Heart Surgery-MarinