whichever way there will be some surgeon attached to the case in that way the 'stenter' can run 100 miles after 24 hours and leave you to pick the pieces. One patient recently spent 2 months in our ICU and then died after descending stent ?and I never saw the stenters after the first week (in this case stenters were vascular surgeons) another was paraplegic and spent weeks, also died, again stenters nowhere to be seen. > > > > Unless you have aortic surgeons (who also do/did the open surgical equivalents) doing these I think you will find we will still be left to pick up the pieces left by stent cowboys in our various localities. The morbidity of these procedures and post-op care required is not trivial and requires as intense detail and care as for patients having surgical repair. Minimally invasive surgery etc is a misnomer and gives patients and physicians the false security that the treatment is no big deal. However, looking aat TAVI or TEVAR data, it is clear the procedures are very invasive indeed and patients are still subject to the whole gamut of complications (or some new ones) and mortality as patients having the conventional procedures. > > > > Ani > >> Date: Sat, 31 Oct 2009 22:44:26 -0400 >> Subject: Re: [HSF] Changing field in Our specialty-get on board or be left out >> From: msfirst@gmail.com >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> I have no problem giving up the descending stent graft work PROVIDED whoever >> does it takes care of these patients afterwards. I find many of this >> patients have horrible comorbidities, poorly controlled hypertension, >> diabetes, etc that no one wants to deal with. Many have not seen a doctors >> in years - if ever and rarely do they have insurance (not that I care about >> that). If a Radiologist wants to put a stent graft in, then he/she can take >> responsibility for all of the patients other medical, social, >> economic problems. Knock yourselves out and good luck........ >> >> Everyone wants to put the stent(s) in whatever vessel and walk away - sorry, >> doesnt work that way......... >> >> -michael >> >> On Sat, Oct 31, 2009 at 7:06 PM, wrote: >> >> > >> > My humble prediction >> > Open descending and/or thoracoabdominal aortic aneurysm surgery is destined >> > to the same fate as open gastric surgery or open gallbladder surgery within >> > the next 10 yrs and those who don't get on board with endovascular methods >> > will be left out. >> > >> > Tom Martin >> > U of Florida >> > Gainesville >> > >> > -----Original Message----- >> > From: Igor Rudez >> > To: OpenHeart-L@lists.hsforum.com >> > Sent: Sat, Oct 31, 2009 6:31 pm >> > Subject: RE: [HSF] Changing field in Our specialty >> > >> > >> > >> > Zhou, >> > partially agree with you! Of course we have to master those (new) skills >> > s well, but do not be afraid we are going to lose patients! >> > can remember many of our colleagues were convinced that we're going to be >> > ut of job because of drug eluting stents! And what happened? >> > o, OK, yes, master the skills but no, we are still far, far in front of >> > hem! And when they make a hole pushing some device, stent, whatever in the >> > eart, aorta, wherever, who do you think they are going to call? >> > Igor >> > -----Original Message----- >> > rom: openheart-l-bounces@lists.hsforum.com >> > mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Zhandong Zhou >> > ent: Saturday, October 31, 2009 7:02 PM >> > o: OpenHeart-L@lists.hsforum.com >> > ubject: [HSF] Changing field in Our specialty >> > >> > o all, >> > I am in DC for a endovascular course for thoracic aneurysm. Only 25% >> > re CV surgeons. Others are vascular, radiology, cardiologist. >> > We need to catch up, without these skills, we are going to lose the >> > ercutaneous valve. >> > Any thoughts? >> > Z Zhou >> > >> > ______________________________________________ >> > penHeart-L mailing list >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > ttp://mmp.cjp.com/mailman/listinfo/openheart-l >> > All messages transmitted by the OpenHeart-L are subject to the policies and >> > isclaimers posted at: >> > ttp://www.hsforum.com/listdisclaim >> > ---------------------------------------- >> > _______________________________________________ >> > penHeart-L mailing list >> > Send postings to: >> > OpenHeart-L@lists.hsforum.com >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> > ttp://mmp.cjp.com/mailman/listinfo/openheart-l >> > All messages transmitted by the OpenHeart-L are subject to the policies and >> > isclaimers posted at: >> > ttp://www.hsforum.com/listdisclaim >> > ---------------------------------------- >> > >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@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@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 >> ----------------------------------------- > > _________________________________________________________________ > Download Messenger onto your mobile for free > http://clk.atdmt.com/UKM/go/174426567/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From johnschor at mac.com Sun Nov 1 05:57:41 2009 From: johnschor at mac.com (John Schor) Date: Sun Nov 1 08:02:21 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: <1631739193-1257075519-cardhu_decombobulator_blackberry.rim.net-901706-@bda735.bisx.prod.on.blackberry> References: <886062.42502.qm@web81604.mail.mud.yahoo.com> <8CC8CAE0-C686-4BC5-854F-8EB04752ACD8@pol.net> <7BD195DF-4D3A-41A1-A94A-D4496CF12A9C@mac.com> <1631739193-1257075519-cardhu_decombobulator_blackberry.rim.net-901706-@bda735.bisx.prod.on.blackberry> Message-ID: <0FF01183-6BDF-4A47-BE9F-8C585CFBF114@mac.com> I agree with Hal about suboptimal results with some of these disruptive technologies, BUT, the train is rolling. As we all know, patient flow is controlled by the cardiologists, and 99% believe that surgery is bad and catheters are good. John John Schor, MD Thoracic and Cardiovascular Surgery Heart and Vascular Center of Northern Arizona Flagstaff, Sedona, and Cottonwood, AZ Tel: 928-649-2584 On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: > John, > Agree it will be a "scary ride", mainly for the patients as some of > those technqies you describe give them clearly suboptimal results. > I strongly suspect the doc at TCT doing the ostial LM stenting with > a "perfect" result would be getting conventional LIMA to LAD if he > had the same anatomy. I won't even begin to tell you my thoughts of > an E Valve clip and a c.s. Screwing up the anatomy of a repairable > valve. > > > > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: John Schor > Date: Sat, 31 Oct 2009 21:18:51 > To: > Subject: Re: [HSF] Changing field in Our specialty > > In thoracic cases, the same size criteria is used for stent grafting > as for open surgery. > > I have believed for the past 9 yrs that "open surgery" would be > relegated to history books. As doctors( not just as CV surgeons), we > should be prepared for 1. repairs (of all organ systems) rather than > replacements 2. Avoidance of incisions--or increased use of scopes-- > whenever possible 3. Natural Orifice access surgery 4. Medication > rather than surgery. > > The aorta, from the sinotubular junction to the bifurcation, will be > "fixed" with endovascular techniques. (probably in less than 10 yrs) > Agree with Tom. Even in my small community hospital working alone in > the OR (no PA or first assistants), I have been able to fix 10cm > ruptured AAA with stent grafting. > > You should all attend a Cardiology meeting such as the TCT. You will > be amazed to see such things as L Main stenting for 95% ostial > lesion-- > with PERFECT result. Transfemoral and transapical AVR's done safely. > MV repairs with clips and then reinforced with coronary sinus > rings........ > > Hold on to your hats. It's gonna be a scary ride. > > John > > John Schor, MD > Thoracic and Cardiovascular Surgery > Heart and Vascular Center of > Northern Arizona > Flagstaff, Sedona, and > Cottonwood, AZ > Tel: 928-649-2584 > > On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: > >> What is your threshold for intervention, i mean the size for >> descending aorta. >> >> Zhandong Zhou, MD >> St. Joseph Hospital >> Syracuse, New York >> Tel: 315 423 7192 >> >> On Oct 31, 2009, at 5:30 PM, John Schor wrote: >> >>> Agree. >>> See many of my previous posts. >>> John >>> John Schor, MD >>> Thoracic and Cardiovascular Surgery >>> Heart and Vascular Center of >>> Northern Arizona >>> Flagstaff, Sedona, and >>> Cottonwood, AZ >>> Tel: 928-649-2584 >>> >>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>> >>>> To all, >>>> >>>> I am in DC for a endovascular course for thoracic aneurysm. Only >>>> 25% are CV surgeons. Others are vascular, radiology, cardiologist. >>>> >>>> We need to catch up, without these skills, we are going to lose >>>> the percutaneous valve. >>>> >>>> Any thoughts? >>>> >>>> Z Zhou_______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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 anddisclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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 anddisclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 anddisclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- From johnschor at mac.com Sun Nov 1 06:06:12 2009 From: johnschor at mac.com (John Schor) Date: Sun Nov 1 08:10:56 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr> <8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com> Message-ID: <28767B37-74F6-47C3-AB0C-669AE4B73CB0@mac.com> Agree with Ani, and that's why I am in the game. John Schor, MD Thoracic and Cardiovascular Surgery Heart and Vascular Center of Northern Arizona Flagstaff, Sedona, and Cottonwood, AZ Tel: 928-649-2584 On Nov 1, 2009, at 5:20 AM, Ani Anyanwu wrote: > >> Everyone wants to put the stent(s) in whatever vessel and walk away >> - sorry, >> doesnt work that way......... >> >> -michael > > > > Unfortunately, it will work that way and even if surgeon does not > put them in he will still be burdened with dealing with > complications and post-op issues. In one way or the other the > patient willl be connected to a surgeon. Many patients will get to > the 'stenter' through a surgeon. Some patients will have > 'debranching' procedures which have to be done by a surgeon, or > stenter will ask surgeon to help with vascular access. Whichever way > there will be some surgeon attached to the case in that way the > 'stenter' can run 100 miles after 24 hours and leave you to pick the > pieces. One patient recently spent 2 months in our ICU and then died > after descending stent and I never saw the stenters after the first > week (in this case stenters were vascular surgeons) another was > paraplegic and spent weeks, also died, again stenters nowhere to be > seen. > > > > Unless you have aortic surgeons (who also do/did the open surgical > equivalents) doing these I think you will find we will still be left > to pick up the pieces left by stent cowboys in our various > localities. The morbidity of these procedures and post-op care > required is not trivial and requires as intense detail and care as > for patients having surgical repair. Minimally invasive surgery etc > is a misnomer and gives patients and physicians the false security > that the treatment is no big deal. However, looking aat TAVI or > TEVAR data, it is clear the procedures are very invasive indeed and > patients are still subject to the whole gamut of complications (or > some new ones) and mortality as patients having the conventional > procedures. > > > > Ani > >> Date: Sat, 31 Oct 2009 22:44:26 -0400 >> Subject: Re: [HSF] Changing field in Our specialty-get on board or >> be left out >> From: msfirst@gmail.com >> To: OpenHeart-L@lists.hsforum.com >> CC: >> >> I have no problem giving up the descending stent graft work >> PROVIDED whoever >> does it takes care of these patients afterwards. I find many of this >> patients have horrible comorbidities, poorly controlled hypertension, >> diabetes, etc that no one wants to deal with. Many have not seen a >> doctors >> in years - if ever and rarely do they have insurance (not that I >> care about >> that). If a Radiologist wants to put a stent graft in, then he/she >> can take >> responsibility for all of the patients other medical, social, >> economic problems. Knock yourselves out and good luck........ >> >> Everyone wants to put the stent(s) in whatever vessel and walk away >> - sorry, >> doesnt work that way......... >> >> -michael >> >> On Sat, Oct 31, 2009 at 7:06 PM, wrote: >> >>> >>> My humble prediction >>> Open descending and/or thoracoabdominal aortic aneurysm surgery is >>> destined >>> to the same fate as open gastric surgery or open gallbladder >>> surgery within >>> the next 10 yrs and those who don't get on board with endovascular >>> methods >>> will be left out. >>> >>> Tom Martin >>> U of Florida >>> Gainesville >>> >>> -----Original Message----- >>> From: Igor Rudez >>> To: OpenHeart-L@lists.hsforum.com >>> Sent: Sat, Oct 31, 2009 6:31 pm >>> Subject: RE: [HSF] Changing field in Our specialty >>> >>> >>> >>> Zhou, >>> partially agree with you! Of course we have to master those (new) >>> skills >>> s well, but do not be afraid we are going to lose patients! >>> can remember many of our colleagues were convinced that we're >>> going to be >>> ut of job because of drug eluting stents! And what happened? >>> o, OK, yes, master the skills but no, we are still far, far in >>> front of >>> hem! And when they make a hole pushing some device, stent, >>> whatever in the >>> eart, aorta, wherever, who do you think they are going to call? >>> Igor >>> -----Original Message----- >>> rom: openheart-l-bounces@lists.hsforum.com >>> mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of >>> Zhandong Zhou >>> ent: Saturday, October 31, 2009 7:02 PM >>> o: OpenHeart-L@lists.hsforum.com >>> ubject: [HSF] Changing field in Our specialty >>> >>> o all, >>> I am in DC for a endovascular course for thoracic aneurysm. Only 25% >>> re CV surgeons. Others are vascular, radiology, cardiologist. >>> We need to catch up, without these skills, we are going to lose the >>> ercutaneous valve. >>> Any thoughts? >>> Z Zhou >>> >>> ______________________________________________ >>> penHeart-L mailing list >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> isclaimers posted at: >>> ttp://www.hsforum.com/listdisclaim >>> ---------------------------------------- >>> _______________________________________________ >>> penHeart-L mailing list >>> Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >>> All messages transmitted by the OpenHeart-L are subject to the >>> policies and >>> isclaimers posted at: >>> ttp://www.hsforum.com/listdisclaim >>> ---------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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 >> ----------------------------------------- > > _________________________________________________________________ > Download Messenger onto your mobile for free > http://clk.atdmt.com/UKM/go/174426567/direct/01/_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From prasannasimha at gmail.com Sun Nov 1 17:44:54 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 08:51:58 2009 Subject: [HSF] Is the 3F Aortic Valve a Good Alternative? In-Reply-To: <215969449-1257077442-cardhu_decombobulator_blackberry.rim.net-327658898-@bda735.bisx.prod.on.blackberry> References: <89c4ed2d0911010310q5eb82b2buaec8dc31494189c4@mail.gmail.com> <1261356619-1257076169-cardhu_decombobulator_blackberry.rim.net-304367925-@bda735.bisx.prod.on.blackberry> <89c4ed2d0911010400t55711ca0ka2655b6dffcb0a11@mail.gmail.com> <215969449-1257077442-cardhu_decombobulator_blackberry.rim.net-327658898-@bda735.bisx.prod.on.blackberry> Message-ID: <89c4ed2d0911010414k545c510dqda032c8327272e0c@mail.gmail.com> What about your use of Biocor ? Do you use it a lot ? Prasanna On Sun, Nov 1, 2009 at 5:39 PM, wrote: > Prasanna, > ?I agree, but I will take me chances on a valve made by a company I trust. ?Be assured, I will be vigilant for any early failures. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Prasanna Simha M > Date: Sun, 1 Nov 2009 17:30:34 > To: > Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? > > Yes, the only thing I wanted to high light ?is that while one may be > good ?when some changes are made the efficacy may not always be > translated to the new product. > > Incidentally my patients with the autopericardial valves came for > follow up. I have done 5 implants as a preliminary trial pilot. One > patient who had a perfect function @ 6 weeks came with viral > pneumonitis @ 2 months (2 weeks after the follow up echo) and died of > respiratory failure (patient came in extremis and died before deep > swabs for PCR were sent.I have a suspicion of pH1N1. We had an echo > showing good valve function at that time). The other 4 are OK and > functioning well. > Prasanna > On Sun, Nov 1, 2009 at 5:18 PM, ? wrote: >> Prasanna, >> ?Not sure of the Magna data either, but it is made with Edwards pericardial leaflets for which I have 19 years of experience in private practice. ?The number of senescent Edwards pericardial valves I've replaced I could count on one hand, and I've never replaced one I inserted. ?Not a scientific paper, but strong empiric personal experience, IMHO. >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: Prasanna Simha M >> Date: Sun, 1 Nov 2009 16:40:28 >> To: >> Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? >> >> Hal , how long is the Magna around ? We have been using it in India >> for a few years (frightfully expensive here). I am not sure how many >> years follow up is there for the Magna . Remember that even ?changes >> in these valves do not equate to similar results though the name may >> be the same.I doubt that Magna has a follow up equal to that of even >> teh mitroflow.Any one has literature ? I think the earliest reports >> were that of Totaro et al in 2003 or 2005 >> Prasanna >> >> On Sat, Oct 31, 2009 at 5:44 PM, ? wrote: >>> Dave, >>> ?Which "Edwards 23" are you referring? ?Maybe the old Perimount, ?but I >>> highly doubt a Mitroflow 19 is equivalent to an Edwards Magna Ease ?23. ?In >>> addition, I doubt that Mitroflow has the kind of durability ?data. ?If so, >>> please provide references. >>> >>> Hal >>> >>> >>> In a message dated 10/31/2009 4:45:34 A.M. Eastern Daylight Time, >>> drdharris@yahoo.co.uk writes: >>> >>> I would ?personally only use that valve if there are distinct technical >>> advantages - ?like the Mitroflow (good long term results reported at EACTS). >>> Mitroflow 19 ?also reported to be equiv to Edwards 23. If I was at a high >>> volume academic ?centre I would use it, with good follow up...there is always >>> potential for ?better results long term-which may become irrelevant with the >>> new ?transcatheter valves. Dave >>> >>> Giuseppe Rescigno wrote: >>>> ?Hal, >>>> I have implanted three 3F aortic valves. They are quite easy to ?implant >>> and there is a theretical benefit in tubular prostheses. You should, ?as for >>> every stentless, be horizontal with the stitches without following the >>> annulus. It is therefore quite easy to put the commisures at the right >>> positions thanks to the holder. Aortotomy should be horizontal and above the ?STJ. >>> They works pretty well but trans gradient are not so low as company says. ?I >>> implanted it in over 80 yo people and this should be the ideal population >>> for a limited follow-up valve. Sorin Fredom Solo is probably more friendly >>> and ?the number of implants is significantly greater (at least in Italy). >>> Nevertheless during last year I came to the conclusion that stented valves >>> warrant the best reproducible result and I stopped using either 3F and ?Solo. >>>> Giuseppe >>>> Il giorno 26/ott/09, alle ore 00:57, ?Hgrmd@aol.com ha scritto: >>>>> Members, >>>>> ? Lately, ?I've gotten a lot of heat from the ATS rep trying to >>> convince ?me >>>>> to use the 3F aortic valve. ?Having been in this ?profession ?long >>> enough to >>>>> see valves come and go, I'd like ?to hear thoughts from other ?members, >>>>> especially the ?users. >>>>> >>>>> Hal >>>>> ?_______________________________________________ >>>>> OpenHeart-L ?mailing list >>>>> >>>>> Send postings to: >>>>> ? OpenHeart-L@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@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 >>> anddisclaimers ?posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ?----------------------------------------- >>> >>>_______________________________________________ >>> OpenHeart-L ?mailing list >>> >>> Send postings ?to: >>> OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >>_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From hgrmd at aol.com Sun Nov 1 13:57:47 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Sun Nov 1 08:59:16 2009 Subject: [HSF] Is the 3F Aortic Valve a Good Alternative? In-Reply-To: <89c4ed2d0911010414k545c510dqda032c8327272e0c@mail.gmail.com> References: <89c4ed2d0911010310q5eb82b2buaec8dc31494189c4@mail.gmail.com> <1261356619-1257076169-cardhu_decombobulator_blackberry.rim.net-304367925-@bda735.bisx.prod.on.blackberry><89c4ed2d0911010400t55711ca0ka2655b6dffcb0a11@mail.gmail.com> <215969449-1257077442-cardhu_decombobulator_blackberry.rim.net-327658898-@bda735.bisx.prod.on.blackberry><89c4ed2d0911010414k545c510dqda032c8327272e0c@mail.gmail.com> Message-ID: <600184444-1257083925-cardhu_decombobulator_blackberry.rim.net-1929433115-@bda735.bisx.prod.on.blackberry> Prasanna, I quit using Biocor once mitral Magna was released. It has a low profile, plus, it's not a pig. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: Prasanna Simha M Date: Sun, 1 Nov 2009 17:44:54 To: Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? What about your use of Biocor ? Do you use it a lot ? Prasanna On Sun, Nov 1, 2009 at 5:39 PM, wrote: > Prasanna, > ?I agree, but I will take me chances on a valve made by a company I trust. ?Be assured, I will be vigilant for any early failures. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Prasanna Simha M > Date: Sun, 1 Nov 2009 17:30:34 > To: > Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? > > Yes, the only thing I wanted to high light ?is that while one may be > good ?when some changes are made the efficacy may not always be > translated to the new product. > > Incidentally my patients with the autopericardial valves came for > follow up. I have done 5 implants as a preliminary trial pilot. One > patient who had a perfect function @ 6 weeks came with viral > pneumonitis @ 2 months (2 weeks after the follow up echo) and died of > respiratory failure (patient came in extremis and died before deep > swabs for PCR were sent.I have a suspicion of pH1N1. We had an echo > showing good valve function at that time). The other 4 are OK and > functioning well. > Prasanna > On Sun, Nov 1, 2009 at 5:18 PM, ? wrote: >> Prasanna, >> ?Not sure of the Magna data either, but it is made with Edwards pericardial leaflets for which I have 19 years of experience in private practice. ?The number of senescent Edwards pericardial valves I've replaced I could count on one hand, and I've never replaced one I inserted. ?Not a scientific paper, but strong empiric personal experience, IMHO. >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: Prasanna Simha M >> Date: Sun, 1 Nov 2009 16:40:28 >> To: >> Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? >> >> Hal , how long is the Magna around ? We have been using it in India >> for a few years (frightfully expensive here). I am not sure how many >> years follow up is there for the Magna . Remember that even ?changes >> in these valves do not equate to similar results though the name may >> be the same.I doubt that Magna has a follow up equal to that of even >> teh mitroflow.Any one has literature ? I think the earliest reports >> were that of Totaro et al in 2003 or 2005 >> Prasanna >> >> On Sat, Oct 31, 2009 at 5:44 PM, ? wrote: >>> Dave, >>> ?Which "Edwards 23" are you referring? ?Maybe the old Perimount, ?but I >>> highly doubt a Mitroflow 19 is equivalent to an Edwards Magna Ease ?23. ?In >>> addition, I doubt that Mitroflow has the kind of durability ?data. ?If so, >>> please provide references. >>> >>> Hal >>> >>> >>> In a message dated 10/31/2009 4:45:34 A.M. Eastern Daylight Time, >>> drdharris@yahoo.co.uk writes: >>> >>> I would ?personally only use that valve if there are distinct technical >>> advantages - ?like the Mitroflow (good long term results reported at EACTS). >>> Mitroflow 19 ?also reported to be equiv to Edwards 23. If I was at a high >>> volume academic ?centre I would use it, with good follow up...there is always >>> potential for ?better results long term-which may become irrelevant with the >>> new ?transcatheter valves. Dave >>> >>> Giuseppe Rescigno wrote: >>>> ?Hal, >>>> I have implanted three 3F aortic valves. They are quite easy to ?implant >>> and there is a theretical benefit in tubular prostheses. You should, ?as for >>> every stentless, be horizontal with the stitches without following the >>> annulus. It is therefore quite easy to put the commisures at the right >>> positions thanks to the holder. Aortotomy should be horizontal and above the ?STJ. >>> They works pretty well but trans gradient are not so low as company says. ?I >>> implanted it in over 80 yo people and this should be the ideal population >>> for a limited follow-up valve. Sorin Fredom Solo is probably more friendly >>> and ?the number of implants is significantly greater (at least in Italy). >>> Nevertheless during last year I came to the conclusion that stented valves >>> warrant the best reproducible result and I stopped using either 3F and ?Solo. >>>> Giuseppe >>>> Il giorno 26/ott/09, alle ore 00:57, ?Hgrmd@aol.com ha scritto: >>>>> Members, >>>>> ? Lately, ?I've gotten a lot of heat from the ATS rep trying to >>> convince ?me >>>>> to use the 3F aortic valve. ?Having been in this ?profession ?long >>> enough to >>>>> see valves come and go, I'd like ?to hear thoughts from other ?members, >>>>> especially the ?users. >>>>> >>>>> Hal >>>>> ?_______________________________________________ >>>>> OpenHeart-L ?mailing list >>>>> >>>>> Send postings to: >>>>> ? OpenHeart-L@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@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 >>> anddisclaimers ?posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ?----------------------------------------- >>> >>>_______________________________________________ >>> OpenHeart-L ?mailing list >>> >>> Send postings ?to: >>> OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >>_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M >_______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From hgrmd at aol.com Sun Nov 1 13:59:41 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Sun Nov 1 09:02:10 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: <0FF01183-6BDF-4A47-BE9F-8C585CFBF114@mac.com> References: <886062.42502.qm@web81604.mail.mud.yahoo.com><8CC8CAE0-C686-4BC5-854F-8EB04752ACD8@pol.net><7BD195DF-4D3A-41A1-A94A-D4496CF12A9C@mac.com><1631739193-1257075519-cardhu_decombobulator_blackberry.rim.net-901706-@bda735.bisx.prod.on.blackberry><0FF01183-6BDF-4A47-BE9F-8C585CFBF114@mac.com> Message-ID: <266282114-1257084039-cardhu_decombobulator_blackberry.rim.net-1559261154-@bda735.bisx.prod.on.blackberry> Sm9obiwNCiAgSG9wZWZ1bGx5LCB0aGUgRmVkcyBhbmQgdGhlIHByb3ZpZGVycyB3aWxsIGtlZXAg dGhlbSBpbiBjaGVjay4gIFRoZXkndmUgZG9uZSB0aGF0IHdpdGggQ0FTLg0KDQpIYWwNClNlbnQg ZnJvbSBteSBWZXJpem9uIFdpcmVsZXNzIEJsYWNrQmVycnkNCg0KLS0tLS1PcmlnaW5hbCBNZXNz 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aXN0ZGlzY2xhaW0NCj4gLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0N Cg0KX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX19fX18NCk9wZW5I ZWFydC1MIG1haWxpbmcgbGlzdA0KDQpTZW5kIHBvc3RpbmdzIHRvOg0KIE9wZW5IZWFydC1MQGxp c3RzLmhzZm9ydW0uY29tDQoNClRvIFVOU1VCU0NSSUJFLCB0byBDSEFOR0UgZW1haWwgYWRkcmVz cywgb3IgdG8gdmlldyBhcmNoaXZlczoNCmh0dHA6Ly9tbXAuY2pwLmNvbS9tYWlsbWFuL2xpc3Rp bmZvL29wZW5oZWFydC1sDQoNCkFsbCBtZXNzYWdlcyB0cmFuc21pdHRlZCBieSB0aGUgT3Blbkhl YXJ0LUwgYXJlIHN1YmplY3QgdG8gdGhlIHBvbGljaWVzIGFuZCANCmRpc2NsYWltZXJzIHBvc3Rl ZCBhdDoNCmh0dHA6Ly93d3cuaHNmb3J1bS5jb20vbGlzdGRpc2NsYWltDQotLS0tLS0tLS0tLS0t LS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLQ0K From msfirst at gmail.com Sun Nov 1 10:04:29 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Nov 1 10:34:11 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: <28767B37-74F6-47C3-AB0C-669AE4B73CB0@mac.com> References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr> <8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com> <28767B37-74F6-47C3-AB0C-669AE4B73CB0@mac.com> Message-ID: I too agree with Ani. I recently took care of a 92 year/old with critical aortic stensosis and left main disease - who arrested when they were putting in an aortic stent graft (for indications that are still unclear to me.... I try to stay up on the indications for some of our interventions - maybe it is just me - and the recent infected graft that we discussed, where I asked what the indications were for the debranching on the chronic type B - I was never given an answer). When I saw the guy for management of his heart disease - his groin wounds will still falling apart...... and he never followed up with his stented who did this procedure at a small community hospital - talk about high risk - but did they even know or care (was just a poke in the groin?) The way that WE have control of this problem is to subject these procedures to the same quality and outcomes measures that we use for everything else. For example - US News and World report in their rankings looks at surgical mortality based upon a subset of procedures (I think medicare is the same) that include just about every vascular type of intervention - such as IVC filters, IABP, and I assume these things. Hence, if a Radiologist is putting them in and there is a bad outcome, then it reflects on the Cardiovascular surgery "product line" outcomes - credentialed or not, if there are bad outcomes (as Ani mentions) then the program needs to be revamped (or maybe organized in the first place) or shut down! If they want to play in our sandbox - then they have to play by our rules. See how your hospital administration likes the answer to why your outcomes are out of wack because Radiologists are putting stent grafts in everyone who walks through the door. It is my growing experience that physicians (typically not surgeons) who pick up procedures as hobbies tend to have very little follow-up or follow-through. I recently evaluated a patient for surgery - however she had an afib ablation at another hosital several months ago and had some "problem" with her left leg. The leg looked horrible and still had dressing and wound VACs in place and had been on antibiotics for months. No one was managing anything. She came to my attention since she was transferred for possible prosthetic valve dysfunction (19 mm st jude mechanical with high gradients) - which she did not have. I got an MRI of the leg and she had an undrained fluid collection that was now draining a multi-drug resistant Pseudomonas - and she had 2 mechanical valves! (In reality, she needs her severe TR dealt with also) - obviously she had a huge infected hemoatoma that was never addressed. She never followed up this the people who took care of her after discharge - they, according to her - refused to see her in follow-up and said she should follow-up with her primary care doctors. Maybe this is all a function of the 80 hr rules - but there appears to be a huge disconnect between procedures and outcomes (or complications)? Who was that mother of a famous rap star out in California who died after elective liposuction - the Plastic surgeon (who as I recall was not board certified) claimed the "procedure was a success but she must of have died of something related to her heart or a blood clot to her lungs" Welcome to modern medicine...... Denial is a river in Egypt. -michael On Sun, Nov 1, 2009 at 8:06 AM, John Schor wrote: > Agree with Ani, and that's why I am in the game. > > John Schor, MD > Thoracic and Cardiovascular Surgery > Heart and Vascular Center of > Northern Arizona > Flagstaff, Sedona, and > Cottonwood, AZ > Tel: 928-649-2584 > > On Nov 1, 2009, at 5:20 AM, Ani Anyanwu wrote: > > >> Everyone wants to put the stent(s) in whatever vessel and walk away - >>> sorry, >>> doesnt work that way......... >>> >>> -michael >>> >> >> >> >> Unfortunately, it will work that way and even if surgeon does not put them >> in he will still be burdened with dealing with complications and post-op >> issues. In one way or the other the patient willl be connected to a surgeon. >> Many patients will get to the 'stenter' through a surgeon. Some patients >> will have 'debranching' procedures which have to be done by a surgeon, or >> stenter will ask surgeon to help with vascular access. Whichever way there >> will be some surgeon attached to the case in that way the 'stenter' can run >> 100 miles after 24 hours and leave you to pick the pieces. One patient >> recently spent 2 months in our ICU and then died after descending stent and >> I never saw the stenters after the first week (in this case stenters were >> vascular surgeons) another was paraplegic and spent weeks, also died, again >> stenters nowhere to be seen. >> >> >> >> Unless you have aortic surgeons (who also do/did the open surgical >> equivalents) doing these I think you will find we will still be left to pick >> up the pieces left by stent cowboys in our various localities. The morbidity >> of these procedures and post-op care required is not trivial and requires as >> intense detail and care as for patients having surgical repair. Minimally >> invasive surgery etc is a misnomer and gives patients and physicians the >> false security that the treatment is no big deal. However, looking aat TAVI >> or TEVAR data, it is clear the procedures are very invasive indeed and >> patients are still subject to the whole gamut of complications (or some new >> ones) and mortality as patients having the conventional procedures. >> >> >> >> Ani >> >> Date: Sat, 31 Oct 2009 22:44:26 -0400 >>> Subject: Re: [HSF] Changing field in Our specialty-get on board or be >>> left out >>> From: msfirst@gmail.com >>> To: OpenHeart-L@lists.hsforum.com >>> CC: >>> >>> I have no problem giving up the descending stent graft work PROVIDED >>> whoever >>> does it takes care of these patients afterwards. I find many of this >>> patients have horrible comorbidities, poorly controlled hypertension, >>> diabetes, etc that no one wants to deal with. Many have not seen a >>> doctors >>> in years - if ever and rarely do they have insurance (not that I care >>> about >>> that). If a Radiologist wants to put a stent graft in, then he/she can >>> take >>> responsibility for all of the patients other medical, social, >>> economic problems. Knock yourselves out and good luck........ >>> >>> Everyone wants to put the stent(s) in whatever vessel and walk away - >>> sorry, >>> doesnt work that way......... >>> >>> -michael >>> >>> On Sat, Oct 31, 2009 at 7:06 PM, wrote: >>> >>> >>>> My humble prediction >>>> Open descending and/or thoracoabdominal aortic aneurysm surgery is >>>> destined >>>> to the same fate as open gastric surgery or open gallbladder surgery >>>> within >>>> the next 10 yrs and those who don't get on board with endovascular >>>> methods >>>> will be left out. >>>> >>>> Tom Martin >>>> U of Florida >>>> Gainesville >>>> >>>> -----Original Message----- >>>> From: Igor Rudez >>>> To: OpenHeart-L@lists.hsforum.com >>>> Sent: Sat, Oct 31, 2009 6:31 pm >>>> Subject: RE: [HSF] Changing field in Our specialty >>>> >>>> >>>> >>>> Zhou, >>>> partially agree with you! Of course we have to master those (new) skills >>>> s well, but do not be afraid we are going to lose patients! >>>> can remember many of our colleagues were convinced that we're going to >>>> be >>>> ut of job because of drug eluting stents! And what happened? >>>> o, OK, yes, master the skills but no, we are still far, far in front of >>>> hem! And when they make a hole pushing some device, stent, whatever in >>>> the >>>> eart, aorta, wherever, who do you think they are going to call? >>>> Igor >>>> -----Original Message----- >>>> rom: openheart-l-bounces@lists.hsforum.com >>>> mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Zhandong >>>> Zhou >>>> ent: Saturday, October 31, 2009 7:02 PM >>>> o: OpenHeart-L@lists.hsforum.com >>>> ubject: [HSF] Changing field in Our specialty >>>> >>>> o all, >>>> I am in DC for a endovascular course for thoracic aneurysm. Only 25% >>>> re CV surgeons. Others are vascular, radiology, cardiologist. >>>> We need to catch up, without these skills, we are going to lose the >>>> ercutaneous valve. >>>> Any thoughts? >>>> Z Zhou >>>> >>>> ______________________________________________ >>>> penHeart-L mailing list >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>> and >>>> isclaimers posted at: >>>> ttp://www.hsforum.com/listdisclaim >>>> ---------------------------------------- >>>> _______________________________________________ >>>> penHeart-L mailing list >>>> Send postings to: >>>> OpenHeart-L@lists.hsforum.com >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>> ttp://mmp.cjp.com/mailman/listinfo/openheart-l >>>> All messages transmitted by the OpenHeart-L are subject to the policies >>>> and >>>> isclaimers posted at: >>>> ttp://www.hsforum.com/listdisclaim >>>> ---------------------------------------- >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> _________________________________________________________________ >> Download Messenger onto your mobile for free >> >> http://clk.atdmt.com/UKM/go/174426567/direct/01/_______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 > anddisclaimers posted at: > > http://www.hsforum.com/listdisclaim > ----------------------------------------- > From tfurnary at starrwood.com Sun Nov 1 07:44:43 2009 From: tfurnary at starrwood.com (Anthony P Furnary MD) Date: Sun Nov 1 10:45:19 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr> <8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com> <28767B37-74F6-47C3-AB0C-669AE4B73CB0@mac.com> Message-ID: Re: "I try to stay up on the indications for some of our interventions - maybe it is just me - and the recent infected graft that we discussed, where I asked what the indications were for the debranching on the chronic type B - I was never given an answer). " Michael, Yes you were given the answer -- I also think it was "just another occulo-stento-cool procedure reflex" But maybe my response was too obtuse for anyone other than Tea. This is what I posted back to you: --------- As far as I can tell it they walked from a cave into the bright light with a new stent in hand. Sent from my iPhone On Oct 20, 2009, at 12:44 PM, Michael Firstenberg wrote: > excuse me, but someone clarify what the indications were for this > debranching repair of a type B dissection after a previous type A? > Or is > this just another occulo-stento-cool procedure reflex? > > -michael On Nov 1, 2009, at 7:04 AM, Michael Firstenberg wrote: From msfirst at gmail.com Sun Nov 1 10:58:43 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Nov 1 10:59:01 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr> <8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com> <28767B37-74F6-47C3-AB0C-669AE4B73CB0@mac.com> Message-ID: My apologies - hopefully obviously not directed to you and your judgement (something from your posts in general that I do not nor will not question and since I know you didnt put it in). I must have missed you response - and yes, that answered my question. Do they know the whole thing is now infected? How is the patient doing? I have not had the chance to look, but what is the infection rate for these things? or are infections after stent grafts always blamed on something else? My boss had a very similar patient as your a year ago - she presented with an infected pseudoaneurysm that was eroding into her airway........ -michael On Nov 1, 2009, at 10:44 AM, Anthony P Furnary MD wrote: > Re: "I try to stay up on the indications for some of our > interventions - maybe it is just me - and the recent infected graft > that we discussed, where I asked what the indications were for the > debranching on the chronic type B - I was never given an answer). " > > > Michael, Yes you were given the answer -- I also think it was "just > another occulo-stento-cool procedure reflex" > But maybe my response was too obtuse for anyone other than Tea. > This is what I posted back to you: > > --------- > As far as I can tell it they walked from a cave into the bright > light with a new stent in hand. > > Sent from my iPhone > > On Oct 20, 2009, at 12:44 PM, Michael Firstenberg > wrote: > >> excuse me, but someone clarify what the indications were for this >> debranching repair of a type B dissection after a previous type A? >> Or is >> this just another occulo-stento-cool procedure reflex? >> >> -michael > On Nov 1, 2009, at 7:04 AM, Michael Firstenberg wrote: > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From GoldmanS at MLHS.ORG Sun Nov 1 11:35:23 2009 From: GoldmanS at MLHS.ORG (Goldman, Scott) Date: Sun Nov 1 11:35:56 2009 Subject: [HSF] Changing field in Our specialty-get on board or be left out In-Reply-To: References: <000901ca5a79$d31ebc70$1d23a8c0@kbd.hr> <8CC2895E4992B9A-4718-4FC2@webmail-d090.sysops.aol.com>, Message-ID: <6FF71BF92ACC044F80A522679DCF118502EC8393D3@MLHMB2.ad.mlhs.org> The post procedure ICU care for TEVAR is no different than an open TAA graft. Spinal fluid drainage and precise BP control with frequent neuro checks. I believe that a team consisting of vascular and cardiothoracic surgery is best suited to perform these procedures and care for these patients. In our institution TEVAR credentialing is only for the team. Scott Goldman MD Chairman Department of Surgery Main Line Health ________________________________________ From: openheart-l-bounces@lists.hsforum.com [openheart-l-bounces@lists.hsforum.com] On Behalf Of Michael Firstenberg [msfirst@gmail.com] Sent: Saturday, October 31, 2009 10:44 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Changing field in Our specialty-get on board or be left out I have no problem giving up the descending stent graft work PROVIDED whoever does it takes care of these patients afterwards. I find many of this patients have horrible comorbidities, poorly controlled hypertension, diabetes, etc that no one wants to deal with. Many have not seen a doctors in years - if ever and rarely do they have insurance (not that I care about that). If a Radiologist wants to put a stent graft in, then he/she can take responsibility for all of the patients other medical, social, economic problems. Knock yourselves out and good luck........ Everyone wants to put the stent(s) in whatever vessel and walk away - sorry, doesnt work that way......... -michael On Sat, Oct 31, 2009 at 7:06 PM, wrote: > > My humble prediction > Open descending and/or thoracoabdominal aortic aneurysm surgery is destined > to the same fate as open gastric surgery or open gallbladder surgery within > the next 10 yrs and those who don't get on board with endovascular methods > will be left out. > > Tom Martin > U of Florida > Gainesville > > -----Original Message----- > From: Igor Rudez > To: OpenHeart-L@lists.hsforum.com > Sent: Sat, Oct 31, 2009 6:31 pm > Subject: RE: [HSF] Changing field in Our specialty > > > > Zhou, > partially agree with you! Of course we have to master those (new) skills > s well, but do not be afraid we are going to lose patients! > can remember many of our colleagues were convinced that we're going to be > ut of job because of drug eluting stents! And what happened? > o, OK, yes, master the skills but no, we are still far, far in front of > hem! And when they make a hole pushing some device, stent, whatever in the > eart, aorta, wherever, who do you think they are going to call? > Igor > -----Original Message----- > rom: openheart-l-bounces@lists.hsforum.com > mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Zhandong Zhou > ent: Saturday, October 31, 2009 7:02 PM > o: OpenHeart-L@lists.hsforum.com > ubject: [HSF] Changing field in Our specialty > > o all, > I am in DC for a endovascular course for thoracic aneurysm. Only 25% > re CV surgeons. Others are vascular, radiology, cardiologist. > We need to catch up, without these skills, we are going to lose the > ercutaneous valve. > Any thoughts? > Z Zhou > > ______________________________________________ > penHeart-L mailing list > Send postings to: > OpenHeart-L@lists.hsforum.com > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > ttp://mmp.cjp.com/mailman/listinfo/openheart-l > All messages transmitted by the OpenHeart-L are subject to the policies and > isclaimers posted at: > ttp://www.hsforum.com/listdisclaim > ---------------------------------------- > _______________________________________________ > penHeart-L mailing list > Send postings to: > OpenHeart-L@lists.hsforum.com > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > ttp://mmp.cjp.com/mailman/listinfo/openheart-l > All messages transmitted by the OpenHeart-L are subject to the policies and > isclaimers posted at: > ttp://www.hsforum.com/listdisclaim > ---------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 ----------------------------------------- From prasannasimha at gmail.com Sun Nov 1 20:10:56 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 11:47:38 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: <266282114-1257084039-cardhu_decombobulator_blackberry.rim.net-1559261154-@bda735.bisx.prod.on.blackberry> References: <886062.42502.qm@web81604.mail.mud.yahoo.com> <8CC8CAE0-C686-4BC5-854F-8EB04752ACD8@pol.net> <7BD195DF-4D3A-41A1-A94A-D4496CF12A9C@mac.com> <1631739193-1257075519-cardhu_decombobulator_blackberry.rim.net-901706-@bda735.bisx.prod.on.blackberry> <0FF01183-6BDF-4A47-BE9F-8C585CFBF114@mac.com> <266282114-1257084039-cardhu_decombobulator_blackberry.rim.net-1559261154-@bda735.bisx.prod.on.blackberry> Message-ID: <89c4ed2d0911010640q702496a1l4194b75a098ca5f4@mail.gmail.com> What is CAS ? Prasanna On Sun, Nov 1, 2009 at 7:29 PM, wrote: > John, > ?Hopefully, the Feds and the providers will keep them in check. ?They've done that with CAS. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: John Schor > Date: Sun, 01 Nov 2009 05:57:41 > To: > Subject: Re: [HSF] Changing field in Our specialty > > I agree with Hal about suboptimal results with some of these > disruptive technologies, BUT, the train is rolling. As we all know, > patient flow is controlled by the cardiologists, and 99% believe that > surgery is bad and catheters are good. > John > John Schor, MD > Thoracic and Cardiovascular Surgery > Heart and Vascular Center of > Northern Arizona > Flagstaff, Sedona, and > Cottonwood, AZ > Tel: 928-649-2584 > > On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: > >> John, >> ?Agree it will be a "scary ride", mainly for the patients as some of >> those technqies you describe give them clearly suboptimal results. >> I strongly suspect the doc at TCT doing the ostial LM stenting with >> a "perfect" result would be getting conventional LIMA to LAD if he >> had the same anatomy. ?I won't even begin to tell you my thoughts of >> an E Valve clip and a c.s. Screwing up the anatomy of a repairable >> valve. >> >> >> >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: John Schor >> Date: Sat, 31 Oct 2009 21:18:51 >> To: >> Subject: Re: [HSF] Changing field in Our specialty >> >> In thoracic cases, the same size criteria is used for stent grafting >> as for open surgery. >> >> I have believed for the past 9 yrs that "open surgery" would be >> relegated to history books. As doctors( not just as CV surgeons), we >> should be prepared for ?1. repairs (of all organ systems) rather than >> replacements 2. Avoidance of incisions--or increased use of scopes-- >> whenever possible 3. Natural Orifice access surgery 4. Medication >> rather than surgery. >> >> The aorta, from the sinotubular junction to the bifurcation, will be >> "fixed" with endovascular techniques. (probably in less than 10 yrs) >> Agree with Tom. Even in my small community hospital working alone in >> the OR (no PA or first assistants), I have been able to fix 10cm >> ruptured AAA with stent grafting. >> >> You should all attend a Cardiology meeting such as the TCT. You will >> be amazed to see such things as L Main stenting for 95% ostial >> lesion-- >> with PERFECT result. Transfemoral and transapical AVR's done safely. >> MV repairs with clips and then reinforced with coronary sinus >> rings........ >> >> Hold on to your hats. It's gonna be a scary ride. >> >> John >> >> John Schor, MD >> Thoracic and Cardiovascular Surgery >> Heart and Vascular Center of >> Northern Arizona >> Flagstaff, Sedona, and >> Cottonwood, AZ >> Tel: 928-649-2584 >> >> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: >> >>> What is your threshold for intervention, i mean the size for >>> descending aorta. >>> >>> Zhandong Zhou, MD >>> St. Joseph Hospital >>> Syracuse, New York >>> Tel: 315 423 7192 >>> >>> On Oct 31, 2009, at 5:30 PM, John Schor wrote: >>> >>>> Agree. >>>> See many of my previous posts. >>>> John >>>> John Schor, MD >>>> Thoracic and Cardiovascular Surgery >>>> Heart and Vascular Center of >>>> Northern Arizona >>>> Flagstaff, Sedona, and >>>> Cottonwood, AZ >>>> Tel: 928-649-2584 >>>> >>>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>>> >>>>> To all, >>>>> >>>>> I am in DC for a endovascular course for thoracic aneurysm. Only >>>>> 25% are CV surgeons. Others are vascular, radiology, cardiologist. >>>>> >>>>> We need to catch up, without these skills, we are going to lose >>>>> the percutaneous valve. >>>>> >>>>> Any thoughts? >>>>> >>>>> Z Zhou_______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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 anddisclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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 anddisclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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@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@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 > ----------------------------------------- > -- Prasanna Simha M From Hgrmd at aol.com Sun Nov 1 11:59:17 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Nov 1 12:00:28 2009 Subject: [HSF] Changing field in Our specialty Message-ID: Prasanna, Sorry, CAS is carotid artery stenting. Medicare is quite strict about the clinical conditions for which it will pay for this procedure. I am hopeful that AVI's will be restricted to patients deemed high risk and not just because the pt prefers a needle stick to an incision. Hal In a message dated 11/1/2009 11:49:09 A.M. Eastern Standard Time, prasannasimha@gmail.com writes: What is CAS ? Prasanna On Sun, Nov 1, 2009 at 7:29 PM, wrote: > John, > Hopefully, the Feds and the providers will keep them in check. They've done that with CAS. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: John Schor > Date: Sun, 01 Nov 2009 05:57:41 > To: > Subject: Re: [HSF] Changing field in Our specialty > > I agree with Hal about suboptimal results with some of these > disruptive technologies, BUT, the train is rolling. As we all know, > patient flow is controlled by the cardiologists, and 99% believe that > surgery is bad and catheters are good. > John > John Schor, MD > Thoracic and Cardiovascular Surgery > Heart and Vascular Center of > Northern Arizona > Flagstaff, Sedona, and > Cottonwood, AZ > Tel: 928-649-2584 > > On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: > >> John, >> Agree it will be a "scary ride", mainly for the patients as some of >> those technqies you describe give them clearly suboptimal results. >> I strongly suspect the doc at TCT doing the ostial LM stenting with >> a "perfect" result would be getting conventional LIMA to LAD if he >> had the same anatomy. I won't even begin to tell you my thoughts of >> an E Valve clip and a c.s. Screwing up the anatomy of a repairable >> valve. >> >> >> >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: John Schor >> Date: Sat, 31 Oct 2009 21:18:51 >> To: >> Subject: Re: [HSF] Changing field in Our specialty >> >> In thoracic cases, the same size criteria is used for stent grafting >> as for open surgery. >> >> I have believed for the past 9 yrs that "open surgery" would be >> relegated to history books. As doctors( not just as CV surgeons), we >> should be prepared for 1. repairs (of all organ systems) rather than >> replacements 2. Avoidance of incisions--or increased use of scopes-- >> whenever possible 3. Natural Orifice access surgery 4. Medication >> rather than surgery. >> >> The aorta, from the sinotubular junction to the bifurcation, will be >> "fixed" with endovascular techniques. (probably in less than 10 yrs) >> Agree with Tom. Even in my small community hospital working alone in >> the OR (no PA or first assistants), I have been able to fix 10cm >> ruptured AAA with stent grafting. >> >> You should all attend a Cardiology meeting such as the TCT. You will >> be amazed to see such things as L Main stenting for 95% ostial >> lesion-- >> with PERFECT result. Transfemoral and transapical AVR's done safely. >> MV repairs with clips and then reinforced with coronary sinus >> rings........ >> >> Hold on to your hats. It's gonna be a scary ride. >> >> John >> >> John Schor, MD >> Thoracic and Cardiovascular Surgery >> Heart and Vascular Center of >> Northern Arizona >> Flagstaff, Sedona, and >> Cottonwood, AZ >> Tel: 928-649-2584 >> >> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: >> >>> What is your threshold for intervention, i mean the size for >>> descending aorta. >>> >>> Zhandong Zhou, MD >>> St. Joseph Hospital >>> Syracuse, New York >>> Tel: 315 423 7192 >>> >>> On Oct 31, 2009, at 5:30 PM, John Schor wrote: >>> >>>> Agree. >>>> See many of my previous posts. >>>> John >>>> John Schor, MD >>>> Thoracic and Cardiovascular Surgery >>>> Heart and Vascular Center of >>>> Northern Arizona >>>> Flagstaff, Sedona, and >>>> Cottonwood, AZ >>>> Tel: 928-649-2584 >>>> >>>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>>> >>>>> To all, >>>>> >>>>> I am in DC for a endovascular course for thoracic aneurysm. Only >>>>> 25% are CV surgeons. Others are vascular, radiology, cardiologist. >>>>> >>>>> We need to catch up, without these skills, we are going to lose >>>>> the percutaneous valve. >>>>> >>>>> Any thoughts? >>>>> >>>>> Z Zhou_______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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 anddisclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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 anddisclaimers posted at: >>> http://www.hsforum.com/listdisclaim >>> ----------------------------------------- >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From msfirst at gmail.com Sun Nov 1 12:08:08 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Nov 1 12:08:29 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: References: Message-ID: <7EE344A0-B82E-4373-A138-6AF61EC703DA@gmail.com> so what you are implying is that the patient should not have a say in what they want? -michael On Nov 1, 2009, at 11:59 AM, Hgrmd@aol.com wrote: > Prasanna, > Sorry, CAS is carotid artery stenting. Medicare is quite strict > about > the clinical conditions for which it will pay for this procedure. > I am > hopeful that AVI's will be restricted to patients deemed high risk > and not just > because the pt prefers a needle stick to an incision. > > Hal > > > In a message dated 11/1/2009 11:49:09 A.M. Eastern Standard Time, > prasannasimha@gmail.com writes: > > What is CAS ? > Prasanna > > On Sun, Nov 1, 2009 at 7:29 PM, wrote: >> John, >> Hopefully, the Feds and the providers will keep them in check. >> They've > done that with CAS. >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: John Schor >> Date: Sun, 01 Nov 2009 05:57:41 >> To: >> Subject: Re: [HSF] Changing field in Our specialty >> >> I agree with Hal about suboptimal results with some of these >> disruptive technologies, BUT, the train is rolling. As we all know, >> patient flow is controlled by the cardiologists, and 99% believe >> that >> surgery is bad and catheters are good. >> John >> John Schor, MD >> Thoracic and Cardiovascular Surgery >> Heart and Vascular Center of >> Northern Arizona >> Flagstaff, Sedona, and >> Cottonwood, AZ >> Tel: 928-649-2584 >> >> On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: >> >>> John, >>> Agree it will be a "scary ride", mainly for the patients as some of >>> those technqies you describe give them clearly suboptimal results. >>> I strongly suspect the doc at TCT doing the ostial LM stenting with >>> a "perfect" result would be getting conventional LIMA to LAD if he >>> had the same anatomy. I won't even begin to tell you my thoughts >>> of >>> an E Valve clip and a c.s. Screwing up the anatomy of a repairable >>> valve. >>> >>> >>> >>> >>> Hal >>> Sent from my Verizon Wireless BlackBerry >>> >>> -----Original Message----- >>> From: John Schor >>> Date: Sat, 31 Oct 2009 21:18:51 >>> To: >>> Subject: Re: [HSF] Changing field in Our specialty >>> >>> In thoracic cases, the same size criteria is used for stent >>> grafting >>> as for open surgery. >>> >>> I have believed for the past 9 yrs that "open surgery" would be >>> relegated to history books. As doctors( not just as CV surgeons), >>> we >>> should be prepared for 1. repairs (of all organ systems) rather >>> than >>> replacements 2. Avoidance of incisions--or increased use of >>> scopes-- >>> whenever possible 3. Natural Orifice access surgery 4. Medication >>> rather than surgery. >>> >>> The aorta, from the sinotubular junction to the bifurcation, will >>> be >>> "fixed" with endovascular techniques. (probably in less than 10 >>> yrs) >>> Agree with Tom. Even in my small community hospital working alone >>> in >>> the OR (no PA or first assistants), I have been able to fix 10cm >>> ruptured AAA with stent grafting. >>> >>> You should all attend a Cardiology meeting such as the TCT. You >>> will >>> be amazed to see such things as L Main stenting for 95% ostial >>> lesion-- >>> with PERFECT result. Transfemoral and transapical AVR's done >>> safely. >>> MV repairs with clips and then reinforced with coronary sinus >>> rings........ >>> >>> Hold on to your hats. It's gonna be a scary ride. >>> >>> John >>> >>> John Schor, MD >>> Thoracic and Cardiovascular Surgery >>> Heart and Vascular Center of >>> Northern Arizona >>> Flagstaff, Sedona, and >>> Cottonwood, AZ >>> Tel: 928-649-2584 >>> >>> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: >>> >>>> What is your threshold for intervention, i mean the size for >>>> descending aorta. >>>> >>>> Zhandong Zhou, MD >>>> St. Joseph Hospital >>>> Syracuse, New York >>>> Tel: 315 423 7192 >>>> >>>> On Oct 31, 2009, at 5:30 PM, John Schor wrote: >>>> >>>>> Agree. >>>>> See many of my previous posts. >>>>> John >>>>> John Schor, MD >>>>> Thoracic and Cardiovascular Surgery >>>>> Heart and Vascular Center of >>>>> Northern Arizona >>>>> Flagstaff, Sedona, and >>>>> Cottonwood, AZ >>>>> Tel: 928-649-2584 >>>>> >>>>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>>>> >>>>>> To all, >>>>>> >>>>>> I am in DC for a endovascular course for thoracic aneurysm. Only >>>>>> 25% are CV surgeons. Others are vascular, radiology, >>>>>> cardiologist. >>>>>> >>>>>> We need to catch up, without these skills, we are going to lose >>>>>> the percutaneous valve. >>>>>> >>>>>> Any thoughts? >>>>>> >>>>>> Z Zhou_______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>> http://www.hsforum.com/listdisclaim >>>>>> ----------------------------------------- >>>>> >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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 anddisclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- From Hgrmd at aol.com Sun Nov 1 12:17:58 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Nov 1 12:18:33 2009 Subject: [HSF] Changing field in Our specialty Message-ID: Michael, Of course they should have a say, but criteria need to be met. Otherwise, the patient is welcome to pay out of his own pocket. The patient should be able to decide if it is a borderline case. To me, it's the same thinking as in seat belt laws. Not everyone is thrilled with them, but the public interest is best served. Hal In a message dated 11/1/2009 12:09:36 P.M. Eastern Standard Time, msfirst@gmail.com writes: so what you are implying is that the patient should not have a say in what they want? -michael On Nov 1, 2009, at 11:59 AM, Hgrmd@aol.com wrote: > Prasanna, > Sorry, CAS is carotid artery stenting. Medicare is quite strict > about > the clinical conditions for which it will pay for this procedure. > I am > hopeful that AVI's will be restricted to patients deemed high risk > and not just > because the pt prefers a needle stick to an incision. > > Hal > > > In a message dated 11/1/2009 11:49:09 A.M. Eastern Standard Time, > prasannasimha@gmail.com writes: > > What is CAS ? > Prasanna > > On Sun, Nov 1, 2009 at 7:29 PM, wrote: >> John, >> Hopefully, the Feds and the providers will keep them in check. >> They've > done that with CAS. >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: John Schor >> Date: Sun, 01 Nov 2009 05:57:41 >> To: >> Subject: Re: [HSF] Changing field in Our specialty >> >> I agree with Hal about suboptimal results with some of these >> disruptive technologies, BUT, the train is rolling. As we all know, >> patient flow is controlled by the cardiologists, and 99% believe >> that >> surgery is bad and catheters are good. >> John >> John Schor, MD >> Thoracic and Cardiovascular Surgery >> Heart and Vascular Center of >> Northern Arizona >> Flagstaff, Sedona, and >> Cottonwood, AZ >> Tel: 928-649-2584 >> >> On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: >> >>> John, >>> Agree it will be a "scary ride", mainly for the patients as some of >>> those technqies you describe give them clearly suboptimal results. >>> I strongly suspect the doc at TCT doing the ostial LM stenting with >>> a "perfect" result would be getting conventional LIMA to LAD if he >>> had the same anatomy. I won't even begin to tell you my thoughts >>> of >>> an E Valve clip and a c.s. Screwing up the anatomy of a repairable >>> valve. >>> >>> >>> >>> >>> Hal >>> Sent from my Verizon Wireless BlackBerry >>> >>> -----Original Message----- >>> From: John Schor >>> Date: Sat, 31 Oct 2009 21:18:51 >>> To: >>> Subject: Re: [HSF] Changing field in Our specialty >>> >>> In thoracic cases, the same size criteria is used for stent >>> grafting >>> as for open surgery. >>> >>> I have believed for the past 9 yrs that "open surgery" would be >>> relegated to history books. As doctors( not just as CV surgeons), >>> we >>> should be prepared for 1. repairs (of all organ systems) rather >>> than >>> replacements 2. Avoidance of incisions--or increased use of >>> scopes-- >>> whenever possible 3. Natural Orifice access surgery 4. Medication >>> rather than surgery. >>> >>> The aorta, from the sinotubular junction to the bifurcation, will >>> be >>> "fixed" with endovascular techniques. (probably in less than 10 >>> yrs) >>> Agree with Tom. Even in my small community hospital working alone >>> in >>> the OR (no PA or first assistants), I have been able to fix 10cm >>> ruptured AAA with stent grafting. >>> >>> You should all attend a Cardiology meeting such as the TCT. You >>> will >>> be amazed to see such things as L Main stenting for 95% ostial >>> lesion-- >>> with PERFECT result. Transfemoral and transapical AVR's done >>> safely. >>> MV repairs with clips and then reinforced with coronary sinus >>> rings........ >>> >>> Hold on to your hats. It's gonna be a scary ride. >>> >>> John >>> >>> John Schor, MD >>> Thoracic and Cardiovascular Surgery >>> Heart and Vascular Center of >>> Northern Arizona >>> Flagstaff, Sedona, and >>> Cottonwood, AZ >>> Tel: 928-649-2584 >>> >>> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: >>> >>>> What is your threshold for intervention, i mean the size for >>>> descending aorta. >>>> >>>> Zhandong Zhou, MD >>>> St. Joseph Hospital >>>> Syracuse, New York >>>> Tel: 315 423 7192 >>>> >>>> On Oct 31, 2009, at 5:30 PM, John Schor wrote: >>>> >>>>> Agree. >>>>> See many of my previous posts. >>>>> John >>>>> John Schor, MD >>>>> Thoracic and Cardiovascular Surgery >>>>> Heart and Vascular Center of >>>>> Northern Arizona >>>>> Flagstaff, Sedona, and >>>>> Cottonwood, AZ >>>>> Tel: 928-649-2584 >>>>> >>>>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>>>> >>>>>> To all, >>>>>> >>>>>> I am in DC for a endovascular course for thoracic aneurysm. Only >>>>>> 25% are CV surgeons. Others are vascular, radiology, >>>>>> cardiologist. >>>>>> >>>>>> We need to catch up, without these skills, we are going to lose >>>>>> the percutaneous valve. >>>>>> >>>>>> Any thoughts? >>>>>> >>>>>> Z Zhou_______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>> http://www.hsforum.com/listdisclaim >>>>>> ----------------------------------------- >>>>> >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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 anddisclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>> >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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@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 ----------------------------------------- From prasannasimha at gmail.com Sun Nov 1 22:37:53 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 12:30:24 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: References: Message-ID: <89c4ed2d0911010907r5e1e0e3du8fd4be0044c6a12@mail.gmail.com> They need to be !! Prasanna On Sun, Nov 1, 2009 at 10:29 PM, wrote: > Prasanna, > ?Sorry, CAS is carotid artery stenting. ?Medicare is quite ?strict about > the clinical conditions for which it will pay for this ?procedure. ?I am > hopeful that AVI's will be restricted to patients deemed ?high risk and not just > because the pt prefers a needle stick to an ?incision. > > Hal > > > In a message dated 11/1/2009 11:49:09 A.M. Eastern Standard Time, > prasannasimha@gmail.com writes: > > What is ?CAS ? > Prasanna > > On Sun, Nov 1, 2009 at 7:29 PM, ? wrote: >> John, >> ?Hopefully, the Feds ?and the providers will keep them in check. ?They've > done that with ?CAS. >> >> Hal >> Sent from my Verizon Wireless ?BlackBerry >> >> -----Original Message----- >> From: John Schor ? >> Date: Sun, 01 Nov 2009 05:57:41 >> To: ? >> Subject: Re: [HSF] Changing ?field in Our specialty >> >> I agree with Hal about suboptimal ?results with some of these >> disruptive technologies, BUT, the train is ?rolling. As we all know, >> patient flow is controlled by the ?cardiologists, and 99% believe that >> surgery is bad and catheters are ?good. >> John >> John Schor, MD >> Thoracic and Cardiovascular ?Surgery >> Heart and Vascular Center of >> Northern Arizona >> ?Flagstaff, Sedona, and >> Cottonwood, AZ >> Tel: ?928-649-2584 >> >> On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com ?wrote: >> >>> John, >>> ?Agree it will be a "scary ?ride", mainly for the patients as some of >>> those technqies you ?describe give them clearly suboptimal results. >>> I strongly suspect ?the doc at TCT doing the ostial LM stenting with >>> a "perfect" ?result would be getting conventional LIMA to LAD if he >>> had the ?same anatomy. ?I won't even begin to tell you my thoughts of >>> ?an E Valve clip and a c.s. Screwing up the anatomy of a repairable >>> ?valve. >>> >>> >>> >>> >>> ?Hal >>> Sent from my Verizon Wireless ?BlackBerry >>> >>> -----Original Message----- >>> ?From: John Schor >>> Date: Sat, 31 Oct 2009 ?21:18:51 >>> To: >>> ?Subject: Re: [HSF] Changing field in Our specialty >>> >>> In ?thoracic cases, the same size criteria is used for stent grafting >>> ?as for open surgery. >>> >>> I have believed for the past 9 ?yrs that "open surgery" would be >>> relegated to history books. As ?doctors( not just as CV surgeons), we >>> should be prepared for ?1. repairs (of all organ systems) rather than >>> replacements ?2. Avoidance of incisions--or increased use of scopes-- >>> whenever ?possible 3. Natural Orifice access surgery 4. Medication >>> rather ?than surgery. >>> >>> The aorta, from the sinotubular junction ?to the bifurcation, will be >>> "fixed" with endovascular techniques. ?(probably in less than 10 yrs) >>> Agree with Tom. Even in my small ?community hospital working alone in >>> the OR (no PA or first ?assistants), I have been able to fix 10cm >>> ruptured AAA with stent ?grafting. >>> >>> You should all attend a Cardiology meeting ?such as the TCT. You will >>> be amazed to see such things as L Main ?stenting for 95% ostial >>> lesion-- >>> with PERFECT result. ?Transfemoral and transapical AVR's done safely. >>> MV repairs with ?clips and then reinforced with coronary sinus >>> ?rings........ >>> >>> Hold on to your hats. It's gonna be a ?scary ride. >>> >>> John >>> >>> John Schor, ?MD >>> Thoracic and Cardiovascular Surgery >>> Heart and ?Vascular Center of >>> Northern Arizona >>> Flagstaff, Sedona, ?and >>> Cottonwood, AZ >>> Tel: ?928-649-2584 >>> >>> On Oct 31, 2009, at 2:49 PM, Zhandong ?Zhou wrote: >>> >>>> What is your threshold for ?intervention, i mean the size for >>>> descending ?aorta. >>>> >>>> Zhandong Zhou, MD >>>> St. ?Joseph Hospital >>>> Syracuse, New York >>>> Tel: 315 ?423 7192 >>>> >>>> On Oct 31, 2009, at 5:30 PM, John ?Schor wrote: >>>> >>>>> ?Agree. >>>>> See many of my previous posts. >>>>> ?John >>>>> John Schor, MD >>>>> Thoracic and ?Cardiovascular Surgery >>>>> Heart and Vascular Center ?of >>>>> Northern Arizona >>>>> Flagstaff, Sedona, ?and >>>>> Cottonwood, AZ >>>>> Tel: ?928-649-2584 >>>>> >>>>> On Oct 31, 2009, at 11:02 ?AM, Zhandong Zhou wrote: >>>>> >>>>>> To ?all, >>>>>> >>>>>> I am in DC for a ?endovascular course for thoracic aneurysm. Only >>>>>> 25% ?are CV surgeons. Others are vascular, radiology, ?cardiologist. >>>>>> >>>>>> We need to catch ?up, without these skills, we are going to lose >>>>>> the ?percutaneous valve. >>>>>> >>>>>> Any ?thoughts? >>>>>> >>>>>> Z ?Zhou_______________________________________________ >>>>>> ?OpenHeart-L mailing list >>>>>> >>>>>> Send ?postings to: >>>>>> ?OpenHeart-L@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 anddisclaimers posted ?at: >>>>>> ?http://www.hsforum.com/listdisclaim >>>>>> ?----------------------------------------- >>>>> >>>>> ?_______________________________________________ >>>>> ?OpenHeart-L mailing list >>>>> >>>>> Send postings ?to: >>>>> ?OpenHeart-L@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 anddisclaimers posted at: >>>>> ?http://www.hsforum.com/listdisclaim >>>>> ?----------------------------------------- >>>> ?_______________________________________________ >>>> OpenHeart-L ?mailing list >>>> >>>> Send postings to: >>>> ?OpenHeart-L@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 anddisclaimers posted at: >>>> ?http://www.hsforum.com/listdisclaim >>>> ?----------------------------------------- >>> >>> ?_______________________________________________ >>> OpenHeart-L ?mailing list >>> >>> Send postings to: >>> ?OpenHeart-L@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@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@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@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 >> ?----------------------------------------- >> > > > > -- > Prasanna Simha ?M > _______________________________________________ > OpenHeart-L mailing ?list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From msfirst at gmail.com Sun Nov 1 12:40:39 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Nov 1 12:41:00 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: References: Message-ID: just teasing - and trying to get you fired up....... my case yesterday was a double valve (AVR/TVR) endocarditis case I did in July - he came back in with a root abscess extending to his mitral & LVOT, septic emboli, and a avr gradient that went from 25->80 mmHg over two weeks..... and new heart block....febrile with positive blood cultures going into the OR. Was a disaster...... but he is awake, so there is hope....... On Nov 1, 2009, at 12:17 PM, hgrmd@aol.com wrote: > Michael, > Of course they should have a say, but criteria need to be met. > Otherwise, the patient is welcome to pay out of his own pocket. > The patient should > be able to decide if it is a borderline case. To me, it's the same > thinking as in seat belt laws. Not everyone is thrilled with them, > but the public > interest is best served. > > Hal > > > In a message dated 11/1/2009 12:09:36 P.M. Eastern Standard Time, > msfirst@gmail.com writes: > > so what you are implying is that the patient should not have a say in > what they want? > > > -michael > > > On Nov 1, 2009, at 11:59 AM, Hgrmd@aol.com wrote: > >> Prasanna, >> Sorry, CAS is carotid artery stenting. Medicare is quite strict >> about >> the clinical conditions for which it will pay for this procedure. >> I am >> hopeful that AVI's will be restricted to patients deemed high risk >> and not just >> because the pt prefers a needle stick to an incision. >> >> Hal >> >> >> In a message dated 11/1/2009 11:49:09 A.M. Eastern Standard Time, >> prasannasimha@gmail.com writes: >> >> What is CAS ? >> Prasanna >> >> On Sun, Nov 1, 2009 at 7:29 PM, wrote: >>> John, >>> Hopefully, the Feds and the providers will keep them in check. >>> They've >> done that with CAS. >>> >>> Hal >>> Sent from my Verizon Wireless BlackBerry >>> >>> -----Original Message----- >>> From: John Schor >>> Date: Sun, 01 Nov 2009 05:57:41 >>> To: >>> Subject: Re: [HSF] Changing field in Our specialty >>> >>> I agree with Hal about suboptimal results with some of these >>> disruptive technologies, BUT, the train is rolling. As we all >>> know, >>> patient flow is controlled by the cardiologists, and 99% believe >>> that >>> surgery is bad and catheters are good. >>> John >>> John Schor, MD >>> Thoracic and Cardiovascular Surgery >>> Heart and Vascular Center of >>> Northern Arizona >>> Flagstaff, Sedona, and >>> Cottonwood, AZ >>> Tel: 928-649-2584 >>> >>> On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: >>> >>>> John, >>>> Agree it will be a "scary ride", mainly for the patients as >>>> some of >>>> those technqies you describe give them clearly suboptimal >>>> results. >>>> I strongly suspect the doc at TCT doing the ostial LM stenting >>>> with >>>> a "perfect" result would be getting conventional LIMA to LAD if >>>> he >>>> had the same anatomy. I won't even begin to tell you my thoughts >>>> of >>>> an E Valve clip and a c.s. Screwing up the anatomy of a repairable >>>> valve. >>>> >>>> >>>> >>>> >>>> Hal >>>> Sent from my Verizon Wireless BlackBerry >>>> >>>> -----Original Message----- >>>> From: John Schor >>>> Date: Sat, 31 Oct 2009 21:18:51 >>>> To: >>>> Subject: Re: [HSF] Changing field in Our specialty >>>> >>>> In thoracic cases, the same size criteria is used for stent >>>> grafting >>>> as for open surgery. >>>> >>>> I have believed for the past 9 yrs that "open surgery" would be >>>> relegated to history books. As doctors( not just as CV surgeons), >>>> we >>>> should be prepared for 1. repairs (of all organ systems) rather >>>> than >>>> replacements 2. Avoidance of incisions--or increased use of >>>> scopes-- >>>> whenever possible 3. Natural Orifice access surgery 4. Medication >>>> rather than surgery. >>>> >>>> The aorta, from the sinotubular junction to the bifurcation, will >>>> be >>>> "fixed" with endovascular techniques. (probably in less than 10 >>>> yrs) >>>> Agree with Tom. Even in my small community hospital working alone >>>> in >>>> the OR (no PA or first assistants), I have been able to fix 10cm >>>> ruptured AAA with stent grafting. >>>> >>>> You should all attend a Cardiology meeting such as the TCT. You >>>> will >>>> be amazed to see such things as L Main stenting for 95% ostial >>>> lesion-- >>>> with PERFECT result. Transfemoral and transapical AVR's done >>>> safely. >>>> MV repairs with clips and then reinforced with coronary sinus >>>> rings........ >>>> >>>> Hold on to your hats. It's gonna be a scary ride. >>>> >>>> John >>>> >>>> John Schor, MD >>>> Thoracic and Cardiovascular Surgery >>>> Heart and Vascular Center of >>>> Northern Arizona >>>> Flagstaff, Sedona, and >>>> Cottonwood, AZ >>>> Tel: 928-649-2584 >>>> >>>> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: >>>> >>>>> What is your threshold for intervention, i mean the size for >>>>> descending aorta. >>>>> >>>>> Zhandong Zhou, MD >>>>> St. Joseph Hospital >>>>> Syracuse, New York >>>>> Tel: 315 423 7192 >>>>> >>>>> On Oct 31, 2009, at 5:30 PM, John Schor >>>>> wrote: >>>>> >>>>>> Agree. >>>>>> See many of my previous posts. >>>>>> John >>>>>> John Schor, MD >>>>>> Thoracic and Cardiovascular Surgery >>>>>> Heart and Vascular Center of >>>>>> Northern Arizona >>>>>> Flagstaff, Sedona, and >>>>>> Cottonwood, AZ >>>>>> Tel: 928-649-2584 >>>>>> >>>>>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>>>>> >>>>>>> To all, >>>>>>> >>>>>>> I am in DC for a endovascular course for thoracic aneurysm. >>>>>>> Only >>>>>>> 25% are CV surgeons. Others are vascular, radiology, >>>>>>> cardiologist. >>>>>>> >>>>>>> We need to catch up, without these skills, we are going to >>>>>>> lose >>>>>>> the percutaneous valve. >>>>>>> >>>>>>> Any thoughts? >>>>>>> >>>>>>> Z Zhou_______________________________________________ >>>>>>> OpenHeart-L mailing list >>>>>>> >>>>>>> Send postings to: >>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>> http://www.hsforum.com/listdisclaim >>>>>>> ----------------------------------------- >>>>>> >>>>>> _______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>> http://www.hsforum.com/listdisclaim >>>>>> ----------------------------------------- >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ----------------------------------------- >>>> >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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@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@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 > ----------------------------------------- From ecdouville at orclinic.com Sun Nov 1 09:59:24 2009 From: ecdouville at orclinic.com (Douville, Chuck) Date: Sun Nov 1 13:04:49 2009 Subject: [HSF] Hemolysis References: <89c4ed2d0910310612l6de1ebfbs7b1f7fa8d025c31a@mail.gmail.com> <1948979935-1257002223-cardhu_decombobulator_blackberry.rim.net-173659308-@bda735.bisx.prod.on.blackberry> <89c4ed2d0910310825n6bd760beg6fbdddd5985dc626@mail.gmail.com> Message-ID: Thanks for all of the thoughts from all of you. The aortic valve gradient is old based on previous echoes; I think that she has had pt prosthesis mismatch since 1990 in the aortic position. Frankly, I did not think a Manougian enlargement would be feasible but from Prasanna's suggestion it could be. I have not seen a Konno procedure other than in textbooks ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M Sent: Sat 10/31/2009 8:25 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Hemolysis 50 mm Hg would qualify as an indication by itself de novo.That makes me worried and I would be also concerned weaning the patient off CPB. I think an apical aortic conduit should be kept as a salvage option in these cases and primary transaortic ejection would be important to maintain long term aortic function (windkessel etc).(At least that's my thought). There are problems noted with retrograde cerebral,coronary and aortic flow in kids in certain surgeries where this sort of thing was done so while it may not be a big issue in old people it may be an issue especially in the young.(not so sure if 66 years would be considered young or old with average life expectancies in the 80's) Prasanna On Sat, Oct 31, 2009 at 8:46 PM, wrote: > Prasanna, > Thanks for the advice. As for the case described by Chuck, I think it's a mistake to leave a 50 mm aortic gradient and just do the mitral. Getting that pt off CPB may be problematic with severe prosthetic a.s. Even if he gets the pt through surgery, I'll bet the pt remains symptomatic. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Prasanna Simha M > Date: Sat, 31 Oct 2009 18:42:08 > To: > Subject: Re: [HSF] Hemolysis > > Stark de Leval's text book and Kirklin give a fairly good explanation. You > cna also see Vouhe's technique for subaortic stenosis resection (Mini Konno) > in MMCTS which is instructive (though it does not deal with a full Konno > which is nothing but an extension into the aorta.with an additional patch to > cover the whole "sin". I would also recommend reading the course of the > first septal artery in relation to the septum which I feel is mandatory > reading for people doing a Konno and a Ross.. I will dig out the references > for you. > Prasanna > > On Sat, Oct 31, 2009 at 7:31 AM, wrote: > >> Prasanna, >> Could you provide a link to the best description of how to do a Konno? >> Thanks in advance to the "brain trust" of HSF. >> >> Hal >> >> >> In a message dated 10/30/2009 9:42:47 P.M. Eastern Daylight Time, >> prasannasimha@gmail.com writes: >> >> How sure are you that the aortic valve is not a part of the problem ? >> Incidentally I have done these redo's through midline via a transeptal >> approach. The key is to partially detatch the valave and simultaneoulsy >> and >> immediately take the sutures to the annulus. (if the valve is removed the >> annulus will disappaera behind the aortic bulge.) >> If you are doing a redo why not do a manouguian double valve or better >> still >> a Konno as your aortic gradient is 50 ? Since there are adhesions , a >> Konno >> will actually become easier. >> Prasanna >> On Fri, Oct 30, 2009 at 10:45 PM, Douville, Chuck >> wrote: >> >> > I have a pt who needs her third heart operation. She is now 66; at age >> 45 >> > she a mitral commissurotomy, at age 50 she had St. Jude aortic and >> mitral >> > replacements (19 and 27), old op nots describes LVOT as very >> hypoplastic. >> > Now weight loss, failure to thrive,weakness. LDH is over 2000. Blood >> > cultures no growth. Echo shows 50 mm mean aortic gradient, unchanged >> past 2 >> > yrs but new mild to mod MR, (perivalvular) and mod TR. If cath is ok, I >> am >> > planning to through right thoracotomy to re-do MVR and repair tricuspid. >> Has >> > anyone ever done this and regretted the exposure of the >> > Mitral with the rigid aortic prosthesis in place? I am going to leave >> her >> > aortic valve alone; gradient is old and I think it will take a Konno to >> > improve it. Apical ortic conduit later if needed is my thought. Thx >> > >> > Chuck >> > >> > Sent from my iPhone >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@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 >> > anddisclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> > >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Sun Nov 1 23:48:05 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 13:18:52 2009 Subject: [HSF] Hemolysis In-Reply-To: References: <89c4ed2d0910310612l6de1ebfbs7b1f7fa8d025c31a@mail.gmail.com> <1948979935-1257002223-cardhu_decombobulator_blackberry.rim.net-173659308-@bda735.bisx.prod.on.blackberry> <89c4ed2d0910310825n6bd760beg6fbdddd5985dc626@mail.gmail.com> Message-ID: <89c4ed2d0911011018s35bed22fu8a151702681d8740@mail.gmail.com> Chuck, are you familiar with a Ross. If so you can use Hvass's modification which involves steps that are familiar to those who do a Ross procedure. Prasanna On Sun, Nov 1, 2009 at 11:29 PM, Douville, Chuck wrote: > Thanks for all of the thoughts from all of you. The aortic valve gradient is old based on previous echoes; I think that she has had pt prosthesis mismatch since 1990 in the aortic position. Frankly, I did not think a Manougian ?enlargement would be feasible but from Prasanna's suggestion it could be. I have not seen a Konno procedure other than in textbooks > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M > Sent: Sat 10/31/2009 8:25 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Hemolysis > > > > 50 mm Hg would qualify as an indication by itself de novo.That makes > me worried and I would be also concerned weaning the patient off CPB. > I think an apical aortic conduit should be kept as a salvage option in > these cases and primary transaortic ejection would be important to > maintain long term aortic function (windkessel etc).(At least that's > my thought). There are problems noted with retrograde > cerebral,coronary and aortic flow in kids in certain surgeries where > this sort of thing was done so while it may not be a big issue in old > people it may be an issue especially in the young.(not so sure if 66 > years would be considered young or old with average life expectancies > in the 80's) > Prasanna > > On Sat, Oct 31, 2009 at 8:46 PM, ? wrote: >> Prasanna, >> ?Thanks for the advice. As for the case described by Chuck, I think it's a mistake to leave a 50 mm aortic gradient and just do the mitral. ?Getting that pt off CPB may be problematic with severe prosthetic a.s. ?Even if he gets the pt through surgery, I'll bet the pt remains symptomatic. >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: Prasanna Simha M >> Date: Sat, 31 Oct 2009 18:42:08 >> To: >> Subject: Re: [HSF] Hemolysis >> >> Stark de Leval's text book and Kirklin give a fairly good explanation. You >> cna also see Vouhe's technique for subaortic stenosis resection (Mini Konno) >> in MMCTS which is instructive (though it does not deal with a full Konno >> which is nothing but an extension into the aorta.with an additional patch to >> cover the whole "sin". I would also recommend reading the course of the >> first septal artery in relation to the septum which I feel is mandatory >> reading for people doing a Konno and a Ross.. I will dig out the references >> for you. >> Prasanna >> >> On Sat, Oct 31, 2009 at 7:31 AM, wrote: >> >>> Prasanna, >>> ?Could you provide a link to the best description of how to do a ?Konno? >>> Thanks in advance to the "brain trust" of HSF. >>> >>> Hal >>> >>> >>> In a message dated 10/30/2009 9:42:47 P.M. Eastern Daylight Time, >>> prasannasimha@gmail.com writes: >>> >>> How sure ?are you that the aortic valve is not a part of the problem ? >>> Incidentally I ?have done these redo's through midline ?via a transeptal >>> approach. The ?key is to partially detatch the valave and simultaneoulsy >>> and >>> immediately ?take the sutures to the annulus. (if the valve is removed the >>> annulus will ?disappaera behind the aortic bulge.) >>> If you are doing a redo why not do a ?manouguian double valve or better >>> still >>> a Konno as your aortic gradient is ?50 ? Since there are adhesions , a >>> Konno >>> will actually become ?easier. >>> Prasanna >>> On Fri, Oct 30, 2009 at 10:45 PM, Douville, ?Chuck >>> wrote: >>> >>> > I have a pt who ?needs her third heart operation. She is now 66; at age >>> 45 >>> > she a mitral ?commissurotomy, at age 50 she had St. Jude aortic and >>> mitral >>> > ?replacements (19 and 27), old op nots describes LVOT as very >>> hypoplastic. >>> > Now weight loss, failure to thrive,weakness. LDH is over ?2000. Blood >>> > cultures no growth. Echo shows 50 mm mean aortic gradient, ?unchanged >>> past 2 >>> > yrs but new mild to mod MR, (perivalvular) and mod ?TR. If cath is ok, I >>> am >>> > planning to through right thoracotomy to re-do ?MVR and repair tricuspid. >>> Has >>> > anyone ever done this and regretted the ?exposure of the >>> > Mitral with the rigid aortic prosthesis in ?place? ?I am going to leave >>> her >>> > aortic valve alone; gradient is ?old and I think it will take a Konno to >>> > improve it. Apical ortic ?conduit later if needed is my thought. Thx >>> > >>> > ?Chuck >>> > >>> > Sent from my iPhone >>> > ?_______________________________________________ >>> > OpenHeart-L mailing ?list >>> > >>> > Send postings to: >>> > ?OpenHeart-L@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 >>> > ?anddisclaimers posted at: >>> > http://www.hsforum.com/listdisclaim >>> > ?----------------------------------------- >>> > >>> >>> >>> >>> -- >>> Prasanna Simha ?M >>> _______________________________________________ >>> OpenHeart-L mailing ?list >>> >>> Send postings to: >>> OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From ecdouville at orclinic.com Sun Nov 1 10:20:35 2009 From: ecdouville at orclinic.com (Douville, Chuck) Date: Sun Nov 1 13:22:56 2009 Subject: [HSF] Hemolysis References: <89c4ed2d0910310612l6de1ebfbs7b1f7fa8d025c31a@mail.gmail.com><1948979935-1257002223-cardhu_decombobulator_blackberry.rim.net-173659308-@bda735.bisx.prod.on.blackberry><89c4ed2d0910310825n6bd760beg6fbdddd5985dc626@mail.gmail.com> Message-ID: Sorry I did not finish the post. I am most concerned about not being able to get in a larger aortic prosthesis if both are done together, which is why I was thinking right thoraocotomy, since I strongly suspect the proble is from her mitral valve regurg.. Ed thanks for your tips also and Dave thanks for the tips about the usual St Jude aortic washing jet often making the right chest approach a bit more difficult though not impossible. I think most of us adult surgeons would be reluctant to do a Konno, but perhaps I am alone in this. If she is really better off with a konno, I will find someone able to do it who can assure me it will not be their first. My sense from your helpful comments is to bite the bullet and just do the double valve replacement transsternally clamped, and the tricuspid repari unclamped. Prasanna I do not know the answer to your question about whether it could be the aortic valve. It seems unlikely to me, since the aortic valve gradient has been the same for years and the mitral regurg and hemolysis are new. chuck ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Douville, Chuck Sent: Sun 11/1/2009 9:59 AM To: OpenHeart-L@lists.hsforum.com Subject: RE: [HSF] Hemolysis Thanks for all of the thoughts from all of you. The aortic valve gradient is old based on previous echoes; I think that she has had pt prosthesis mismatch since 1990 in the aortic position. Frankly, I did not think a Manougian enlargement would be feasible but from Prasanna's suggestion it could be. I have not seen a Konno procedure other than in textbooks ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M Sent: Sat 10/31/2009 8:25 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Hemolysis 50 mm Hg would qualify as an indication by itself de novo.That makes me worried and I would be also concerned weaning the patient off CPB. I think an apical aortic conduit should be kept as a salvage option in these cases and primary transaortic ejection would be important to maintain long term aortic function (windkessel etc).(At least that's my thought). There are problems noted with retrograde cerebral,coronary and aortic flow in kids in certain surgeries where this sort of thing was done so while it may not be a big issue in old people it may be an issue especially in the young.(not so sure if 66 years would be considered young or old with average life expectancies in the 80's) Prasanna On Sat, Oct 31, 2009 at 8:46 PM, wrote: > Prasanna, > Thanks for the advice. As for the case described by Chuck, I think it's a mistake to leave a 50 mm aortic gradient and just do the mitral. Getting that pt off CPB may be problematic with severe prosthetic a.s. Even if he gets the pt through surgery, I'll bet the pt remains symptomatic. > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Prasanna Simha M > Date: Sat, 31 Oct 2009 18:42:08 > To: > Subject: Re: [HSF] Hemolysis > > Stark de Leval's text book and Kirklin give a fairly good explanation. You > cna also see Vouhe's technique for subaortic stenosis resection (Mini Konno) > in MMCTS which is instructive (though it does not deal with a full Konno > which is nothing but an extension into the aorta.with an additional patch to > cover the whole "sin". I would also recommend reading the course of the > first septal artery in relation to the septum which I feel is mandatory > reading for people doing a Konno and a Ross.. I will dig out the references > for you. > Prasanna > > On Sat, Oct 31, 2009 at 7:31 AM, wrote: > >> Prasanna, >> Could you provide a link to the best description of how to do a Konno? >> Thanks in advance to the "brain trust" of HSF. >> >> Hal >> >> >> In a message dated 10/30/2009 9:42:47 P.M. Eastern Daylight Time, >> prasannasimha@gmail.com writes: >> >> How sure are you that the aortic valve is not a part of the problem ? >> Incidentally I have done these redo's through midline via a transeptal >> approach. The key is to partially detatch the valave and simultaneoulsy >> and >> immediately take the sutures to the annulus. (if the valve is removed the >> annulus will disappaera behind the aortic bulge.) >> If you are doing a redo why not do a manouguian double valve or better >> still >> a Konno as your aortic gradient is 50 ? Since there are adhesions , a >> Konno >> will actually become easier. >> Prasanna >> On Fri, Oct 30, 2009 at 10:45 PM, Douville, Chuck >> wrote: >> >> > I have a pt who needs her third heart operation. She is now 66; at age >> 45 >> > she a mitral commissurotomy, at age 50 she had St. Jude aortic and >> mitral >> > replacements (19 and 27), old op nots describes LVOT as very >> hypoplastic. >> > Now weight loss, failure to thrive,weakness. LDH is over 2000. Blood >> > cultures no growth. Echo shows 50 mm mean aortic gradient, unchanged >> past 2 >> > yrs but new mild to mod MR, (perivalvular) and mod TR. If cath is ok, I >> am >> > planning to through right thoracotomy to re-do MVR and repair tricuspid. >> Has >> > anyone ever done this and regretted the exposure of the >> > Mitral with the rigid aortic prosthesis in place? I am going to leave >> her >> > aortic valve alone; gradient is old and I think it will take a Konno to >> > improve it. Apical ortic conduit later if needed is my thought. Thx >> > >> > Chuck >> > >> > Sent from my iPhone >> > _______________________________________________ >> > OpenHeart-L mailing list >> > >> > Send postings to: >> > OpenHeart-L@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 >> > anddisclaimers posted at: >> > http://www.hsforum.com/listdisclaim >> > ----------------------------------------- >> > >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From ecdouville at orclinic.com Sun Nov 1 10:20:56 2009 From: ecdouville at orclinic.com (Douville, Chuck) Date: Sun Nov 1 13:22:58 2009 Subject: [HSF] Hemolysis References: <89c4ed2d0910310612l6de1ebfbs7b1f7fa8d025c31a@mail.gmail.com> <1948979935-1257002223-cardhu_decombobulator_blackberry.rim.net-173659308-@bda735.bisx.prod.on.blackberry><89c4ed2d0910310825n6bd760beg6fbdddd5985dc626@mail.gmail.com> <89c4ed2d0911011018s35bed22fu8a151702681d8740@mail.gmail.com> Message-ID: Thanks Prasanna but only from meetings, videos and texts. So although I will review those references, but would not be prepared to offer her the Konno at this point. As usual, great teaching points from you, thank you. chuck ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M Sent: Sun 11/1/2009 10:18 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Hemolysis Chuck, are you familiar with a Ross. If so you can use Hvass's modification which involves steps that are familiar to those who do a Ross procedure. Prasanna On Sun, Nov 1, 2009 at 11:29 PM, Douville, Chuck wrote: > Thanks for all of the thoughts from all of you. The aortic valve gradient is old based on previous echoes; I think that she has had pt prosthesis mismatch since 1990 in the aortic position. Frankly, I did not think a Manougian enlargement would be feasible but from Prasanna's suggestion it could be. I have not seen a Konno procedure other than in textbooks > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M > Sent: Sat 10/31/2009 8:25 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Hemolysis > > > > 50 mm Hg would qualify as an indication by itself de novo.That makes > me worried and I would be also concerned weaning the patient off CPB. > I think an apical aortic conduit should be kept as a salvage option in > these cases and primary transaortic ejection would be important to > maintain long term aortic function (windkessel etc).(At least that's > my thought). There are problems noted with retrograde > cerebral,coronary and aortic flow in kids in certain surgeries where > this sort of thing was done so while it may not be a big issue in old > people it may be an issue especially in the young.(not so sure if 66 > years would be considered young or old with average life expectancies > in the 80's) > Prasanna > > On Sat, Oct 31, 2009 at 8:46 PM, wrote: >> Prasanna, >> Thanks for the advice. As for the case described by Chuck, I think it's a mistake to leave a 50 mm aortic gradient and just do the mitral. Getting that pt off CPB may be problematic with severe prosthetic a.s. Even if he gets the pt through surgery, I'll bet the pt remains symptomatic. >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: Prasanna Simha M >> Date: Sat, 31 Oct 2009 18:42:08 >> To: >> Subject: Re: [HSF] Hemolysis >> >> Stark de Leval's text book and Kirklin give a fairly good explanation. You >> cna also see Vouhe's technique for subaortic stenosis resection (Mini Konno) >> in MMCTS which is instructive (though it does not deal with a full Konno >> which is nothing but an extension into the aorta.with an additional patch to >> cover the whole "sin". I would also recommend reading the course of the >> first septal artery in relation to the septum which I feel is mandatory >> reading for people doing a Konno and a Ross.. I will dig out the references >> for you. >> Prasanna >> >> On Sat, Oct 31, 2009 at 7:31 AM, wrote: >> >>> Prasanna, >>> Could you provide a link to the best description of how to do a Konno? >>> Thanks in advance to the "brain trust" of HSF. >>> >>> Hal >>> >>> >>> In a message dated 10/30/2009 9:42:47 P.M. Eastern Daylight Time, >>> prasannasimha@gmail.com writes: >>> >>> How sure are you that the aortic valve is not a part of the problem ? >>> Incidentally I have done these redo's through midline via a transeptal >>> approach. The key is to partially detatch the valave and simultaneoulsy >>> and >>> immediately take the sutures to the annulus. (if the valve is removed the >>> annulus will disappaera behind the aortic bulge.) >>> If you are doing a redo why not do a manouguian double valve or better >>> still >>> a Konno as your aortic gradient is 50 ? Since there are adhesions , a >>> Konno >>> will actually become easier. >>> Prasanna >>> On Fri, Oct 30, 2009 at 10:45 PM, Douville, Chuck >>> wrote: >>> >>> > I have a pt who needs her third heart operation. She is now 66; at age >>> 45 >>> > she a mitral commissurotomy, at age 50 she had St. Jude aortic and >>> mitral >>> > replacements (19 and 27), old op nots describes LVOT as very >>> hypoplastic. >>> > Now weight loss, failure to thrive,weakness. LDH is over 2000. Blood >>> > cultures no growth. Echo shows 50 mm mean aortic gradient, unchanged >>> past 2 >>> > yrs but new mild to mod MR, (perivalvular) and mod TR. If cath is ok, I >>> am >>> > planning to through right thoracotomy to re-do MVR and repair tricuspid. >>> Has >>> > anyone ever done this and regretted the exposure of the >>> > Mitral with the rigid aortic prosthesis in place? I am going to leave >>> her >>> > aortic valve alone; gradient is old and I think it will take a Konno to >>> > improve it. Apical ortic conduit later if needed is my thought. Thx >>> > >>> > Chuck >>> > >>> > Sent from my iPhone >>> > _______________________________________________ >>> > OpenHeart-L mailing list >>> > >>> > Send postings to: >>> > OpenHeart-L@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 >>> > anddisclaimers posted at: >>> > http://www.hsforum.com/listdisclaim >>> > ----------------------------------------- >>> > >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From hgrmd at aol.com Sun Nov 1 18:22:18 2009 From: hgrmd at aol.com (hgrmd@aol.com) Date: Sun Nov 1 13:23:44 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: References: Message-ID: <2105951765-1257099796-cardhu_decombobulator_blackberry.rim.net-172959978-@bda735.bisx.prod.on.blackberry> TWljaGFlbCwNCiAgSG93IGRpZCB5b3UgZGVhbCB3aXRoIHRoZSByb290IGFic2Nlc3M/DQoNCkhh bA0KU2VudCBmcm9tIG15IFZlcml6b24gV2lyZWxlc3MgQmxhY2tCZXJyeQ0KDQotLS0tLU9yaWdp bmFsIE1lc3NhZ2UtLS0tLQ0KRnJvbTogTWljaGFlbCBGaXJzdGVuYmVyZyA8bXNmaXJzdEBnbWFp bC5jb20+DQpEYXRlOiBTdW4sIDEgTm92IDIwMDkgMTI6NDA6MzkgDQpUbzogPE9wZW5IZWFydC1M QGxpc3RzLmhzZm9ydW0uY29tPg0KU3ViamVjdDogUmU6IFtIU0ZdIENoYW5naW5nIGZpZWxkIGlu IE91ciBzcGVjaWFsdHkNCg0KanVzdCB0ZWFzaW5nIC0gYW5kIHRyeWluZyB0byBnZXQgeW91IGZp cmVkIHVwLi4uLi4uLg0KDQpteSBjYXNlIHllc3RlcmRheSB3YXMgYSBkb3VibGUgdmFsdmUgKEFW Ui9UVlIpIGVuZG9jYXJkaXRpcyBjYXNlIEkgZGlkICANCmluIEp1bHkgLSBoZSBjYW1lIGJhY2sg aW4gd2l0aCBhIHJvb3QgYWJzY2VzcyBleHRlbmRpbmcgdG8gaGlzIG1pdHJhbCAgDQomIExWT1Qs IHNlcHRpYyBlbWJvbGksIGFuZCBhIGF2ciBncmFkaWVudCB0aGF0IHdlbnQgZnJvbSAyNS0+ODAg 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dG8gdmlldyBhcmNoaXZlczoNCj4gaHR0cDovL21tcC5janAuY29tL21haWxtYW4vbGlzdGluZm8v b3BlbmhlYXJ0LWwNCj4NCj4gQWxsIG1lc3NhZ2VzIHRyYW5zbWl0dGVkIGJ5IHRoZSBPcGVuSGVh cnQtTCBhcmUgc3ViamVjdCB0byB0aGUgIA0KPiBwb2xpY2llcyBhbmQNCj4gZGlzY2xhaW1lcnMg cG9zdGVkIGF0Og0KPiBodHRwOi8vd3d3LmhzZm9ydW0uY29tL2xpc3RkaXNjbGFpbQ0KPiAtLS0t LS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLQ0KDQpfX19fX19fX19fX19fX19f X19fX19fX19fX19fX19fX19fX19fX19fX19fX19fXw0KT3BlbkhlYXJ0LUwgbWFpbGluZyBsaXN0 DQoNClNlbmQgcG9zdGluZ3MgdG86DQogT3BlbkhlYXJ0LUxAbGlzdHMuaHNmb3J1bS5jb20NCg0K VG8gVU5TVUJTQ1JJQkUsIHRvIENIQU5HRSBlbWFpbCBhZGRyZXNzLCBvciB0byB2aWV3IGFyY2hp dmVzOg0KaHR0cDovL21tcC5janAuY29tL21haWxtYW4vbGlzdGluZm8vb3BlbmhlYXJ0LWwNCg0K QWxsIG1lc3NhZ2VzIHRyYW5zbWl0dGVkIGJ5IHRoZSBPcGVuSGVhcnQtTCBhcmUgc3ViamVjdCB0 byB0aGUgcG9saWNpZXMgYW5kIA0KZGlzY2xhaW1lcnMgcG9zdGVkIGF0Og0KaHR0cDovL3d3dy5o c2ZvcnVtLmNvbS9saXN0ZGlzY2xhaW0NCi0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0tLS0t LS0tLS0tLS0tDQo= From ebender001 at me.com Sun Nov 1 12:29:30 2009 From: ebender001 at me.com (Edward Bender) Date: Sun Nov 1 13:30:04 2009 Subject: [HSF] Hemolysis In-Reply-To: Message-ID: Chuck: You are correct in the statement that most surgeons who do not do pediatric surgery would be hesitant to do a Konno. I know I would. I was visiting the Univ. of Michigan one day, and Mike Deeb (an accomplished aortic valve surgeon) had just such a case. He did the Konno with Ed Bove (pediatric chief). Ed Bender, MD On 11/1/09 12:20 PM, "Douville, Chuck" wrote: > Sorry I did not finish the post. I am most concerned about not being able to > get in a larger aortic prosthesis if both are done together, which is why I > was thinking right thoraocotomy, since I strongly suspect the proble is from > her mitral valve regurg.. Ed thanks for your tips also and Dave thanks for the > tips about the usual St Jude aortic washing jet often making the right chest > approach a bit more difficult though not impossible. I think most of us adult > surgeons would be reluctant to do a Konno, but perhaps I am alone in this. If > she is really better off with a konno, I will find someone able to do it who > can assure me it will not be their first. My sense from your helpful comments > is to bite the bullet and just do the double valve replacement transsternally > clamped, and the tricuspid repari unclamped. Prasanna I do not know the answer > to your question about whether it could be the aortic valve. It seems unlikely > to me, since the aortic valve gradient has been the same for years and the > mitral regurg and hemolysis are new. > chuck > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Douville, Chuck > Sent: Sun 11/1/2009 9:59 AM > To: OpenHeart-L@lists.hsforum.com > Subject: RE: [HSF] Hemolysis > > > > Thanks for all of the thoughts from all of you. The aortic valve gradient is > old based on previous echoes; I think that she has had pt prosthesis mismatch > since 1990 in the aortic position. Frankly, I did not think a Manougian > enlargement would be feasible but from Prasanna's suggestion it could be. I > have not seen a Konno procedure other than in textbooks > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M > Sent: Sat 10/31/2009 8:25 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Hemolysis > > > > 50 mm Hg would qualify as an indication by itself de novo.That makes > me worried and I would be also concerned weaning the patient off CPB. > I think an apical aortic conduit should be kept as a salvage option in > these cases and primary transaortic ejection would be important to > maintain long term aortic function (windkessel etc).(At least that's > my thought). There are problems noted with retrograde > cerebral,coronary and aortic flow in kids in certain surgeries where > this sort of thing was done so while it may not be a big issue in old > people it may be an issue especially in the young.(not so sure if 66 > years would be considered young or old with average life expectancies > in the 80's) > Prasanna > > On Sat, Oct 31, 2009 at 8:46 PM, wrote: >> Prasanna, >> Thanks for the advice. As for the case described by Chuck, I think it's a >> mistake to leave a 50 mm aortic gradient and just do the mitral. Getting >> that pt off CPB may be problematic with severe prosthetic a.s. Even if he >> gets the pt through surgery, I'll bet the pt remains symptomatic. >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: Prasanna Simha M >> Date: Sat, 31 Oct 2009 18:42:08 >> To: >> Subject: Re: [HSF] Hemolysis >> >> Stark de Leval's text book and Kirklin give a fairly good explanation. You >> cna also see Vouhe's technique for subaortic stenosis resection (Mini Konno) >> in MMCTS which is instructive (though it does not deal with a full Konno >> which is nothing but an extension into the aorta.with an additional patch to >> cover the whole "sin". I would also recommend reading the course of the >> first septal artery in relation to the septum which I feel is mandatory >> reading for people doing a Konno and a Ross.. I will dig out the references >> for you. >> Prasanna >> >> On Sat, Oct 31, 2009 at 7:31 AM, wrote: >> >>> Prasanna, >>> Could you provide a link to the best description of how to do a Konno? >>> Thanks in advance to the "brain trust" of HSF. >>> >>> Hal >>> >>> >>> In a message dated 10/30/2009 9:42:47 P.M. Eastern Daylight Time, >>> prasannasimha@gmail.com writes: >>> >>> How sure are you that the aortic valve is not a part of the problem ? >>> Incidentally I have done these redo's through midline via a transeptal >>> approach. The key is to partially detatch the valave and simultaneoulsy >>> and >>> immediately take the sutures to the annulus. (if the valve is removed the >>> annulus will disappaera behind the aortic bulge.) >>> If you are doing a redo why not do a manouguian double valve or better >>> still >>> a Konno as your aortic gradient is 50 ? Since there are adhesions , a >>> Konno >>> will actually become easier. >>> Prasanna >>> On Fri, Oct 30, 2009 at 10:45 PM, Douville, Chuck >>> wrote: >>> >>>> I have a pt who needs her third heart operation. She is now 66; at age >>> 45 >>>> she a mitral commissurotomy, at age 50 she had St. Jude aortic and >>> mitral >>>> replacements (19 and 27), old op nots describes LVOT as very >>> hypoplastic. >>>> Now weight loss, failure to thrive,weakness. LDH is over 2000. Blood >>>> cultures no growth. Echo shows 50 mm mean aortic gradient, unchanged >>> past 2 >>>> yrs but new mild to mod MR, (perivalvular) and mod TR. If cath is ok, I >>> am >>>> planning to through right thoracotomy to re-do MVR and repair tricuspid. >>> Has >>>> anyone ever done this and regretted the exposure of the >>>> Mitral with the rigid aortic prosthesis in place? I am going to leave >>> her >>>> aortic valve alone; gradient is old and I think it will take a Konno to >>>> improve it. Apical ortic conduit later if needed is my thought. Thx >>>> >>>> Chuck >>>> >>>> Sent from my iPhone >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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 >>>> anddisclaimers posted at: >>>> http://www.hsforum.com/listdisclaim >>>> ----------------------------------------- >>>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- From ebender001 at me.com Sun Nov 1 12:26:11 2009 From: ebender001 at me.com (Edward Bender) Date: Sun Nov 1 13:30:34 2009 Subject: [HSF] Health Care Baby Sitting Message-ID: Eight months ago I did double valve replacement (MVR/AVR) on a 75 year old man with unremitting sepsis, heart failure, and infected native valves. He was admitted to our hospital yesterday for alcohol toxicity/detox, covered in feces, and a cold left leg (previous fem-pop bypass occluded). An echo was obtained showing normal prosthetic valves functioning without any vegetations. No signs of sepsis, but the hospitalist who admitted the patient wanted to make sure there was no cardiac source for an embolus. Patient is in sinus rhythm. As long as we operate on patients like this, we will have outcomes that are worse than what we would hope for. It would be nice if our health care plans could attend to the needs of the patient after discharge. Home health agencies will not see the uninsured, the under insured, or medicaid patients. What we need is a healthcare baby-sitting service. If we are to be graded/judged on our outcomes, those that are doing the judging should own up to the fact that sometimes its the patients and not the ?greedy? doctors. Ed Bender, MD From grescigno at mac.com Sun Nov 1 19:36:06 2009 From: grescigno at mac.com (Giuseppe Rescigno) Date: Sun Nov 1 13:42:57 2009 Subject: [HSF] Health Care Baby Sitting In-Reply-To: References: Message-ID: Ed, we cannot adopt our patients for the rest of their lives. I am a strong supporter of an additional tax for people with a BMI over 30. People should understand that we will not be able to cover the expenses for their silly choices. If someone decides to smoke, eat excessively, drink too much, he/she should accept to have a limited health insurance. Giuseppe Il giorno 01/nov/09, alle ore 19:26, Edward Bender ha scritto: > Eight months ago I did double valve replacement (MVR/AVR) on a 75 > year old > man with unremitting sepsis, heart failure, and infected native > valves. He > was admitted to our hospital yesterday for alcohol toxicity/detox, > covered > in feces, and a cold left leg (previous fem-pop bypass occluded). > An echo > was obtained showing normal prosthetic valves functioning without any > vegetations. No signs of sepsis, but the hospitalist who admitted the > patient wanted to make sure there was no cardiac source for an > embolus. > Patient is in sinus rhythm. > > As long as we operate on patients like this, we will have outcomes > that are > worse than what we would hope for. It would be nice if our health > care > plans could attend to the needs of the patient after discharge. > Home health > agencies will not see the uninsured, the under insured, or medicaid > patients. What we need is a healthcare baby-sitting service. If we > are to be > graded/judged on our outcomes, those that are doing the judging > should own > up to the fact that sometimes its the patients and not the ?greedy? > doctors. > > Ed Bender, MD > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From prasannasimha at gmail.com Mon Nov 2 00:09:08 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 13:47:30 2009 Subject: [HSF] Hemolysis In-Reply-To: References: Message-ID: <89c4ed2d0911011039j3b36c9bex3a67db7a500a9ff5@mail.gmail.com> I was about to type - involve a pediatric surgeon. GUCH (Grown Up Congenital Heart) disease is going to be an ever present problem and is best coordinated by one who does both or get two (an adult and pediatric surgeon) involved.There are somethings unique to adult and congenital surgery so it may be better if a combined effort is used. (Somehow It did not strike me that training has got so dichotomized) . If a shoehorned 19 mm has to be made to 23 or 25 mm an anterior approach will offer the best option especially since there was a tunnel stenosis commented in the OR notes previously. Prasanna On Sun, Nov 1, 2009 at 11:59 PM, Edward Bender wrote: > Chuck: > You are correct in the statement that most surgeons who do not do pediatric > surgery would be hesitant to do a Konno. I know I would. I was visiting the > Univ. of Michigan one day, and Mike Deeb (an accomplished aortic valve > surgeon) had just such a case. He did the Konno with Ed Bove (pediatric > chief). > Ed Bender, MD > > > On 11/1/09 12:20 PM, "Douville, Chuck" wrote: > >> Sorry I did not finish the post. I am most concerned about not being able to >> get in a larger aortic prosthesis if both are done together, which is why I >> was thinking right thoraocotomy, since I strongly suspect the proble is from >> her mitral valve regurg.. Ed thanks for your tips also and Dave thanks for the >> tips about the usual St Jude aortic washing jet often making the right chest >> approach a bit more difficult though not impossible. I think most of us adult >> surgeons would be reluctant to do a Konno, but perhaps I am alone in this. If >> she is really better off with a konno, I will find someone able to do it who >> can assure me it will not be their first. My sense from your helpful comments >> is to bite the bullet and just do the double valve replacement transsternally >> clamped, and the tricuspid repari unclamped. Prasanna I do not know the answer >> to your question about whether it could be the aortic valve. It seems unlikely >> to me, since the aortic valve gradient has been the same for years and the >> mitral regurg and hemolysis are new. >> chuck >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Douville, Chuck >> Sent: Sun 11/1/2009 9:59 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: RE: [HSF] Hemolysis >> >> >> >> Thanks for all of the thoughts from all of you. The aortic valve gradient is >> old based on previous echoes; I think that she has had pt prosthesis mismatch >> since 1990 in the aortic position. Frankly, I did not think a Manougian >> enlargement would be feasible but from Prasanna's suggestion it could be. I >> have not seen a Konno procedure other than in textbooks >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M >> Sent: Sat 10/31/2009 8:25 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Hemolysis >> >> >> >> 50 mm Hg would qualify as an indication by itself de novo.That makes >> me worried and I would be also concerned weaning the patient off CPB. >> I think an apical aortic conduit should be kept as a salvage option in >> these cases and primary transaortic ejection would be important to >> maintain long term aortic function (windkessel etc).(At least that's >> my thought). There are problems noted with retrograde >> cerebral,coronary and aortic flow in kids in certain surgeries where >> this sort of thing was done so while it may not be a big issue in old >> people it may be an issue especially in the young.(not so sure if 66 >> years would be considered young or old with average life expectancies >> in the 80's) >> Prasanna >> >> On Sat, Oct 31, 2009 at 8:46 PM, ? wrote: >>> Prasanna, >>> ?Thanks for the advice. As for the case described by Chuck, I think it's a >>> mistake to leave a 50 mm aortic gradient and just do the mitral. ?Getting >>> that pt off CPB may be problematic with severe prosthetic a.s. ?Even if he >>> gets the pt through surgery, I'll bet the pt remains symptomatic. >>> >>> Hal >>> Sent from my Verizon Wireless BlackBerry >>> >>> -----Original Message----- >>> From: Prasanna Simha M >>> Date: Sat, 31 Oct 2009 18:42:08 >>> To: >>> Subject: Re: [HSF] Hemolysis >>> >>> Stark de Leval's text book and Kirklin give a fairly good explanation. You >>> cna also see Vouhe's technique for subaortic stenosis resection (Mini Konno) >>> in MMCTS which is instructive (though it does not deal with a full Konno >>> which is nothing but an extension into the aorta.with an additional patch to >>> cover the whole "sin". I would also recommend reading the course of the >>> first septal artery in relation to the septum which I feel is mandatory >>> reading for people doing a Konno and a Ross.. I will dig out the references >>> for you. >>> Prasanna >>> >>> On Sat, Oct 31, 2009 at 7:31 AM, wrote: >>> >>>> Prasanna, >>>> ?Could you provide a link to the best description of how to do a ?Konno? >>>> Thanks in advance to the "brain trust" of HSF. >>>> >>>> Hal >>>> >>>> >>>> In a message dated 10/30/2009 9:42:47 P.M. Eastern Daylight Time, >>>> prasannasimha@gmail.com writes: >>>> >>>> How sure ?are you that the aortic valve is not a part of the problem ? >>>> Incidentally I ?have done these redo's through midline ?via a transeptal >>>> approach. The ?key is to partially detatch the valave and simultaneoulsy >>>> and >>>> immediately ?take the sutures to the annulus. (if the valve is removed the >>>> annulus will ?disappaera behind the aortic bulge.) >>>> If you are doing a redo why not do a ?manouguian double valve or better >>>> still >>>> a Konno as your aortic gradient is ?50 ? Since there are adhesions , a >>>> Konno >>>> will actually become ?easier. >>>> Prasanna >>>> On Fri, Oct 30, 2009 at 10:45 PM, Douville, ?Chuck >>>> wrote: >>>> >>>>> I have a pt who ?needs her third heart operation. She is now 66; at age >>>> 45 >>>>> she a mitral ?commissurotomy, at age 50 she had St. Jude aortic and >>>> mitral >>>>> ?replacements (19 and 27), old op nots describes LVOT as very >>>> hypoplastic. >>>>> Now weight loss, failure to thrive,weakness. LDH is over ?2000. Blood >>>>> cultures no growth. Echo shows 50 mm mean aortic gradient, ?unchanged >>>> past 2 >>>>> yrs but new mild to mod MR, (perivalvular) and mod ?TR. If cath is ok, I >>>> am >>>>> planning to through right thoracotomy to re-do ?MVR and repair tricuspid. >>>> Has >>>>> anyone ever done this and regretted the ?exposure of the >>>>> Mitral with the rigid aortic prosthesis in ?place? ?I am going to leave >>>> her >>>>> aortic valve alone; gradient is ?old and I think it will take a Konno to >>>>> improve it. Apical ortic ?conduit later if needed is my thought. Thx >>>>> >>>>> ?Chuck >>>>> >>>>> Sent from my iPhone >>>>> ?_______________________________________________ >>>>> OpenHeart-L mailing ?list >>>>> >>>>> Send postings to: >>>>> ?OpenHeart-L@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 >>>>> ?anddisclaimers posted at: >>>>> http://www.hsforum.com/listdisclaim >>>>> ?----------------------------------------- >>>>> >>>> >>>> >>>> >>>> -- >>>> Prasanna Simha ?M >>>> _______________________________________________ >>>> OpenHeart-L mailing ?list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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 >>>> ----------------------------------------- >>>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> ?OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@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@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@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Mon Nov 2 00:11:41 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 13:49:09 2009 Subject: [HSF] Health Care Baby Sitting In-Reply-To: References: Message-ID: <89c4ed2d0911011041y68eaca3cseb194462f49b2bb5@mail.gmail.com> And also begs for the concern regarding alcohol addiction. the tyranny of the patients demands does not also factor in the patients duties.I had one colleague who would refuse to do elective CABG's till they were off cigarettes. Maybe seems extreme but but it used to work well. Prasanna On Sun, Nov 1, 2009 at 11:56 PM, Edward Bender wrote: > Eight months ago I did double valve replacement (MVR/AVR) on a 75 year old > man with unremitting sepsis, heart failure, and infected native valves. ?He > was admitted to our hospital yesterday for alcohol toxicity/detox, covered > in feces, and a cold left leg (previous fem-pop bypass occluded). An echo > was obtained showing normal prosthetic valves functioning without any > vegetations. No signs of sepsis, but the hospitalist who admitted the > patient wanted to make sure there was no cardiac source for an embolus. > Patient is in sinus rhythm. > > As long as we operate on patients like this, we will have outcomes that are > worse than what we would hope for. ?It would be nice if our health care > plans could attend to the needs of the patient after discharge. Home health > agencies will not see the uninsured, the under insured, or medicaid > patients. What we need is a healthcare baby-sitting service. If we are to be > graded/judged on our outcomes, those that are doing the judging should own > up to the fact that sometimes its the patients and not the ?greedy? doctors. > > Ed Bender, MD > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Mon Nov 2 00:15:46 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 13:54:13 2009 Subject: [HSF] Health Care Baby Sitting In-Reply-To: References: Message-ID: <89c4ed2d0911011045j4cad06b6t36c7652fc2a7e02a@mail.gmail.com> I think a insurance tax on cigarettes should be charged too. prasanna On Mon, Nov 2, 2009 at 12:06 AM, Giuseppe Rescigno wrote: > Ed, > > we cannot adopt our patients for the rest of their lives. I am a strong > supporter of an additional tax for people with a BMI over 30. People should > ?understand that we will not be able to cover the expenses for their silly > choices. If someone decides to smoke, eat excessively, drink too much, > he/she should accept to have a limited health insurance. > > Giuseppe > > > > Il giorno 01/nov/09, alle ore 19:26, Edward Bender ha scritto: > >> Eight months ago I did double valve replacement (MVR/AVR) on a 75 year old >> man with unremitting sepsis, heart failure, and infected native valves. >> ?He >> was admitted to our hospital yesterday for alcohol toxicity/detox, covered >> in feces, and a cold left leg (previous fem-pop bypass occluded). An echo >> was obtained showing normal prosthetic valves functioning without any >> vegetations. No signs of sepsis, but the hospitalist who admitted the >> patient wanted to make sure there was no cardiac source for an embolus. >> Patient is in sinus rhythm. >> >> As long as we operate on patients like this, we will have outcomes that >> are >> worse than what we would hope for. ?It would be nice if our health care >> plans could attend to the needs of the patient after discharge. Home >> health >> agencies will not see the uninsured, the under insured, or medicaid >> patients. What we need is a healthcare baby-sitting service. If we are to >> be >> graded/judged on our outcomes, those that are doing the judging should own >> up to the fact that sometimes its the patients and not the ?greedy? >> doctors. >> >> Ed Bender, MD >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@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@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 > anddisclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From dukeb60 at aol.com Sun Nov 1 13:54:49 2009 From: dukeb60 at aol.com (Edward P. Raines) Date: Sun Nov 1 13:56:03 2009 Subject: [HSF] Hemolysis In-Reply-To: <89c4ed2d0911011018s35bed22fu8a151702681d8740@mail.gmail.com> References: <89c4ed2d0910310612l6de1ebfbs7b1f7fa8d025c31a@mail.gmail.com> <1948979935-1257002223-cardhu_decombobulator_blackberry.rim.net-173659308-@bda735.bisx.prod.on.blackberry><89c4ed2d0910310825n6bd760beg6fbdddd5985dc626@mail.gmail.com> <89c4ed2d0911011018s35bed22fu8a151702681d8740@mail.gmail.com> Message-ID: <8CC293BEC70FCE9-4F18-2790@webmail-d052.sysops.aol.com> Prasanna, Ross in this instance would indeed be a good option especially since the root can be enlarged anteriorly like a Konno. Have done this a couple times with good results. Combined with a redo mitral would be a substantial case but would solve the LVOT/AV gradient effectively. Can't remember but wasn't the LV pretty good. Excellent myocardial protection for the long clamp time would be essential. Ed -----Original Message----- From: Prasanna Simha M To: OpenHeart-L@lists.hsforum.com Sent: Sun, Nov 1, 2009 12:18 pm Subject: Re: [HSF] Hemolysis Chuck, are you familiar with a Ross. If so you can use Hvass's modification which involves steps that are familiar to those who do a Ross procedure. Prasanna On Sun, Nov 1, 2009 at 11:29 PM, Douville, Chuck wrote: > Thanks for all of the thoughts from all of you. The aortic valve gradient is old based on previous echoes; I think that she has had pt prosthesis mismatch since 1990 in the aortic position. Frankly, I did not think a Manougian enlargement would be feasible but from Prasanna's suggestion it could be. I have not seen a Konno procedure other than in textbooks > > ________________________________ > > From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M > Sent: Sat 10/31/2009 8:25 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Hemolysis > > > > 50 mm Hg would qualify as an indication by itself de novo.That makes > me worried and I would be also concerned weaning the patient off CPB. > I think an apical aortic conduit should be kept as a salvage option in > these cases and primary transaortic ejection would be important to > maintain long term aortic function (windkessel etc).(At least that's > my thought). There are problems noted with retrograde > cerebral,coronary and aortic flow in kids in certain surgeries where > this sort of thing was done so while it may not be a big issue in old > people it may be an issue especially in the young.(not so sure if 66 > years would be considered young or old with average life expectancies > in the 80's) > Prasanna > > On Sat, Oct 31, 2009 at 8:46 PM, wrote: >> Prasanna, >> Thanks for the advice. As for the case described by Chuck, I think it's a mistake to leave a 50 mm aortic gradient and just do the mitral. Getting that pt off CPB may be problematic with severe prosthetic a.s. Even if he gets the pt through surgery, I'll bet the pt remains symptomatic. >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: Prasanna Simha M >> Date: Sat, 31 Oct 2009 18:42:08 >> To: >> Subject: Re: [HSF] Hemolysis >> >> Stark de Leval's text book and Kirklin give a fairly good explanation. You >> cna also see Vouhe's technique for subaortic stenosis resection (Mini Konno) >> in MMCTS which is instructive (though it does not deal with a full Konno >> which is nothing but an extension into the aorta.with an additional patch to >> cover the whole "sin". I would also recommend reading the course of the >> first septal artery in relation to the septum which I feel is mandatory >> reading for people doing a Konno and a Ross.. I will dig out the references >> for you. >> Prasanna >> >> On Sat, Oct 31, 2009 at 7:31 AM, wrote: >> >>> Prasanna, >>> Could you provide a link to the best description of how to do a Konno? >>> Thanks in advance to the "brain trust" of HSF. >>> >>> Hal >>> >>> >>> In a message dated 10/30/2009 9:42:47 P.M. Eastern Daylight Time, >>> prasannasimha@gmail.com writes: >>> >>> How sure are you that the aortic valve is not a part of the problem ? >>> Incidentally I have done these redo's through midline via a transeptal >>> approach. The key is to partially detatch the valave and simultaneoulsy >>> and >>> immediately take the sutures to the annulus. (if the valve is removed the >>> annulus will disappaera behind the aortic bulge.) >>> If you are doing a redo why not do a manouguian double valve or better >>> still >>> a Konno as your aortic gradient is 50 ? Since there are adhesions , a >>> Konno >>> will actually become easier. >>> Prasanna >>> On Fri, Oct 30, 2009 at 10:45 PM, Douville, Chuck >>> wrote: >>> >>> > I have a pt who needs her third heart operation. She is now 66; at age >>> 45 >>> > she a mitral commissurotomy, at age 50 she had St. Jude aortic and >>> mitral >>> > replacements (19 and 27), old op nots describes LVOT as very >>> hypoplastic. >>> > Now weight loss, failure to thrive,weakness. LDH is over 2000. Blood >>> > cultures no growth. Echo shows 50 mm mean aortic gradient, unchanged >>> past 2 >>> > yrs but new mild to mod MR, (perivalvular) and mod TR. If cath is ok, I >>> am >>> > planning to through right thoracotomy to re-do MVR and repair tricuspid. >>> Has >>> > anyone ever done this and regretted the exposure of the >>> > Mitral with the rigid aortic prosthesis in place? I am going to leave >>> her >>> > aortic valve alone; gradient is old and I think it will take a Konno to >>> > improve it. Apical ortic conduit later if needed is my thought. Thx >>> > >>> > Chuck >>> > >>> > Sent from my iPhone >>> > _______________________________________________ >>> > OpenHeart-L mailing list >>> > >>> > Send postings to: >>> > OpenHeart-L@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 >>> > anddisclaimers posted at: >>> > http://www.hsforum.com/listdisclaim >>> > ----------------------------------------- >>> > >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From prasannasimha at gmail.com Mon Nov 2 00:14:15 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 14:11:56 2009 Subject: [HSF] Health Care Baby Sitting In-Reply-To: <89c4ed2d0911011041y68eaca3cseb194462f49b2bb5@mail.gmail.com> References: <89c4ed2d0911011041y68eaca3cseb194462f49b2bb5@mail.gmail.com> Message-ID: <89c4ed2d0911011044x6c421a98tc3454b7286b630d6@mail.gmail.com> I generally insist that they go off cigarettes and start them on a deaddiction program. One advantage in India is to set the wife on nagging mode on the husband. Prasanna On Mon, Nov 2, 2009 at 12:11 AM, Prasanna Simha M wrote: > And also begs for the concern regarding alcohol addiction. the tyranny > of the patients demands does not also factor in the patients duties.I > had one colleague who would refuse to do elective CABG's till they > were off cigarettes. Maybe seems extreme but but it used to work well. > Prasanna > > On Sun, Nov 1, 2009 at 11:56 PM, Edward Bender wrote: >> Eight months ago I did double valve replacement (MVR/AVR) on a 75 year old >> man with unremitting sepsis, heart failure, and infected native valves. ?He >> was admitted to our hospital yesterday for alcohol toxicity/detox, covered >> in feces, and a cold left leg (previous fem-pop bypass occluded). An echo >> was obtained showing normal prosthetic valves functioning without any >> vegetations. No signs of sepsis, but the hospitalist who admitted the >> patient wanted to make sure there was no cardiac source for an embolus. >> Patient is in sinus rhythm. >> >> As long as we operate on patients like this, we will have outcomes that are >> worse than what we would hope for. ?It would be nice if our health care >> plans could attend to the needs of the patient after discharge. Home health >> agencies will not see the uninsured, the under insured, or medicaid >> patients. What we need is a healthcare baby-sitting service. If we are to be >> graded/judged on our outcomes, those that are doing the judging should own >> up to the fact that sometimes its the patients and not the ?greedy? doctors. >> >> Ed Bender, MD >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From prasannasimha at gmail.com Mon Nov 2 00:34:13 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 14:37:51 2009 Subject: [HSF] Hemolysis In-Reply-To: <8CC293BEC70FCE9-4F18-2790@webmail-d052.sysops.aol.com> References: <89c4ed2d0910310612l6de1ebfbs7b1f7fa8d025c31a@mail.gmail.com> <1948979935-1257002223-cardhu_decombobulator_blackberry.rim.net-173659308-@bda735.bisx.prod.on.blackberry> <89c4ed2d0910310825n6bd760beg6fbdddd5985dc626@mail.gmail.com> <89c4ed2d0911011018s35bed22fu8a151702681d8740@mail.gmail.com> <8CC293BEC70FCE9-4F18-2790@webmail-d052.sysops.aol.com> Message-ID: <89c4ed2d0911011104k1bc3e10at7339b5d47f497ad1@mail.gmail.com> Full Ross + MVR would be a good option for this patient (i would consider it if I get hold of a homograft if I was doing the case) but since Chuck was a bit worried, I was thinking of the shorter exposure only method as a way to ease an anterior Konno.One the native valve was out a trans RA transseptal MVR would be pretty quick and then could concnetrate on the aortic pathology. As you mentioned myocardial protection would be very very improtant but this surgey would not be for one to do for a person not conversant with it. Prasanna On Mon, Nov 2, 2009 at 12:24 AM, Edward P. Raines wrote: > Prasanna, > > > ? ?Ross in this instance would indeed be a good option especially since the root can be enlarged anteriorly like a Konno. ?Have done this a couple times with good results. ?Combined with a redo mitral would be a substantial case but would solve the LVOT/AV gradient effectively. ?Can't remember but wasn't the LV pretty good. ?Excellent myocardial protection for the long clamp time would be essential. > > > > > Ed > > > > > > > -----Original Message----- > From: Prasanna Simha M > To: OpenHeart-L@lists.hsforum.com > Sent: Sun, Nov 1, 2009 12:18 pm > Subject: Re: [HSF] Hemolysis > > > > > > > > > Chuck, are you familiar with a Ross. If so you can use Hvass's > modification which involves steps that are familiar to those who do a > Ross procedure. > Prasanna > > On Sun, Nov 1, 2009 at 11:29 PM, Douville, Chuck > wrote: >> Thanks for all of the thoughts from all of you. The aortic valve gradient is > old based on previous echoes; I think that she has had pt prosthesis mismatch > since 1990 in the aortic position. Frankly, I did not think a Manougian > ?enlargement would be feasible but from Prasanna's suggestion it could be. I > have not seen a Konno procedure other than in textbooks >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M >> Sent: Sat 10/31/2009 8:25 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Hemolysis >> >> >> >> 50 mm Hg would qualify as an indication by itself de novo.That makes >> me worried and I would be also concerned weaning the patient off CPB. >> I think an apical aortic conduit should be kept as a salvage option in >> these cases and primary transaortic ejection would be important to >> maintain long term aortic function (windkessel etc).(At least that's >> my thought). There are problems noted with retrograde >> cerebral,coronary and aortic flow in kids in certain surgeries where >> this sort of thing was done so while it may not be a big issue in old >> people it may be an issue especially in the young.(not so sure if 66 >> years would be considered young or old with average life expectancies >> in the 80's) >> Prasanna >> >> On Sat, Oct 31, 2009 at 8:46 PM, ? wrote: >>> Prasanna, >>> ?Thanks for the advice. As for the case described by Chuck, I think it's a > mistake to leave a 50 mm aortic gradient and just do the mitral. ?Getting that > pt off CPB may be problematic with severe prosthetic a.s. ?Even if he gets the > pt through surgery, I'll bet the pt remains symptomatic. >>> >>> Hal >>> Sent from my Verizon Wireless BlackBerry >>> >>> -----Original Message----- >>> From: Prasanna Simha M >>> Date: Sat, 31 Oct 2009 18:42:08 >>> To: >>> Subject: Re: [HSF] Hemolysis >>> >>> Stark de Leval's text book and Kirklin give a fairly good explanation. You >>> cna also see Vouhe's technique for subaortic stenosis resection (Mini Konno) >>> in MMCTS which is instructive (though it does not deal with a full Konno >>> which is nothing but an extension into the aorta.with an additional patch to >>> cover the whole "sin". I would also recommend reading the course of the >>> first septal artery in relation to the septum which I feel is mandatory >>> reading for people doing a Konno and a Ross.. I will dig out the references >>> for you. >>> Prasanna >>> >>> On Sat, Oct 31, 2009 at 7:31 AM, wrote: >>> >>>> Prasanna, >>>> ?Could you provide a link to the best description of how to do a ?Konno? >>>> Thanks in advance to the "brain trust" of HSF. >>>> >>>> Hal >>>> >>>> >>>> In a message dated 10/30/2009 9:42:47 P.M. Eastern Daylight Time, >>>> prasannasimha@gmail.com writes: >>>> >>>> How sure ?are you that the aortic valve is not a part of the problem ? >>>> Incidentally I ?have done these redo's through midline ?via a transeptal >>>> approach. The ?key is to partially detatch the valave and simultaneoulsy >>>> and >>>> immediately ?take the sutures to the annulus. (if the valve is removed the >>>> annulus will ?disappaera behind the aortic bulge.) >>>> If you are doing a redo why not do a ?manouguian double valve or better >>>> still >>>> a Konno as your aortic gradient is ?50 ? Since there are adhesions , a >>>> Konno >>>> will actually become ?easier. >>>> Prasanna >>>> On Fri, Oct 30, 2009 at 10:45 PM, Douville, ?Chuck >>>> wrote: >>>> >>>> > I have a pt who ?needs her third heart operation. She is now 66; at age >>>> 45 >>>> > she a mitral ?commissurotomy, at age 50 she had St. Jude aortic and >>>> mitral >>>> > ?replacements (19 and 27), old op nots describes LVOT as very >>>> hypoplastic. >>>> > Now weight loss, failure to thrive,weakness. LDH is over ?2000. Blood >>>> > cultures no growth. Echo shows 50 mm mean aortic gradient, ?unchanged >>>> past 2 >>>> > yrs but new mild to mod MR, (perivalvular) and mod ?TR. If cath is ok, I >>>> am >>>> > planning to through right thoracotomy to re-do ?MVR and repair tricuspid. >>>> Has >>>> > anyone ever done this and regretted the ?exposure of the >>>> > Mitral with the rigid aortic prosthesis in ?place? ?I am going to leave >>>> her >>>> > aortic valve alone; gradient is ?old and I think it will take a Konno to >>>> > improve it. Apical ortic ?conduit later if needed is my thought. Thx >>>> > >>>> > ?Chuck >>>> > >>>> > Sent from my iPhone >>>> > ?_______________________________________________ >>>> > OpenHeart-L mailing ?list >>>> > >>>> > Send postings to: >>>> > ?OpenHeart-L@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 >>>> > ?anddisclaimers posted at: >>>> > http://www.hsforum.com/listdisclaim >>>> > ?----------------------------------------- >>>> > >>>> >>>> >>>> >>>> -- >>>> Prasanna Simha ?M >>>> _______________________________________________ >>>> OpenHeart-L mailing ?list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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 >>>> ----------------------------------------- >>>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> ?OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > ?OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Nov 1 23:51:02 2009 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Nov 1 15:17:34 2009 Subject: [HSF] Hemolysis In-Reply-To: <89c4ed2d0911011018s35bed22fu8a151702681d8740@mail.gmail.com> References: <89c4ed2d0910310612l6de1ebfbs7b1f7fa8d025c31a@mail.gmail.com> <1948979935-1257002223-cardhu_decombobulator_blackberry.rim.net-173659308-@bda735.bisx.prod.on.blackberry> <89c4ed2d0910310825n6bd760beg6fbdddd5985dc626@mail.gmail.com> <89c4ed2d0911011018s35bed22fu8a151702681d8740@mail.gmail.com> Message-ID: <89c4ed2d0911011021q6ac33572y28595f1f26cd92c7@mail.gmail.com> (Hvass did a modification of the Konno where he partially detatchess the pulmonary artery anteriorly to expose the common muscular septum (anterior dissection of the PA in a Ross) which can be incised + patched to enlarge the root after which the pulmonary artery is resutured back. This is an easy procedure for those familiar with Pulmonary autograft explantation. Prasanna On Sun, Nov 1, 2009 at 11:48 PM, Prasanna Simha M wrote: > Chuck, are you familiar with a Ross. If so you can use Hvass's > modification which involves steps that are familiar to those who do a > Ross procedure. > Prasanna > > On Sun, Nov 1, 2009 at 11:29 PM, Douville, Chuck > wrote: >> Thanks for all of the thoughts from all of you. The aortic valve gradient is old based on previous echoes; I think that she has had pt prosthesis mismatch since 1990 in the aortic position. Frankly, I did not think a Manougian ?enlargement would be feasible but from Prasanna's suggestion it could be. I have not seen a Konno procedure other than in textbooks >> >> ________________________________ >> >> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna Simha M >> Sent: Sat 10/31/2009 8:25 AM >> To: OpenHeart-L@lists.hsforum.com >> Subject: Re: [HSF] Hemolysis >> >> >> >> 50 mm Hg would qualify as an indication by itself de novo.That makes >> me worried and I would be also concerned weaning the patient off CPB. >> I think an apical aortic conduit should be kept as a salvage option in >> these cases and primary transaortic ejection would be important to >> maintain long term aortic function (windkessel etc).(At least that's >> my thought). There are problems noted with retrograde >> cerebral,coronary and aortic flow in kids in certain surgeries where >> this sort of thing was done so while it may not be a big issue in old >> people it may be an issue especially in the young.(not so sure if 66 >> years would be considered young or old with average life expectancies >> in the 80's) >> Prasanna >> >> On Sat, Oct 31, 2009 at 8:46 PM, ? wrote: >>> Prasanna, >>> ?Thanks for the advice. As for the case described by Chuck, I think it's a mistake to leave a 50 mm aortic gradient and just do the mitral. ?Getting that pt off CPB may be problematic with severe prosthetic a.s. ?Even if he gets the pt through surgery, I'll bet the pt remains symptomatic. >>> >>> Hal >>> Sent from my Verizon Wireless BlackBerry >>> >>> -----Original Message----- >>> From: Prasanna Simha M >>> Date: Sat, 31 Oct 2009 18:42:08 >>> To: >>> Subject: Re: [HSF] Hemolysis >>> >>> Stark de Leval's text book and Kirklin give a fairly good explanation. You >>> cna also see Vouhe's technique for subaortic stenosis resection (Mini Konno) >>> in MMCTS which is instructive (though it does not deal with a full Konno >>> which is nothing but an extension into the aorta.with an additional patch to >>> cover the whole "sin". I would also recommend reading the course of the >>> first septal artery in relation to the septum which I feel is mandatory >>> reading for people doing a Konno and a Ross.. I will dig out the references >>> for you. >>> Prasanna >>> >>> On Sat, Oct 31, 2009 at 7:31 AM, wrote: >>> >>>> Prasanna, >>>> ?Could you provide a link to the best description of how to do a ?Konno? >>>> Thanks in advance to the "brain trust" of HSF. >>>> >>>> Hal >>>> >>>> >>>> In a message dated 10/30/2009 9:42:47 P.M. Eastern Daylight Time, >>>> prasannasimha@gmail.com writes: >>>> >>>> How sure ?are you that the aortic valve is not a part of the problem ? >>>> Incidentally I ?have done these redo's through midline ?via a transeptal >>>> approach. The ?key is to partially detatch the valave and simultaneoulsy >>>> and >>>> immediately ?take the sutures to the annulus. (if the valve is removed the >>>> annulus will ?disappaera behind the aortic bulge.) >>>> If you are doing a redo why not do a ?manouguian double valve or better >>>> still >>>> a Konno as your aortic gradient is ?50 ? Since there are adhesions , a >>>> Konno >>>> will actually become ?easier. >>>> Prasanna >>>> On Fri, Oct 30, 2009 at 10:45 PM, Douville, ?Chuck >>>> wrote: >>>> >>>> > I have a pt who ?needs her third heart operation. She is now 66; at age >>>> 45 >>>> > she a mitral ?commissurotomy, at age 50 she had St. Jude aortic and >>>> mitral >>>> > ?replacements (19 and 27), old op nots describes LVOT as very >>>> hypoplastic. >>>> > Now weight loss, failure to thrive,weakness. LDH is over ?2000. Blood >>>> > cultures no growth. Echo shows 50 mm mean aortic gradient, ?unchanged >>>> past 2 >>>> > yrs but new mild to mod MR, (perivalvular) and mod ?TR. If cath is ok, I >>>> am >>>> > planning to through right thoracotomy to re-do ?MVR and repair tricuspid. >>>> Has >>>> > anyone ever done this and regretted the ?exposure of the >>>> > Mitral with the rigid aortic prosthesis in ?place? ?I am going to leave >>>> her >>>> > aortic valve alone; gradient is ?old and I think it will take a Konno to >>>> > improve it. Apical ortic ?conduit later if needed is my thought. Thx >>>> > >>>> > ?Chuck >>>> > >>>> > Sent from my iPhone >>>> > ?_______________________________________________ >>>> > OpenHeart-L mailing ?list >>>> > >>>> > Send postings to: >>>> > ?OpenHeart-L@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 >>>> > ?anddisclaimers posted at: >>>> > http://www.hsforum.com/listdisclaim >>>> > ?----------------------------------------- >>>> > >>>> >>>> >>>> >>>> -- >>>> Prasanna Simha ?M >>>> _______________________________________________ >>>> OpenHeart-L mailing ?list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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 >>>> ----------------------------------------- >>>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> ?OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> ?OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > -- Prasanna Simha M From msfirst at gmail.com Sun Nov 1 17:47:29 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Nov 1 18:01:58 2009 Subject: [HSF] Health Care Baby Sitting In-Reply-To: <89c4ed2d0911011041y68eaca3cseb194462f49b2bb5@mail.gmail.com> References: <89c4ed2d0911011041y68eaca3cseb194462f49b2bb5@mail.gmail.com> Message-ID: <60FC9FA3-F64D-4891-9388-5900D8F39F71@gmail.com> Refused CABG unless off smoking - ha! I had a thoracic surgeon teacher who refused thoracic surgery (even cancer operations) unless patients stopped smoking. He was not very busy. It is not entirely the patients fault (although they need to take responsibility for their addictions and medical problems) if the "system" does not help. -michael On Nov 1, 2009, at 1:41 PM, Prasanna Simha M wrote: > And also begs for the concern regarding alcohol addiction. the tyranny > of the patients demands does not also factor in the patients duties.I > had one colleague who would refuse to do elective CABG's till they > were off cigarettes. Maybe seems extreme but but it used to work well. > Prasanna > > On Sun, Nov 1, 2009 at 11:56 PM, Edward Bender > wrote: >> Eight months ago I did double valve replacement (MVR/AVR) on a 75 >> year old >> man with unremitting sepsis, heart failure, and infected native >> valves. He >> was admitted to our hospital yesterday for alcohol toxicity/detox, >> covered >> in feces, and a cold left leg (previous fem-pop bypass occluded). >> An echo >> was obtained showing normal prosthetic valves functioning without any >> vegetations. No signs of sepsis, but the hospitalist who admitted the >> patient wanted to make sure there was no cardiac source for an >> embolus. >> Patient is in sinus rhythm. >> >> As long as we operate on patients like this, we will have outcomes >> that are >> worse than what we would hope for. It would be nice if our health >> care >> plans could attend to the needs of the patient after discharge. >> Home health >> agencies will not see the uninsured, the under insured, or medicaid >> patients. What we need is a healthcare baby-sitting service. If we >> are to be >> graded/judged on our outcomes, those that are doing the judging >> should own >> up to the fact that sometimes its the patients and not the ?greedy? >> doctors. >> >> Ed Bender, MD >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From guilherme at succi.com.br Sun Nov 1 23:10:15 2009 From: guilherme at succi.com.br (guilherme@succi.com.br) Date: Sun Nov 1 18:10:55 2009 Subject: Enc: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? Message-ID: <1807098458-1257117018-cardhu_decombobulator_blackberry.rim.net-1948713565-@bda122.bisx.produk.on.blackberry> Enviado do meu BlackBerry? da TIM -----Original Message----- From: guilherme@succi.com.br Date: Sun, 1 Nov 2009 12:23:16 To: Subject: Res: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? Dear members, I work in Brazil and I can tell you the things were worse down here 5 years ago. I think cardiologists have realized their patients had not done so well with that lot of coronary stenting. Our number of referred patients have grown in the past few years since the stents - proclaimed to be "never occluding" ones started to kill young people with left main or LAD disease. The aortic stenting is a reality and if one don't stop his practice for a six month period or so to get trained in this field he would never be able to compete in the head of the market. I believe there are going to be patients for everyone. And I can't stop my practice for six months to learn endovascular. Guilherme Succi Sao Paulo Brazil Enviado do meu BlackBerry? da TIM -----Original Message----- From: hgrmd@aol.com Date: Sun, 1 Nov 2009 11:48:29 To: Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? Prasanna, Not sure of the Magna data either, but it is made with Edwards pericardial leaflets for which I have 19 years of experience in private practice. The number of senescent Edwards pericardial valves I've replaced I could count on one hand, and I've never replaced one I inserted. Not a scientific paper, but strong empiric personal experience, IMHO. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: Prasanna Simha M Date: Sun, 1 Nov 2009 16:40:28 To: Subject: Re: [HSF] Is the 3F Aortic Valve a Good Alternative? Hal , how long is the Magna around ? We have been using it in India for a few years (frightfully expensive here). I am not sure how many years follow up is there for the Magna . Remember that even changes in these valves do not equate to similar results though the name may be the same.I doubt that Magna has a follow up equal to that of even teh mitroflow.Any one has literature ? I think the earliest reports were that of Totaro et al in 2003 or 2005 Prasanna On Sat, Oct 31, 2009 at 5:44 PM, wrote: > Dave, > ?Which "Edwards 23" are you referring? ?Maybe the old Perimount, ?but I > highly doubt a Mitroflow 19 is equivalent to an Edwards Magna Ease ?23. ?In > addition, I doubt that Mitroflow has the kind of durability ?data. ?If so, > please provide references. > > Hal > > > In a message dated 10/31/2009 4:45:34 A.M. Eastern Daylight Time, > drdharris@yahoo.co.uk writes: > > I would ?personally only use that valve if there are distinct technical > advantages - ?like the Mitroflow (good long term results reported at EACTS). > Mitroflow 19 ?also reported to be equiv to Edwards 23. If I was at a high > volume academic ?centre I would use it, with good follow up...there is always > potential for ?better results long term-which may become irrelevant with the > new ?transcatheter valves. Dave > > Giuseppe Rescigno wrote: >> ?Hal, >> I have implanted three 3F aortic valves. They are quite easy to ?implant > and there is a theretical benefit in tubular prostheses. You should, ?as for > every stentless, be horizontal with the stitches without following the > annulus. It is therefore quite easy to put the commisures at the right > positions thanks to the holder. Aortotomy should be horizontal and above the ?STJ. > They works pretty well but trans gradient are not so low as company says. ?I > implanted it in over 80 yo people and this should be the ideal population > for a limited follow-up valve. Sorin Fredom Solo is probably more friendly > and ?the number of implants is significantly greater (at least in Italy). > Nevertheless during last year I came to the conclusion that stented valves > warrant the best reproducible result and I stopped using either 3F and ?Solo. >> Giuseppe >> Il giorno 26/ott/09, alle ore 00:57, ?Hgrmd@aol.com ha scritto: >>> Members, >>> ? Lately, ?I've gotten a lot of heat from the ATS rep trying to > convince ?me >>> to use the 3F aortic valve. ?Having been in this ?profession ?long > enough to >>> see valves come and go, I'd like ?to hear thoughts from other ?members, >>> especially the ?users. >>> >>> Hal >>> ?_______________________________________________ >>> OpenHeart-L ?mailing list >>> >>> Send postings to: >>> ? OpenHeart-L@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@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 > anddisclaimers ?posted at: >> http://www.hsforum.com/listdisclaim >> ?----------------------------------------- > >_______________________________________________ > OpenHeart-L ?mailing list > > Send postings ?to: > OpenHeart-L@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@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 > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From msfirst at gmail.com Sun Nov 1 17:49:53 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Nov 1 18:17:04 2009 Subject: [HSF] Health Care Baby Sitting In-Reply-To: References: Message-ID: <65E3A5F3-8970-467A-8C69-959B9A29A445@gmail.com> We see a lot of this - we have a very high readmission rate - particularly over the weekend (just took another transfer) - patient go to nursing homes or rehab facilities, they dont like (compared to our very nice 24 hr bedside service hospital), they want to go home instead, complain of a little chest pain or shortness of breath and they get zipped right back..... I can count on at least 1-2 re-admits over the weekend. Typically nothing wrong - maybe give an extra dose or 2 of lasix just to conform someone (us? them? the system?), get an echo and a bunch of other tests, spends lots of money, and start the placement process all over again. Obviously your example is a tragic extreme - we have many patients who spend "at least a month" in the hospital to avoid the uncertainty of a discharge. Hence my previous comments about mechanical valves, coumadin in the elderly, etc. And then we get dumped back on since no one else will re-admit regardless of the problems (see my recent comments about stent grafting).... We had a former fellow who used to say - the only way to succeed is to care slightly less then the next person. -michael On Nov 1, 2009, at 1:26 PM, Edward Bender wrote: > Eight months ago I did double valve replacement (MVR/AVR) on a 75 > year old > man with unremitting sepsis, heart failure, and infected native > valves. He > was admitted to our hospital yesterday for alcohol toxicity/detox, > covered > in feces, and a cold left leg (previous fem-pop bypass occluded). An > echo > was obtained showing normal prosthetic valves functioning without any > vegetations. No signs of sepsis, but the hospitalist who admitted the > patient wanted to make sure there was no cardiac source for an > embolus. > Patient is in sinus rhythm. > > As long as we operate on patients like this, we will have outcomes > that are > worse than what we would hope for. It would be nice if our health > care > plans could attend to the needs of the patient after discharge. Home > health > agencies will not see the uninsured, the under insured, or medicaid > patients. What we need is a healthcare baby-sitting service. If we > are to be > graded/judged on our outcomes, those that are doing the judging > should own > up to the fact that sometimes its the patients and not the ?greedy? > doctors. > > Ed Bender, MD > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From msfirst at gmail.com Sun Nov 1 18:11:57 2009 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Nov 1 18:19:06 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: <2105951765-1257099796-cardhu_decombobulator_blackberry.rim.net-172959978-@bda735.bisx.prod.on.blackberry> References: <2105951765-1257099796-cardhu_decombobulator_blackberry.rim.net-172959978-@bda735.bisx.prod.on.blackberry> Message-ID: <513475FB-FBA5-4D2C-859D-39DFB25EC862@gmail.com> 1. went on bypass through the groin (he of course was morbidly obese) 2. opened the chest 3. dug out the heart (was not as bad as I thought 4 months post-op) 4. cross-clamped (antegrade) 5. opened up the right atrium - direct retrograde (and I make up ice patties to rest on the RV for cases like this) 6. opened up the aorta - looked at the valve, said "ugh, told perfusion to 'get a bigger boat' 7. carried the RA incisions to a transseptal approach to the mitral 8. hacked out the valve valve (which looked horrible - should have taken pictures - but wanted to be efficient and keep moving) (including the annular tissue and anterior mitral which was infected 9. carried the incision from the aorta down to where the mitral leaflet was 10. mobilized buttons. 11. looked at the giant cavity of RA-LV-LA-aorta and told the fellow to close it all up and I will meet him in the ICU 12. replaced the mitral (tissue) to what was left of the posterior annulus 13. pericardium to the anterior portion of the annulus to close the dome of the LA and intra-atrial spetum. 14. sewed in a homograft to what was left of the outflow tract and to the other side of the pericardial patch (folded in half - and sewn in the middle to to mitral - halt to #13 have to the outflow tract). Inverted into LV and 3 sutured at each "commisure" and running closure 15. re-implanted buttons and attached back to ascending aorta 16. took out tricuspid (probably should have done eariler) - but did not look obviously infected, but the early gram strain was) 17. replaced tricuspid. 18 took cross-clamp off and prayed. 19 heart start up. 20 lots of bleeding from homograft - tried to repair without much success 21 re-clamped and opened up ascending. 22 couldn't see obvious source - but new it was coming from suture line. 23 homograft was falling apart from inside?????? 24 tossed out a few swear words, started crying 25 started taking out HG for a tissue valved conduit (i.e. Bentall) - called Senior partner who came in to give me a break and help a little 26 sewing in conduit - he left to evaluate someone for ecmo for H1N1 (another topic) 27 re-implanted buttons attached aorta. 28 cross clamp off. 29 lots of prayer!!!! 30 came off, bleeding didnt look to bad (no not bloodless, lots and lots of help, factor 7, nitric, pulverized kitchen-sink). 31 echo looked reasonable. 32 about an hour after coming off, start to sag big time 33 femV-asc aorta ECMO. Packed chest, left over...... called it a day (608 minutes on-pump.... a new record, for me) 34 re-explored this am early for bleeding, nothing horrible, heart looked reasonable (junctional rhythm) but empty. 35 let him rest for a few days..... will wash out when I recover..... so far, early cultures show everything was infected........ he was wide awake in the ICU this am......... he had an EF of 30 when all of this started - probably ran out of "gas", hopefully didnt bag his RCA button (his RV didnt look that bad coming off). dont know about you, but we have been seeing a lot of bad (multiple valve) and complex endocarditis lately. I had a recent contained ruptured of a of sinus of valsalva abscess that also trashed a couple of valves in a 30 year/old with tons of other problems. Is there a reference surgeon that I can send these patients to? (yeah, right) thoughts comments? -michael On Nov 1, 2009, at 1:22 PM, hgrmd@aol.com wrote: > Michael, > How did you deal with the root abscess? > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Michael Firstenberg > Date: Sun, 1 Nov 2009 12:40:39 > To: > Subject: Re: [HSF] Changing field in Our specialty > > just teasing - and trying to get you fired up....... > > my case yesterday was a double valve (AVR/TVR) endocarditis case I did > in July - he came back in with a root abscess extending to his mitral > & LVOT, septic emboli, and a avr gradient that went from 25->80 mmHg > over two weeks..... and new heart block....febrile with positive blood > cultures going into the OR. > > Was a disaster...... but he is awake, so there is hope....... > > > > On Nov 1, 2009, at 12:17 PM, hgrmd@aol.com wrote: > >> Michael, >> Of course they should have a say, but criteria need to be met. >> Otherwise, the patient is welcome to pay out of his own pocket. >> The patient should >> be able to decide if it is a borderline case. To me, it's the same >> thinking as in seat belt laws. Not everyone is thrilled with them, >> but the public >> interest is best served. >> >> Hal >> >> >> In a message dated 11/1/2009 12:09:36 P.M. Eastern Standard Time, >> msfirst@gmail.com writes: >> >> so what you are implying is that the patient should not have a say >> in >> what they want? >> >> >> -michael >> >> >> On Nov 1, 2009, at 11:59 AM, Hgrmd@aol.com wrote: >> >>> Prasanna, >>> Sorry, CAS is carotid artery stenting. Medicare is quite strict >>> about >>> the clinical conditions for which it will pay for this procedure. >>> I am >>> hopeful that AVI's will be restricted to patients deemed high risk >>> and not just >>> because the pt prefers a needle stick to an incision. >>> >>> Hal >>> >>> >>> In a message dated 11/1/2009 11:49:09 A.M. Eastern Standard Time, >>> prasannasimha@gmail.com writes: >>> >>> What is CAS ? >>> Prasanna >>> >>> On Sun, Nov 1, 2009 at 7:29 PM, wrote: >>>> John, >>>> Hopefully, the Feds and the providers will keep them in check. >>>> They've >>> done that with CAS. >>>> >>>> Hal >>>> Sent from my Verizon Wireless BlackBerry >>>> >>>> -----Original Message----- >>>> From: John Schor >>>> Date: Sun, 01 Nov 2009 05:57:41 >>>> To: >>>> Subject: Re: [HSF] Changing field in Our specialty >>>> >>>> I agree with Hal about suboptimal results with some of these >>>> disruptive technologies, BUT, the train is rolling. As we all >>>> know, >>>> patient flow is controlled by the cardiologists, and 99% believe >>>> that >>>> surgery is bad and catheters are good. >>>> John >>>> John Schor, MD >>>> Thoracic and Cardiovascular Surgery >>>> Heart and Vascular Center of >>>> Northern Arizona >>>> Flagstaff, Sedona, and >>>> Cottonwood, AZ >>>> Tel: 928-649-2584 >>>> >>>> On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: >>>> >>>>> John, >>>>> Agree it will be a "scary ride", mainly for the patients as >>>>> some of >>>>> those technqies you describe give them clearly suboptimal >>>>> results. >>>>> I strongly suspect the doc at TCT doing the ostial LM stenting >>>>> with >>>>> a "perfect" result would be getting conventional LIMA to LAD if >>>>> he >>>>> had the same anatomy. I won't even begin to tell you my >>>>> thoughts >>>>> of >>>>> an E Valve clip and a c.s. Screwing up the anatomy of a >>>>> repairable >>>>> valve. >>>>> >>>>> >>>>> >>>>> >>>>> Hal >>>>> Sent from my Verizon Wireless BlackBerry >>>>> >>>>> -----Original Message----- >>>>> From: John Schor >>>>> Date: Sat, 31 Oct 2009 21:18:51 >>>>> To: >>>>> Subject: Re: [HSF] Changing field in Our specialty >>>>> >>>>> In thoracic cases, the same size criteria is used for stent >>>>> grafting >>>>> as for open surgery. >>>>> >>>>> I have believed for the past 9 yrs that "open surgery" would be >>>>> relegated to history books. As doctors( not just as CV >>>>> surgeons), >>>>> we >>>>> should be prepared for 1. repairs (of all organ systems) rather >>>>> than >>>>> replacements 2. Avoidance of incisions--or increased use of >>>>> scopes-- >>>>> whenever possible 3. Natural Orifice access surgery 4. >>>>> Medication >>>>> rather than surgery. >>>>> >>>>> The aorta, from the sinotubular junction to the bifurcation, >>>>> will >>>>> be >>>>> "fixed" with endovascular techniques. (probably in less than 10 >>>>> yrs) >>>>> Agree with Tom. Even in my small community hospital working >>>>> alone >>>>> in >>>>> the OR (no PA or first assistants), I have been able to fix 10cm >>>>> ruptured AAA with stent grafting. >>>>> >>>>> You should all attend a Cardiology meeting such as the TCT. You >>>>> will >>>>> be amazed to see such things as L Main stenting for 95% ostial >>>>> lesion-- >>>>> with PERFECT result. Transfemoral and transapical AVR's done >>>>> safely. >>>>> MV repairs with clips and then reinforced with coronary sinus >>>>> rings........ >>>>> >>>>> Hold on to your hats. It's gonna be a scary ride. >>>>> >>>>> John >>>>> >>>>> John Schor, MD >>>>> Thoracic and Cardiovascular Surgery >>>>> Heart and Vascular Center of >>>>> Northern Arizona >>>>> Flagstaff, Sedona, and >>>>> Cottonwood, AZ >>>>> Tel: 928-649-2584 >>>>> >>>>> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: >>>>> >>>>>> What is your threshold for intervention, i mean the size for >>>>>> descending aorta. >>>>>> >>>>>> Zhandong Zhou, MD >>>>>> St. Joseph Hospital >>>>>> Syracuse, New York >>>>>> Tel: 315 423 7192 >>>>>> >>>>>> On Oct 31, 2009, at 5:30 PM, John Schor >>>>>> wrote: >>>>>> >>>>>>> Agree. >>>>>>> See many of my previous posts. >>>>>>> John >>>>>>> John Schor, MD >>>>>>> Thoracic and Cardiovascular Surgery >>>>>>> Heart and Vascular Center of >>>>>>> Northern Arizona >>>>>>> Flagstaff, Sedona, and >>>>>>> Cottonwood, AZ >>>>>>> Tel: 928-649-2584 >>>>>>> >>>>>>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>>>>>> >>>>>>>> To all, >>>>>>>> >>>>>>>> I am in DC for a endovascular course for thoracic aneurysm. >>>>>>>> Only >>>>>>>> 25% are CV surgeons. Others are vascular, radiology, >>>>>>>> cardiologist. >>>>>>>> >>>>>>>> We need to catch up, without these skills, we are going to >>>>>>>> lose >>>>>>>> the percutaneous valve. >>>>>>>> >>>>>>>> Any thoughts? >>>>>>>> >>>>>>>> Z Zhou_______________________________________________ >>>>>>>> OpenHeart-L mailing list >>>>>>>> >>>>>>>> Send postings to: >>>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>>> http://www.hsforum.com/listdisclaim >>>>>>>> ----------------------------------------- >>>>>>> >>>>>>> _______________________________________________ >>>>>>> OpenHeart-L mailing list >>>>>>> >>>>>>> Send postings to: >>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>> http://www.hsforum.com/listdisclaim >>>>>>> ----------------------------------------- >>>>>> _______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>> http://www.hsforum.com/listdisclaim >>>>>> ----------------------------------------- >>>>> >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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@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@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@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 >>>> ----------------------------------------- >>>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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@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@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@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 > ----------------------------------------- From flege19 at gmail.com Sun Nov 1 18:25:12 2009 From: flege19 at gmail.com (Flege John) Date: Sun Nov 1 18:25:42 2009 Subject: [HSF] Hemolysis In-Reply-To: <89c4ed2d0911011104k1bc3e10at7339b5d47f497ad1@mail.gmail.com> References: <89c4ed2d0910310612l6de1ebfbs7b1f7fa8d025c31a@mail.gmail.com> <1948979935-1257002223-cardhu_decombobulator_blackberry.rim.net-173659308-@bda735.bisx.prod.on.blackberry> <89c4ed2d0910310825n6bd760beg6fbdddd5985dc626@mail.gmail.com> <89c4ed2d0911011018s35bed22fu8a151702681d8740@mail.gmail.com> <8CC293BEC70FCE9-4F18-2790@webmail-d052.sysops.aol.com> <89c4ed2d0911011104k1bc3e10at7339b5d47f497ad1@mail.gmail.com> Message-ID: <8211D4F8-76D8-4376-860C-C015949E6618@gmail.com> Another possibility would be to extend the aortotomy past the depth of the noncoronary sinus and across the mitral annulus and onto the atrial septum and after the aortic and mitral prosthetic valves are removed the heart is opened like a book. The mitral replacement can be done and then the aortic valve sewn in. The residual defect is then closed with a diamond shaped patch of one's choice suturing it to the edges of the atrial septum, to the sewing rings of the two prosthetic valves, and to the aortic edges. A second patch will be required to close the right atrium. This has been described, I think first by Hugh Scully of Toronto about 40 years ago and more recently by someone else. I have done it twice, the first time with a good result, and the second time not, due to technical mishaps. It should not take very long to do this if you understand the anatomy. Some practice on the bench with a heart from autopsy or a pig heart might be useful. John Flege On Nov 1, 2009, at 2:04 PM, Prasanna Simha M wrote: > Full Ross + MVR would be a good option for this patient (i would > consider it if I get hold of a homograft if I was doing the case) but > since Chuck was a bit worried, I was thinking of the shorter exposure > only method as a way to ease an anterior Konno.One the native valve > was out a trans RA transseptal MVR would be pretty quick and then > could concnetrate on the aortic pathology. As you mentioned myocardial > protection would be very very improtant but this surgey would not be > for one to do for a person not conversant with it. > Prasanna > > On Mon, Nov 2, 2009 at 12:24 AM, Edward P. Raines > wrote: >> Prasanna, >> >> >> Ross in this instance would indeed be a good option especially >> since the root can be enlarged anteriorly like a Konno. Have done >> this a couple times with good results. Combined with a redo mitral >> would be a substantial case but would solve the LVOT/AV gradient >> effectively. Can't remember but wasn't the LV pretty good. >> Excellent myocardial protection for the long clamp time would be >> essential. >> >> >> >> >> Ed >> >> >> >> >> >> >> -----Original Message----- >> From: Prasanna Simha M >> To: OpenHeart-L@lists.hsforum.com >> Sent: Sun, Nov 1, 2009 12:18 pm >> Subject: Re: [HSF] Hemolysis >> >> >> >> >> >> >> >> >> Chuck, are you familiar with a Ross. If so you can use Hvass's >> modification which involves steps that are familiar to those who do a >> Ross procedure. >> Prasanna >> >> On Sun, Nov 1, 2009 at 11:29 PM, Douville, Chuck >> wrote: >>> Thanks for all of the thoughts from all of you. The aortic valve >>> gradient is >> old based on previous echoes; I think that she has had pt >> prosthesis mismatch >> since 1990 in the aortic position. Frankly, I did not think a >> Manougian >> enlargement would be feasible but from Prasanna's suggestion it >> could be. I >> have not seen a Konno procedure other than in textbooks >>> >>> ________________________________ >>> >>> From: openheart-l-bounces@lists.hsforum.com on behalf of Prasanna >>> Simha M >>> Sent: Sat 10/31/2009 8:25 AM >>> To: OpenHeart-L@lists.hsforum.com >>> Subject: Re: [HSF] Hemolysis >>> >>> >>> >>> 50 mm Hg would qualify as an indication by itself de novo.That makes >>> me worried and I would be also concerned weaning the patient off >>> CPB. >>> I think an apical aortic conduit should be kept as a salvage >>> option in >>> these cases and primary transaortic ejection would be important to >>> maintain long term aortic function (windkessel etc).(At least that's >>> my thought). There are problems noted with retrograde >>> cerebral,coronary and aortic flow in kids in certain surgeries where >>> this sort of thing was done so while it may not be a big issue in >>> old >>> people it may be an issue especially in the young.(not so sure if 66 >>> years would be considered young or old with average life >>> expectancies >>> in the 80's) >>> Prasanna >>> >>> On Sat, Oct 31, 2009 at 8:46 PM, wrote: >>>> Prasanna, >>>> Thanks for the advice. As for the case described by Chuck, I >>>> think it's a >> mistake to leave a 50 mm aortic gradient and just do the mitral. >> Getting that >> pt off CPB may be problematic with severe prosthetic a.s. Even if >> he gets the >> pt through surgery, I'll bet the pt remains symptomatic. >>>> >>>> Hal >>>> Sent from my Verizon Wireless BlackBerry >>>> >>>> -----Original Message----- >>>> From: Prasanna Simha M >>>> Date: Sat, 31 Oct 2009 18:42:08 >>>> To: >>>> Subject: Re: [HSF] Hemolysis >>>> >>>> Stark de Leval's text book and Kirklin give a fairly good >>>> explanation. You >>>> cna also see Vouhe's technique for subaortic stenosis resection >>>> (Mini Konno) >>>> in MMCTS which is instructive (though it does not deal with a >>>> full Konno >>>> which is nothing but an extension into the aorta.with an >>>> additional patch to >>>> cover the whole "sin". I would also recommend reading the course >>>> of the >>>> first septal artery in relation to the septum which I feel is >>>> mandatory >>>> reading for people doing a Konno and a Ross.. I will dig out the >>>> references >>>> for you. >>>> Prasanna >>>> >>>> On Sat, Oct 31, 2009 at 7:31 AM, wrote: >>>> >>>>> Prasanna, >>>>> Could you provide a link to the best description of how to do >>>>> a Konno? >>>>> Thanks in advance to the "brain trust" of HSF. >>>>> >>>>> Hal >>>>> >>>>> >>>>> In a message dated 10/30/2009 9:42:47 P.M. Eastern Daylight Time, >>>>> prasannasimha@gmail.com writes: >>>>> >>>>> How sure are you that the aortic valve is not a part of the >>>>> problem ? >>>>> Incidentally I have done these redo's through midline via a >>>>> transeptal >>>>> approach. The key is to partially detatch the valave and >>>>> simultaneoulsy >>>>> and >>>>> immediately take the sutures to the annulus. (if the valve is >>>>> removed the >>>>> annulus will disappaera behind the aortic bulge.) >>>>> If you are doing a redo why not do a manouguian double valve or >>>>> better >>>>> still >>>>> a Konno as your aortic gradient is 50 ? Since there are >>>>> adhesions , a >>>>> Konno >>>>> will actually become easier. >>>>> Prasanna >>>>> On Fri, Oct 30, 2009 at 10:45 PM, Douville, Chuck >>>>> wrote: >>>>> >>>>>> I have a pt who needs her third heart operation. She is now >>>>>> 66; at age >>>>> 45 >>>>>> she a mitral commissurotomy, at age 50 she had St. Jude aortic >>>>>> and >>>>> mitral >>>>>> replacements (19 and 27), old op nots describes LVOT as very >>>>> hypoplastic. >>>>>> Now weight loss, failure to thrive,weakness. LDH is over 2000. >>>>>> Blood >>>>>> cultures no growth. Echo shows 50 mm mean aortic gradient, >>>>>> unchanged >>>>> past 2 >>>>>> yrs but new mild to mod MR, (perivalvular) and mod TR. If cath >>>>>> is ok, I >>>>> am >>>>>> planning to through right thoracotomy to re-do MVR and repair >>>>>> tricuspid. >>>>> Has >>>>>> anyone ever done this and regretted the exposure of the >>>>>> Mitral with the rigid aortic prosthesis in place? I am going >>>>>> to leave >>>>> her >>>>>> aortic valve alone; gradient is old and I think it will take a >>>>>> Konno to >>>>>> improve it. Apical ortic conduit later if needed is my >>>>>> thought. Thx >>>>>> >>>>>> Chuck >>>>>> >>>>>> Sent from my iPhone >>>>>> _______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@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 >>>>>> anddisclaimers posted at: >>>>>> http://www.hsforum.com/listdisclaim >>>>>> ----------------------------------------- >>>>>> >>>>> >>>>> >>>>> >>>>> -- >>>>> Prasanna Simha M >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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@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 >>>>> ----------------------------------------- >>>>> >>>> >>>> >>>> >>>> -- >>>> Prasanna Simha M >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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 >>>> ----------------------------------------- >>>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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 >>> ----------------------------------------- >>> >> >> >> >> -- >> Prasanna Simha M >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@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@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 >> ----------------------------------------- >> > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@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 > ----------------------------------------- From dukeb60 at aol.com Sun Nov 1 18:50:52 2009 From: dukeb60 at aol.com (Edward P. Raines) Date: Sun Nov 1 18:51:44 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: <513475FB-FBA5-4D2C-859D-39DFB25EC862@gmail.com> References: <2105951765-1257099796-cardhu_decombobulator_blackberry.rim.net-172959978-@bda735.bisx.prod.on.blackberry> <513475FB-FBA5-4D2C-859D-39DFB25EC862@gmail.com> Message-ID: <8CC296547754FA3-6AF8-4B0C@webmail-d017.sysops.aol.com> michael, Remarkable job. I started crying myself about 2/3 of the way through your description. Would like details regarding the pulverized kitchen sink. If it works I'll try it. Too bad your fellow was such a pussy and didn't just finish things up for you. Hard to find good help, huh? No matter what you collect for this one it isn't enough. How long were you on suicide watch? Glad I now know of a reference surgeon for these types of cases. How is it best to get ahold of you? Ed -----Original Message----- From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Sun, Nov 1, 2009 5:11 pm Subject: Re: [HSF] Changing field in Our specialty 1. went on bypass through the groin (he of course was morbidly obese) 2. opened the chest 3. dug out the heart (was not as bad as I thought 4 months post-op) 4. cross-clamped (antegrade) 5. opened up the right atrium - direct retrograde (and I make up ice patties to rest on the RV for cases like this) 6. opened up the aorta - looked at the valve, said "ugh, told perfusion to 'get a bigger boat' 7. carried the RA incisions to a transseptal approach to the mitral 8. hacked out the valve valve (which looked horrible - should have taken pictures - but wanted to be efficient and keep moving) (including the annular tissue and anterior mitral which was infected 9. carried the incision from the aorta down to where the mitral leaflet was 10. mobilized buttons. 11. looked at the giant cavity of RA-LV-LA-aorta and told the fellow to close it all up and I will meet him in the ICU 12. replaced the mitral (tissue) to what was left of the posterior annulus 13. pericardium to the anterior portion of the annulus to close the dome of the LA and intra-atrial spetum. 14. sewed in a homograft to what was left of the outflow tract and to the other side of the pericardial patch (folded in half - and sewn in the middle to to mitral - halt to #13 have to the outflow tract). Inverted into LV and 3 sutured at each "commisure" and running closure 15. re-implanted buttons and attached back to ascending aorta 16. took out tricuspid (probably should have done eariler) - but did not look obviously infected, but the early gram strain was) 17. replaced tricuspid. 18 took cross-clamp off and prayed. 19 heart start up. 20 lots of bleeding from homograft - tried to repair without much success 21 re-clamped and opened up ascending. 22 couldn't see obvious source - but new it was coming from suture line. 23 homograft was falling apart from inside?????? 24 tossed out a few swear words, started crying 25 started taking out HG for a tissue valved conduit (i.e. Bentall) - called Senior partner who came in to give me a break and help a little 26 sewing in conduit - he left to evaluate someone for ecmo for H1N1 (another topic) 27 re-implanted buttons attached aorta. 28 cross clamp off. 29 lots of prayer!!!! 30 came off, bleeding didnt look to bad (no not bloodless, lots and lots of help, factor 7, nitric, pulverized kitchen-sink). 31 echo looked reasonable. 32 about an hour after coming off, start to sag big time 33 femV-asc aorta ECMO. Packed chest, left over...... called it a day (608 minutes on-pump.... a new record, for me) 34 re-explored this am early for bleeding, nothing horrible, heart looked reasonable (junctional rhythm) but empty. 35 let him rest for a few days..... will wash out when I recover..... so far, early cultures show everything was infected........ he was wide awake in the ICU this am......... he had an EF of 30 when all of this started - probably ran out of "gas", hopefully didnt bag his RCA button (his RV didnt look that bad coming off). dont know about you, but we have been seeing a lot of bad (multiple valve) and complex endocarditis lately. I had a recent contained ruptured of a of sinus of valsalva abscess that also trashed a couple of valves in a 30 year/old with tons of other problems. Is there a reference surgeon that I can send these patients to? (yeah, right) thoughts comments? -michael On Nov 1, 2009, at 1:22 PM, hgrmd@aol.com wrote: > Michael, > How did you deal with the root abscess? > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Michael Firstenberg > Date: Sun, 1 Nov 2009 12:40:39 > To: > Subject: Re: [HSF] Changing field in Our specialty > > just teasing - and trying to get you fired up....... > > my case yesterday was a double valve (AVR/TVR) endocarditis case I did > in July - he came back in with a root abscess extending to his mitral > & LVOT, septic emboli, and a avr gradient that went from 25->80 mmHg > over two weeks..... and new heart block....febrile with positive blood > cultures going into the OR. > > Was a disaster...... but he is awake, so there is hope....... > > > > On Nov 1, 2009, at 12:17 PM, hgrmd@aol.com wrote: > >> Michael, >> Of course they should have a say, but criteria need to be met. >> Otherwise, the patient is welcome to pay out of his own pocket. >> The patient should >> be able to decide if it is a borderline case. To me, it's the same >> thinking as in seat belt laws. Not everyone is thrilled with them, >> but the public >> interest is best served. >> >> Hal >> >> >> In a message dated 11/1/2009 12:09:36 P.M. Eastern Standard Time, >> msfirst@gmail.com writes: >> >> so what you are implying is that the patient should not have a say >> in >> what they want? >> >> >> -michael >> >> >> On Nov 1, 2009, at 11:59 AM, Hgrmd@aol.com wrote: >> >>> Prasanna, >>> Sorry, CAS is carotid artery stenting. Medicare is quite strict >>> about >>> the clinical conditions for which it will pay for this procedure. >>> I am >>> hopeful that AVI's will be restricted to patients deemed high risk >>> and not just >>> because the pt prefers a needle stick to an incision. >>> >>> Hal >>> >>> >>> In a message dated 11/1/2009 11:49:09 A.M. Eastern Standard Time, >>> prasannasimha@gmail.com writes: >>> >>> What is CAS ? >>> Prasanna >>> >>> On Sun, Nov 1, 2009 at 7:29 PM, wrote: >>>> John, >>>> Hopefully, the Feds and the providers will keep them in check. >>>> They've >>> done that with CAS. >>>> >>>> Hal >>>> Sent from my Verizon Wireless BlackBerry >>>> >>>> -----Original Message----- >>>> From: John Schor >>>> Date: Sun, 01 Nov 2009 05:57:41 >>>> To: >>>> Subject: Re: [HSF] Changing field in Our specialty >>>> >>>> I agree with Hal about suboptimal results with some of these >>>> disruptive technologies, BUT, the train is rolling. As we all >>>> know, >>>> patient flow is controlled by the cardiologists, and 99% believe >>>> that >>>> surgery is bad and catheters are good. >>>> John >>>> John Schor, MD >>>> Thoracic and Cardiovascular Surgery >>>> Heart and Vascular Center of >>>> Northern Arizona >>>> Flagstaff, Sedona, and >>>> Cottonwood, AZ >>>> Tel: 928-649-2584 >>>> >>>> On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: >>>> >>>>> John, >>>>> Agree it will be a "scary ride", mainly for the patients as >>>>> some of >>>>> those technqies you describe give them clearly suboptimal >>>>> results. >>>>> I strongly suspect the doc at TCT doing the ostial LM stenting >>>>> with >>>>> a "perfect" result would be getting conventional LIMA to LAD if >>>>> he >>>>> had the same anatomy. I won't even begin to tell you my >>>>> thoughts >>>>> of >>>>> an E Valve clip and a c.s. Screwing up the anatomy of a >>>>> repairable >>>>> valve. >>>>> >>>>> >>>>> >>>>> >>>>> Hal >>>>> Sent from my Verizon Wireless BlackBerry >>>>> >>>>> -----Original Message----- >>>>> From: John Schor >>>>> Date: Sat, 31 Oct 2009 21:18:51 >>>>> To: >>>>> Subject: Re: [HSF] Changing field in Our specialty >>>>> >>>>> In thoracic cases, the same size criteria is used for stent >>>>> grafting >>>>> as for open surgery. >>>>> >>>>> I have believed for the past 9 yrs that "open surgery" would be >>>>> relegated to history books. As doctors( not just as CV >>>>> surgeons), >>>>> we >>>>> should be prepared for 1. repairs (of all organ systems) rather >>>>> than >>>>> replacements 2. Avoidance of incisions--or increased use of >>>>> scopes-- >>>>> whenever possible 3. Natural Orifice access surgery 4. >>>>> Medication >>>>> rather than surgery. >>>>> >>>>> The aorta, from the sinotubular junction to the bifurcation, >>>>> will >>>>> be >>>>> "fixed" with endovascular techniques. (probably in less than 10 >>>>> yrs) >>>>> Agree with Tom. Even in my small community hospital working >>>>> alone >>>>> in >>>>> the OR (no PA or first assistants), I have been able to fix 10cm >>>>> ruptured AAA with stent grafting. >>>>> >>>>> You should all attend a Cardiology meeting such as the TCT. You >>>>> will >>>>> be amazed to see such things as L Main stenting for 95% ostial >>>>> lesion-- >>>>> with PERFECT result. Transfemoral and transapical AVR's done >>>>> safely. >>>>> MV repairs with clips and then reinforced with coronary sinus >>>>> rings........ >>>>> >>>>> Hold on to your hats. It's gonna be a scary ride. >>>>> >>>>> John >>>>> >>>>> John Schor, MD >>>>> Thoracic and Cardiovascular Surgery >>>>> Heart and Vascular Center of >>>>> Northern Arizona >>>>> Flagstaff, Sedona, and >>>>> Cottonwood, AZ >>>>> Tel: 928-649-2584 >>>>> >>>>> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: >>>>> >>>>>> What is your threshold for intervention, i mean the size for >>>>>> descending aorta. >>>>>> >>>>>> Zhandong Zhou, MD >>>>>> St. Joseph Hospital >>>>>> Syracuse, New York >>>>>> Tel: 315 423 7192 >>>>>> >>>>>> On Oct 31, 2009, at 5:30 PM, John Schor >>>>>> wrote: >>>>>> >>>>>>> Agree. >>>>>>> See many of my previous posts. >>>>>>> John >>>>>>> John Schor, MD >>>>>>> Thoracic and Cardiovascular Surgery >>>>>>> Heart and Vascular Center of >>>>>>> Northern Arizona >>>>>>> Flagstaff, Sedona, and >>>>>>> Cottonwood, AZ >>>>>>> Tel: 928-649-2584 >>>>>>> >>>>>>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>>>>>> >>>>>>>> To all, >>>>>>>> >>>>>>>> I am in DC for a endovascular course for thoracic aneurysm. >>>>>>>> Only >>>>>>>> 25% are CV surgeons. Others are vascular, radiology, >>>>>>>> cardiologist. >>>>>>>> >>>>>>>> We need to catch up, without these skills, we are going to >>>>>>>> lose >>>>>>>> the percutaneous valve. >>>>>>>> >>>>>>>> Any thoughts? >>>>>>>> >>>>>>>> Z Zhou_______________________________________________ >>>>>>>> OpenHeart-L mailing list >>>>>>>> >>>>>>>> Send postings to: >>>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>>> http://www.hsforum.com/listdisclaim >>>>>>>> ----------------------------------------- >>>>>>> >>>>>>> _______________________________________________ >>>>>>> OpenHeart-L mailing list >>>>>>> >>>>>>> Send postings to: >>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>> http://www.hsforum.com/listdisclaim >>>>>>> ----------------------------------------- >>>>>> _______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>> http://www.hsforum.com/listdisclaim >>>>>> ----------------------------------------- >>>>> >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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@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@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@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 >>>> ----------------------------------------- >>>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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@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@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@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@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 anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From Hgrmd at aol.com Sun Nov 1 19:10:54 2009 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Nov 1 19:11:32 2009 Subject: [HSF] Changing field in Our specialty Message-ID: Ed, I think I would have given up when the first homograft fell apart. As for the ECMO, is the ascending aorta the usual arterial site? Hal In a message dated 11/1/2009 6:53:17 P.M. Eastern Standard Time, dukeb60@aol.com writes: michael, Remarkable job. I started crying myself about 2/3 of the way through your description. Would like details regarding the pulverized kitchen sink. If it works I'll try it. Too bad your fellow was such a pussy and didn't just finish things up for you. Hard to find good help, huh? No matter what you collect for this one it isn't enough. How long were you on suicide watch? Glad I now know of a reference surgeon for these types of cases. How is it best to get ahold of you? Ed -----Original Message----- From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Sun, Nov 1, 2009 5:11 pm Subject: Re: [HSF] Changing field in Our specialty 1. went on bypass through the groin (he of course was morbidly obese) 2. opened the chest 3. dug out the heart (was not as bad as I thought 4 months post-op) 4. cross-clamped (antegrade) 5. opened up the right atrium - direct retrograde (and I make up ice patties to rest on the RV for cases like this) 6. opened up the aorta - looked at the valve, said "ugh, told perfusion to 'get a bigger boat' 7. carried the RA incisions to a transseptal approach to the mitral 8. hacked out the valve valve (which looked horrible - should have taken pictures - but wanted to be efficient and keep moving) (including the annular tissue and anterior mitral which was infected 9. carried the incision from the aorta down to where the mitral leaflet was 10. mobilized buttons. 11. looked at the giant cavity of RA-LV-LA-aorta and told the fellow to close it all up and I will meet him in the ICU 12. replaced the mitral (tissue) to what was left of the posterior annulus 13. pericardium to the anterior portion of the annulus to close the dome of the LA and intra-atrial spetum. 14. sewed in a homograft to what was left of the outflow tract and to the other side of the pericardial patch (folded in half - and sewn in the middle to to mitral - halt to #13 have to the outflow tract). Inverted into LV and 3 sutured at each "commisure" and running closure 15. re-implanted buttons and attached back to ascending aorta 16. took out tricuspid (probably should have done eariler) - but did not look obviously infected, but the early gram strain was) 17. replaced tricuspid. 18 took cross-clamp off and prayed. 19 heart start up. 20 lots of bleeding from homograft - tried to repair without much success 21 re-clamped and opened up ascending. 22 couldn't see obvious source - but new it was coming from suture line. 23 homograft was falling apart from inside?????? 24 tossed out a few swear words, started crying 25 started taking out HG for a tissue valved conduit (i.e. Bentall) - called Senior partner who came in to give me a break and help a little 26 sewing in conduit - he left to evaluate someone for ecmo for H1N1 (another topic) 27 re-implanted buttons attached aorta. 28 cross clamp off. 29 lots of prayer!!!! 30 came off, bleeding didnt look to bad (no not bloodless, lots and lots of help, factor 7, nitric, pulverized kitchen-sink). 31 echo looked reasonable. 32 about an hour after coming off, start to sag big time 33 femV-asc aorta ECMO. Packed chest, left over...... called it a day (608 minutes on-pump.... a new record, for me) 34 re-explored this am early for bleeding, nothing horrible, heart looked reasonable (junctional rhythm) but empty. 35 let him rest for a few days..... will wash out when I recover..... so far, early cultures show everything was infected........ he was wide awake in the ICU this am......... he had an EF of 30 when all of this started - probably ran out of "gas", hopefully didnt bag his RCA button (his RV didnt look that bad coming off). dont know about you, but we have been seeing a lot of bad (multiple valve) and complex endocarditis lately. I had a recent contained ruptured of a of sinus of valsalva abscess that also trashed a couple of valves in a 30 year/old with tons of other problems. Is there a reference surgeon that I can send these patients to? (yeah, right) thoughts comments? -michael On Nov 1, 2009, at 1:22 PM, hgrmd@aol.com wrote: > Michael, > How did you deal with the root abscess? > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Michael Firstenberg > Date: Sun, 1 Nov 2009 12:40:39 > To: > Subject: Re: [HSF] Changing field in Our specialty > > just teasing - and trying to get you fired up....... > > my case yesterday was a double valve (AVR/TVR) endocarditis case I did > in July - he came back in with a root abscess extending to his mitral > & LVOT, septic emboli, and a avr gradient that went from 25->80 mmHg > over two weeks..... and new heart block....febrile with positive blood > cultures going into the OR. > > Was a disaster...... but he is awake, so there is hope....... > > > > On Nov 1, 2009, at 12:17 PM, hgrmd@aol.com wrote: > >> Michael, >> Of course they should have a say, but criteria need to be met. >> Otherwise, the patient is welcome to pay out of his own pocket. >> The patient should >> be able to decide if it is a borderline case. To me, it's the same >> thinking as in seat belt laws. Not everyone is thrilled with them, >> but the public >> interest is best served. >> >> Hal >> >> >> In a message dated 11/1/2009 12:09:36 P.M. Eastern Standard Time, >> msfirst@gmail.com writes: >> >> so what you are implying is that the patient should not have a say >> in >> what they want? >> >> >> -michael >> >> >> On Nov 1, 2009, at 11:59 AM, Hgrmd@aol.com wrote: >> >>> Prasanna, >>> Sorry, CAS is carotid artery stenting. Medicare is quite strict >>> about >>> the clinical conditions for which it will pay for this procedure. >>> I am >>> hopeful that AVI's will be restricted to patients deemed high risk >>> and not just >>> because the pt prefers a needle stick to an incision. >>> >>> Hal >>> >>> >>> In a message dated 11/1/2009 11:49:09 A.M. Eastern Standard Time, >>> prasannasimha@gmail.com writes: >>> >>> What is CAS ? >>> Prasanna >>> >>> On Sun, Nov 1, 2009 at 7:29 PM, wrote: >>>> John, >>>> Hopefully, the Feds and the providers will keep them in check. >>>> They've >>> done that with CAS. >>>> >>>> Hal >>>> Sent from my Verizon Wireless BlackBerry >>>> >>>> -----Original Message----- >>>> From: John Schor >>>> Date: Sun, 01 Nov 2009 05:57:41 >>>> To: >>>> Subject: Re: [HSF] Changing field in Our specialty >>>> >>>> I agree with Hal about suboptimal results with some of these >>>> disruptive technologies, BUT, the train is rolling. As we all >>>> know, >>>> patient flow is controlled by the cardiologists, and 99% believe >>>> that >>>> surgery is bad and catheters are good. >>>> John >>>> John Schor, MD >>>> Thoracic and Cardiovascular Surgery >>>> Heart and Vascular Center of >>>> Northern Arizona >>>> Flagstaff, Sedona, and >>>> Cottonwood, AZ >>>> Tel: 928-649-2584 >>>> >>>> On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: >>>> >>>>> John, >>>>> Agree it will be a "scary ride", mainly for the patients as >>>>> some of >>>>> those technqies you describe give them clearly suboptimal >>>>> results. >>>>> I strongly suspect the doc at TCT doing the ostial LM stenting >>>>> with >>>>> a "perfect" result would be getting conventional LIMA to LAD if >>>>> he >>>>> had the same anatomy. I won't even begin to tell you my >>>>> thoughts >>>>> of >>>>> an E Valve clip and a c.s. Screwing up the anatomy of a >>>>> repairable >>>>> valve. >>>>> >>>>> >>>>> >>>>> >>>>> Hal >>>>> Sent from my Verizon Wireless BlackBerry >>>>> >>>>> -----Original Message----- >>>>> From: John Schor >>>>> Date: Sat, 31 Oct 2009 21:18:51 >>>>> To: >>>>> Subject: Re: [HSF] Changing field in Our specialty >>>>> >>>>> In thoracic cases, the same size criteria is used for stent >>>>> grafting >>>>> as for open surgery. >>>>> >>>>> I have believed for the past 9 yrs that "open surgery" would be >>>>> relegated to history books. As doctors( not just as CV >>>>> surgeons), >>>>> we >>>>> should be prepared for 1. repairs (of all organ systems) rather >>>>> than >>>>> replacements 2. Avoidance of incisions--or increased use of >>>>> scopes-- >>>>> whenever possible 3. Natural Orifice access surgery 4. >>>>> Medication >>>>> rather than surgery. >>>>> >>>>> The aorta, from the sinotubular junction to the bifurcation, >>>>> will >>>>> be >>>>> "fixed" with endovascular techniques. (probably in less than 10 >>>>> yrs) >>>>> Agree with Tom. Even in my small community hospital working >>>>> alone >>>>> in >>>>> the OR (no PA or first assistants), I have been able to fix 10cm >>>>> ruptured AAA with stent grafting. >>>>> >>>>> You should all attend a Cardiology meeting such as the TCT. You >>>>> will >>>>> be amazed to see such things as L Main stenting for 95% ostial >>>>> lesion-- >>>>> with PERFECT result. Transfemoral and transapical AVR's done >>>>> safely. >>>>> MV repairs with clips and then reinforced with coronary sinus >>>>> rings........ >>>>> >>>>> Hold on to your hats. It's gonna be a scary ride. >>>>> >>>>> John >>>>> >>>>> John Schor, MD >>>>> Thoracic and Cardiovascular Surgery >>>>> Heart and Vascular Center of >>>>> Northern Arizona >>>>> Flagstaff, Sedona, and >>>>> Cottonwood, AZ >>>>> Tel: 928-649-2584 >>>>> >>>>> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: >>>>> >>>>>> What is your threshold for intervention, i mean the size for >>>>>> descending aorta. >>>>>> >>>>>> Zhandong Zhou, MD >>>>>> St. Joseph Hospital >>>>>> Syracuse, New York >>>>>> Tel: 315 423 7192 >>>>>> >>>>>> On Oct 31, 2009, at 5:30 PM, John Schor >>>>>> wrote: >>>>>> >>>>>>> Agree. >>>>>>> See many of my previous posts. >>>>>>> John >>>>>>> John Schor, MD >>>>>>> Thoracic and Cardiovascular Surgery >>>>>>> Heart and Vascular Center of >>>>>>> Northern Arizona >>>>>>> Flagstaff, Sedona, and >>>>>>> Cottonwood, AZ >>>>>>> Tel: 928-649-2584 >>>>>>> >>>>>>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>>>>>> >>>>>>>> To all, >>>>>>>> >>>>>>>> I am in DC for a endovascular course for thoracic aneurysm. >>>>>>>> Only >>>>>>>> 25% are CV surgeons. Others are vascular, radiology, >>>>>>>> cardiologist. >>>>>>>> >>>>>>>> We need to catch up, without these skills, we are going to >>>>>>>> lose >>>>>>>> the percutaneous valve. >>>>>>>> >>>>>>>> Any thoughts? >>>>>>>> >>>>>>>> Z Zhou_______________________________________________ >>>>>>>> OpenHeart-L mailing list >>>>>>>> >>>>>>>> Send postings to: >>>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>>> http://www.hsforum.com/listdisclaim >>>>>>>> ----------------------------------------- >>>>>>> >>>>>>> _______________________________________________ >>>>>>> OpenHeart-L mailing list >>>>>>> >>>>>>> Send postings to: >>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>> http://www.hsforum.com/listdisclaim >>>>>>> ----------------------------------------- >>>>>> _______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>> http://www.hsforum.com/listdisclaim >>>>>> ----------------------------------------- >>>>> >>>>> _______________________________________________ >>>>> OpenHeart-L mailing list >>>>> >>>>> Send postings to: >>>>> OpenHeart-L@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@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@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@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 >>>> ----------------------------------------- >>>> >>> >>> >>> >>> -- >>> Prasanna Simha M >>> _______________________________________________ >>> OpenHeart-L mailing list >>> >>> Send postings to: >>> OpenHeart-L@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@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@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@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@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@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@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 anddisclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@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 ----------------------------------------- From ebender001 at me.com Sun Nov 1 18:39:51 2009 From: ebender001 at me.com (Edward Bender) Date: Sun Nov 1 19:40:20 2009 Subject: [HSF] Changing field in Our specialty In-Reply-To: <513475FB-FBA5-4D2C-859D-39DFB25EC862@gmail.com> Message-ID: Excellent job! You are now the reference surgeon for these types of cases. Mazel Tov. Ed Bender, MD On 11/1/09 5:11 PM, "Michael Firstenberg" wrote: > 1. went on bypass through the groin (he of course was morbidly obese) > 2. opened the chest > 3. dug out the heart (was not as bad as I thought 4 months post-op) > 4. cross-clamped (antegrade) > 5. opened up the right atrium - direct retrograde (and I make up ice > patties to rest on the RV for cases like this) > 6. opened up the aorta - looked at the valve, said "ugh, told > perfusion to 'get a bigger boat' > 7. carried the RA incisions to a transseptal approach to the mitral > 8. hacked out the valve valve (which looked horrible - should have > taken pictures - but wanted to be efficient and keep moving) > (including the annular tissue and anterior mitral which was infected > 9. carried the incision from the aorta down to where the mitral > leaflet was > 10. mobilized buttons. > > 11. looked at the giant cavity of RA-LV-LA-aorta and told the fellow > to close it all up and I will meet him in the ICU > > 12. replaced the mitral (tissue) to what was left of the posterior > annulus > 13. pericardium to the anterior portion of the annulus to close the > dome of the LA and intra-atrial spetum. > 14. sewed in a homograft to what was left of the outflow tract and to > the other side of the pericardial patch (folded in half - and sewn in > the middle to to mitral - halt to #13 have to the outflow tract). > Inverted into LV and 3 sutured at each "commisure" and running closure > 15. re-implanted buttons and attached back to ascending aorta > 16. took out tricuspid (probably should have done eariler) - but did > not look obviously infected, but the early gram strain was) > 17. replaced tricuspid. > 18 took cross-clamp off and prayed. > 19 heart start up. > 20 lots of bleeding from homograft - tried to repair without much > success > 21 re-clamped and opened up ascending. > 22 couldn't see obvious source - but new it was coming from suture line. > 23 homograft was falling apart from inside?????? > 24 tossed out a few swear words, started crying > 25 started taking out HG for a tissue valved conduit (i.e. Bentall) - > called Senior partner who came in to give me a break and help a little > 26 sewing in conduit - he left to evaluate someone for ecmo for H1N1 > (another topic) > 27 re-implanted buttons attached aorta. > 28 cross clamp off. > 29 lots of prayer!!!! > 30 came off, bleeding didnt look to bad (no not bloodless, lots and > lots of help, factor 7, nitric, pulverized kitchen-sink). > 31 echo looked reasonable. > 32 about an hour after coming off, start to sag big time > 33 femV-asc aorta ECMO. Packed chest, left over...... called it a day > (608 minutes on-pump.... a new record, for me) > 34 re-explored this am early for bleeding, nothing horrible, heart > looked reasonable (junctional rhythm) but empty. > 35 let him rest for a few days..... will wash out when I recover..... > > so far, early cultures show everything was infected........ > he was wide awake in the ICU this am......... > > > he had an EF of 30 when all of this started - probably ran out of > "gas", hopefully didnt bag his RCA button (his RV didnt look that bad > coming off). > > dont know about you, but we have been seeing a lot of bad (multiple > valve) and complex endocarditis lately. I had a recent contained > ruptured of a of sinus of valsalva abscess that also trashed a couple > of valves in a 30 year/old with tons of other problems. > > Is there a reference surgeon that I can send these patients to? > (yeah, right) > > thoughts comments? > > -michael > > > > > > On Nov 1, 2009, at 1:22 PM, hgrmd@aol.com wrote: > >> Michael, >> How did you deal with the root abscess? >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: Michael Firstenberg >> Date: Sun, 1 Nov 2009 12:40:39 >> To: >> Subject: Re: [HSF] Changing field in Our specialty >> >> just teasing - and trying to get you fired up....... >> >> my case yesterday was a double valve (AVR/TVR) endocarditis case I did >> in July - he came back in with a root abscess extending to his mitral >> & LVOT, septic emboli, and a avr gradient that went from 25->80 mmHg >> over two weeks..... and new heart block....febrile with positive blood >> cultures going into the OR. >> >> Was a disaster...... but he is awake, so there is hope....... >> >> >> >> On Nov 1, 2009, at 12:17 PM, hgrmd@aol.com wrote: >> >>> Michael, >>> Of course they should have a say, but criteria need to be met. >>> Otherwise, the patient is welcome to pay out of his own pocket. >>> The patient should >>> be able to decide if it is a borderline case. To me, it's the same >>> thinking as in seat belt laws. Not everyone is thrilled with them, >>> but the public >>> interest is best served. >>> >>> Hal >>> >>> >>> In a message dated 11/1/2009 12:09:36 P.M. Eastern Standard Time, >>> msfirst@gmail.com writes: >>> >>> so what you are implying is that the patient should not have a say >>> in >>> what they want? >>> >>> >>> -michael >>> >>> >>> On Nov 1, 2009, at 11:59 AM, Hgrmd@aol.com wrote: >>> >>>> Prasanna, >>>> Sorry, CAS is carotid artery stenting. Medicare is quite strict >>>> about >>>> the clinical conditions for which it will pay for this procedure. >>>> I am >>>> hopeful that AVI's will be restricted to patients deemed high risk >>>> and not just >>>> because the pt prefers a needle stick to an incision. >>>> >>>> Hal >>>> >>>> >>>> In a message dated 11/1/2009 11:49:09 A.M. Eastern Standard Time, >>>> prasannasimha@gmail.com writes: >>>> >>>> What is CAS ? >>>> Prasanna >>>> >>>> On Sun, Nov 1, 2009 at 7:29 PM, wrote: >>>>> John, >>>>> Hopefully, the Feds and the providers will keep them in check. >>>>> They've >>>> done that with CAS. >>>>> >>>>> Hal >>>>> Sent from my Verizon Wireless BlackBerry >>>>> >>>>> -----Original Message----- >>>>> From: John Schor >>>>> Date: Sun, 01 Nov 2009 05:57:41 >>>>> To: >>>>> Subject: Re: [HSF] Changing field in Our specialty >>>>> >>>>> I agree with Hal about suboptimal results with some of these >>>>> disruptive technologies, BUT, the train is rolling. As we all >>>>> know, >>>>> patient flow is controlled by the cardiologists, and 99% believe >>>>> that >>>>> surgery is bad and catheters are good. >>>>> John >>>>> John Schor, MD >>>>> Thoracic and Cardiovascular Surgery >>>>> Heart and Vascular Center of >>>>> Northern Arizona >>>>> Flagstaff, Sedona, and >>>>> Cottonwood, AZ >>>>> Tel: 928-649-2584 >>>>> >>>>> On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: >>>>> >>>>>> John, >>>>>> Agree it will be a "scary ride", mainly for the patients as >>>>>> some of >>>>>> those technqies you describe give them clearly suboptimal >>>>>> results. >>>>>> I strongly suspect the doc at TCT doing the ostial LM stenting >>>>>> with >>>>>> a "perfect" result would be getting conventional LIMA to LAD if >>>>>> he >>>>>> had the same anatomy. I won't even begin to tell you my >>>>>> thoughts >>>>>> of >>>>>> an E Valve clip and a c.s. Screwing up the anatomy of a >>>>>> repairable >>>>>> valve. >>>>>> >>>>>> >>>>>> >>>>>> >>>>>> Hal >>>>>> Sent from my Verizon Wireless BlackBerry >>>>>> >>>>>> -----Original Message----- >>>>>> From: John Schor >>>>>> Date: Sat, 31 Oct 2009 21:18:51 >>>>>> To: >>>>>> Subject: Re: [HSF] Changing field in Our specialty >>>>>> >>>>>> In thoracic cases, the same size criteria is used for stent >>>>>> grafting >>>>>> as for open surgery. >>>>>> >>>>>> I have believed for the past 9 yrs that "open surgery" would be >>>>>> relegated to history books. As doctors( not just as CV >>>>>> surgeons), >>>>>> we >>>>>> should be prepared for 1. repairs (of all organ systems) rather >>>>>> than >>>>>> replacements 2. Avoidance of incisions--or increased use of >>>>>> scopes-- >>>>>> whenever possible 3. Natural Orifice access surgery 4. >>>>>> Medication >>>>>> rather than surgery. >>>>>> >>>>>> The aorta, from the sinotubular junction to the bifurcation, >>>>>> will >>>>>> be >>>>>> "fixed" with endovascular techniques. (probably in less than 10 >>>>>> yrs) >>>>>> Agree with Tom. Even in my small community hospital working >>>>>> alone >>>>>> in >>>>>> the OR (no PA or first assistants), I have been able to fix 10cm >>>>>> ruptured AAA with stent grafting. >>>>>> >>>>>> You should all attend a Cardiology meeting such as the TCT. You >>>>>> will >>>>>> be amazed to see such things as L Main stenting for 95% ostial >>>>>> lesion-- >>>>>> with PERFECT result. Transfemoral and transapical AVR's done >>>>>> safely. >>>>>> MV repairs with clips and then reinforced with coronary sinus >>>>>> rings........ >>>>>> >>>>>> Hold on to your hats. It's gonna be a scary ride. >>>>>> >>>>>> John >>>>>> >>>>>> John Schor, MD >>>>>> Thoracic and Cardiovascular Surgery >>>>>> Heart and Vascular Center of >>>>>> Northern Arizona >>>>>> Flagstaff, Sedona, and >>>>>> Cottonwood, AZ >>>>>> Tel: 928-649-2584 >>>>>> >>>>>> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: >>>>>> >>>>>>> What is your threshold for intervention, i mean the size for >>>>>>> descending aorta. >>>>>>> >>>>>>> Zhandong Zhou, MD >>>>>>> St. Joseph Hospital >>>>>>> Syracuse, New York >>>>>>> Tel: 315 423 7192 >>>>>>> >>>>>>> On Oct 31, 2009, at 5:30 PM, John Schor >>>>>>> wrote: >>>>>>> >>>>>>>> Agree. >>>>>>>> See many of my previous posts. >>>>>>>> John >>>>>>>> John Schor, MD >>>>>>>> Thoracic and Cardiovascular Surgery >>>>>>>> Heart and Vascular Center of >>>>>>>> Northern Arizona >>>>>>>> Flagstaff, Sedona, and >>>>>>>> Cottonwood, AZ >>>>>>>> Tel: 928-649-2584 >>>>>>>> >>>>>>>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>>>>>>> >>>>>>>>> To all, >>>>>>>>> >>>>>>>>> I am in DC for a endovascular course for thoracic aneurysm. >>>>>>>>> Only >>>>>>>>> 25% are CV surgeons. Others are vascular, radiology, >>>>>>>>> cardiologist. >>>>>>>>> >>>>>>>>> We need to catch up, without these skills, we are going to >>>>>>>>> lose >>>>>>>>> the percutaneous valve. >>>>>>>>> >>>>>>>>> Any thoughts? >>>>>>>>> >>>>>>>>> Z Zhou_______________________________________________ >>>>>>>>> OpenHeart-L mailing list >>>>>>>>> >>>>>>>>> Send postings to: >>>>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>>>> http://www.hsforum.com/listdisclaim >>>>>>>>> ----------------------------------------- >>>>>>>> >>>>>>>> _______________________________________________ >>>>>>>> OpenHeart-L mailing list >>>>>>>> >>>>>>>> Send postings to: >>>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>>> http://www.hsforum.com/listdisclaim >>>>>>>> ----------------------------------------- >>>>>>> _______________________________________________ >>>>>>> OpenHeart-L mailing list >>>>>>> >>>>>>> Send postings to: >>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>> http://www.hsforum.com/listdisclaim >>>>>>> ----------------------------------------- >>>>>> >>>>>> _______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@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@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@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@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 >>>>> ----------------------------------------- >>>>> >>>> >>>> >>>> >>>> -- >>>> Prasanna Simha M >>>> _______________________________________________ >>>> OpenHeart-L mailing list >>>> >>>> Send postings to: >>>> OpenHeart-L@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@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@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@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@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@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@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 > ----------------------------------------- From ecdouville at orclinic.com Sun Nov 1 17:17:29 2009 From: ecdouville at orclinic.com (Douville, Chuck) Date: Sun Nov 1 20:17:56 2009 Subject: [HSF] Changing field in Our specialty References: Message-ID: ________________________________ From: openheart-l-bounces@lists.hsforum.com on behalf of Edward Bender Sent: Sun 11/1/2009 4:39 PM To: HSF List Subject: Re: [HSF] Changing field in Our specialty Excellent job! You are now the reference surgeon for these types of cases. Mazel Tov. Ed Bender, MD On 11/1/09 5:11 PM, "Michael Firstenberg" wrote: > 1. went on bypass through the groin (he of course was morbidly obese) > 2. opened the chest > 3. dug out the heart (was not as bad as I thought 4 months post-op) > 4. cross-clamped (antegrade) > 5. opened up the right atrium - direct retrograde (and I make up ice > patties to rest on the RV for cases like this) > 6. opened up the aorta - looked at the valve, said "ugh, told > perfusion to 'get a bigger boat' > 7. carried the RA incisions to a transseptal approach to the mitral > 8. hacked out the valve valve (which looked horrible - should have > taken pictures - but wanted to be efficient and keep moving) > (including the annular tissue and anterior mitral which was infected > 9. carried the incision from the aorta down to where the mitral > leaflet was > 10. mobilized buttons. > > 11. looked at the giant cavity of RA-LV-LA-aorta and told the fellow > to close it all up and I will meet him in the ICU > > 12. replaced the mitral (tissue) to what was left of the posterior > annulus > 13. pericardium to the anterior portion of the annulus to close the > dome of the LA and intra-atrial spetum. > 14. sewed in a homograft to what was left of the outflow tract and to > the other side of the pericardial patch (folded in half - and sewn in > the middle to to mitral - halt to #13 have to the outflow tract). > Inverted into LV and 3 sutured at each "commisure" and running closure > 15. re-implanted buttons and attached back to ascending aorta > 16. took out tricuspid (probably should have done eariler) - but did > not look obviously infected, but the early gram strain was) > 17. replaced tricuspid. > 18 took cross-clamp off and prayed. > 19 heart start up. > 20 lots of bleeding from homograft - tried to repair without much > success > 21 re-clamped and opened up ascending. > 22 couldn't see obvious source - but new it was coming from suture line. > 23 homograft was falling apart from inside?????? > 24 tossed out a few swear words, started crying > 25 started taking out HG for a tissue valved conduit (i.e. Bentall) - > called Senior partner who came in to give me a break and help a little > 26 sewing in conduit - he left to evaluate someone for ecmo for H1N1 > (another topic) > 27 re-implanted buttons attached aorta. > 28 cross clamp off. > 29 lots of prayer!!!! > 30 came off, bleeding didnt look to bad (no not bloodless, lots and > lots of help, factor 7, nitric, pulverized kitchen-sink). > 31 echo looked reasonable. > 32 about an hour after coming off, start to sag big time > 33 femV-asc aorta ECMO. Packed chest, left over...... called it a day > (608 minutes on-pump.... a new record, for me) > 34 re-explored this am early for bleeding, nothing horrible, heart > looked reasonable (junctional rhythm) but empty. > 35 let him rest for a few days..... will wash out when I recover..... > > so far, early cultures show everything was infected........ > he was wide awake in the ICU this am......... > > > he had an EF of 30 when all of this started - probably ran out of > "gas", hopefully didnt bag his RCA button (his RV didnt look that bad > coming off). > > dont know about you, but we have been seeing a lot of bad (multiple > valve) and complex endocarditis lately. I had a recent contained > ruptured of a of sinus of valsalva abscess that also trashed a couple > of valves in a 30 year/old with tons of other problems. > > Is there a reference surgeon that I can send these patients to? > (yeah, right) > > thoughts comments? > > -michael > > > > > > On Nov 1, 2009, at 1:22 PM, hgrmd@aol.com wrote: > >> Michael, >> How did you deal with the root abscess? >> >> Hal >> Sent from my Verizon Wireless BlackBerry >> >> -----Original Message----- >> From: Michael Firstenberg >> Date: Sun, 1 Nov 2009 12:40:39 >> To: >> Subject: Re: [HSF] Changing field in Our specialty >> >> just teasing - and trying to get you fired up....... >> >> my case yesterday was a double valve (AVR/TVR) endocarditis case I did >> in July - he came back in with a root abscess extending to his mitral >> & LVOT, septic emboli, and a avr gradient that went from 25->80 mmHg >> over two weeks..... and new heart block....febrile with positive blood >> cultures going into the OR. >> >> Was a disaster...... but he is awake, so there is hope....... >> >> >> >> On Nov 1, 2009, at 12:17 PM, hgrmd@aol.com wrote: >> >>> Michael, >>> Of course they should have a say, but criteria need to be met. >>> Otherwise, the patient is welcome to pay out of his own pocket. >>> The patient should >>> be able to decide if it is a borderline case. To me, it's the same >>> thinking as in seat belt laws. Not everyone is thrilled with them, >>> but the public >>> interest is best served. >>> >>> Hal >>> >>> >>> In a message dated 11/1/2009 12:09:36 P.M. Eastern Standard Time, >>> msfirst@gmail.com writes: >>> >>> so what you are implying is that the patient should not have a say >>> in >>> what they want? >>> >>> >>> -michael >>> >>> >>> On Nov 1, 2009, at 11:59 AM, Hgrmd@aol.com wrote: >>> >>>> Prasanna, >>>> Sorry, CAS is carotid artery stenting. Medicare is quite strict >>>> about >>>> the clinical conditions for which it will pay for this procedure. >>>> I am >>>> hopeful that AVI's will be restricted to patients deemed high risk >>>> and not just >>>> because the pt prefers a needle stick to an incision. >>>> >>>> Hal >>>> >>>> >>>> In a message dated 11/1/2009 11:49:09 A.M. Eastern Standard Time, >>>> prasannasimha@gmail.com writes: >>>> >>>> What is CAS ? >>>> Prasanna >>>> >>>> On Sun, Nov 1, 2009 at 7:29 PM, wrote: >>>>> John, >>>>> Hopefully, the Feds and the providers will keep them in check. >>>>> They've >>>> done that with CAS. >>>>> >>>>> Hal >>>>> Sent from my Verizon Wireless BlackBerry >>>>> >>>>> -----Original Message----- >>>>> From: John Schor >>>>> Date: Sun, 01 Nov 2009 05:57:41 >>>>> To: >>>>> Subject: Re: [HSF] Changing field in Our specialty >>>>> >>>>> I agree with Hal about suboptimal results with some of these >>>>> disruptive technologies, BUT, the train is rolling. As we all >>>>> know, >>>>> patient flow is controlled by the cardiologists, and 99% believe >>>>> that >>>>> surgery is bad and catheters are good. >>>>> John >>>>> John Schor, MD >>>>> Thoracic and Cardiovascular Surgery >>>>> Heart and Vascular Center of >>>>> Northern Arizona >>>>> Flagstaff, Sedona, and >>>>> Cottonwood, AZ >>>>> Tel: 928-649-2584 >>>>> >>>>> On Nov 1, 2009, at 4:37 AM, Hgrmd@aol.com wrote: >>>>> >>>>>> John, >>>>>> Agree it will be a "scary ride", mainly for the patients as >>>>>> some of >>>>>> those technqies you describe give them clearly suboptimal >>>>>> results. >>>>>> I strongly suspect the doc at TCT doing the ostial LM stenting >>>>>> with >>>>>> a "perfect" result would be getting conventional LIMA to LAD if >>>>>> he >>>>>> had the same anatomy. I won't even begin to tell you my >>>>>> thoughts >>>>>> of >>>>>> an E Valve clip and a c.s. Screwing up the anatomy of a >>>>>> repairable >>>>>> valve. >>>>>> >>>>>> >>>>>> >>>>>> >>>>>> Hal >>>>>> Sent from my Verizon Wireless BlackBerry >>>>>> >>>>>> -----Original Message----- >>>>>> From: John Schor >>>>>> Date: Sat, 31 Oct 2009 21:18:51 >>>>>> To: >>>>>> Subject: Re: [HSF] Changing field in Our specialty >>>>>> >>>>>> In thoracic cases, the same size criteria is used for stent >>>>>> grafting >>>>>> as for open surgery. >>>>>> >>>>>> I have believed for the past 9 yrs that "open surgery" would be >>>>>> relegated to history books. As doctors( not just as CV >>>>>> surgeons), >>>>>> we >>>>>> should be prepared for 1. repairs (of all organ systems) rather >>>>>> than >>>>>> replacements 2. Avoidance of incisions--or increased use of >>>>>> scopes-- >>>>>> whenever possible 3. Natural Orifice access surgery 4. >>>>>> Medication >>>>>> rather than surgery. >>>>>> >>>>>> The aorta, from the sinotubular junction to the bifurcation, >>>>>> will >>>>>> be >>>>>> "fixed" with endovascular techniques. (probably in less than 10 >>>>>> yrs) >>>>>> Agree with Tom. Even in my small community hospital working >>>>>> alone >>>>>> in >>>>>> the OR (no PA or first assistants), I have been able to fix 10cm >>>>>> ruptured AAA with stent grafting. >>>>>> >>>>>> You should all attend a Cardiology meeting such as the TCT. You >>>>>> will >>>>>> be amazed to see such things as L Main stenting for 95% ostial >>>>>> lesion-- >>>>>> with PERFECT result. Transfemoral and transapical AVR's done >>>>>> safely. >>>>>> MV repairs with clips and then reinforced with coronary sinus >>>>>> rings........ >>>>>> >>>>>> Hold on to your hats. It's gonna be a scary ride. >>>>>> >>>>>> John >>>>>> >>>>>> John Schor, MD >>>>>> Thoracic and Cardiovascular Surgery >>>>>> Heart and Vascular Center of >>>>>> Northern Arizona >>>>>> Flagstaff, Sedona, and >>>>>> Cottonwood, AZ >>>>>> Tel: 928-649-2584 >>>>>> >>>>>> On Oct 31, 2009, at 2:49 PM, Zhandong Zhou wrote: >>>>>> >>>>>>> What is your threshold for intervention, i mean the size for >>>>>>> descending aorta. >>>>>>> >>>>>>> Zhandong Zhou, MD >>>>>>> St. Joseph Hospital >>>>>>> Syracuse, New York >>>>>>> Tel: 315 423 7192 >>>>>>> >>>>>>> On Oct 31, 2009, at 5:30 PM, John Schor >>>>>>> wrote: >>>>>>> >>>>>>>> Agree. >>>>>>>> See many of my previous posts. >>>>>>>> John >>>>>>>> John Schor, MD >>>>>>>> Thoracic and Cardiovascular Surgery >>>>>>>> Heart and Vascular Center of >>>>>>>> Northern Arizona >>>>>>>> Flagstaff, Sedona, and >>>>>>>> Cottonwood, AZ >>>>>>>> Tel: 928-649-2584 >>>>>>>> >>>>>>>> On Oct 31, 2009, at 11:02 AM, Zhandong Zhou wrote: >>>>>>>> >>>>>>>>> To all, >>>>>>>>> >>>>>>>>> I am in DC for a endovascular course for thoracic aneurysm. >>>>>>>>> Only >>>>>>>>> 25% are CV surgeons. Others are vascular, radiology, >>>>>>>>> cardiologist. >>>>>>>>> >>>>>>>>> We need to catch up, without these skills, we are going to >>>>>>>>> lose >>>>>>>>> the percutaneous valve. >>>>>>>>> >>>>>>>>> Any thoughts? >>>>>>>>> >>>>>>>>> Z Zhou_______________________________________________ >>>>>>>>> OpenHeart-L mailing list >>>>>>>>> >>>>>>>>> Send postings to: >>>>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>>>> http://www.hsforum.com/listdisclaim >>>>>>>>> ----------------------------------------- >>>>>>>> >>>>>>>> _______________________________________________ >>>>>>>> OpenHeart-L mailing list >>>>>>>> >>>>>>>> Send postings to: >>>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>>> http://www.hsforum.com/listdisclaim >>>>>>>> ----------------------------------------- >>>>>>> _______________________________________________ >>>>>>> OpenHeart-L mailing list >>>>>>> >>>>>>> Send postings to: >>>>>>> OpenHeart-L@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 anddisclaimers posted at: >>>>>>> http://www.hsforum.com/listdisclaim >>>>>>> ----------------------------------------- >>>>>> >>>>>> _______________________________________________ >>>>>> OpenHeart-L mailing list >>>>>> >>>>>> Send postings to: >>>>>> OpenHeart-L@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@lists.hsforum.com >>>>>> >>>>>> To UNSUBSCRIBE, to CHANGE email addre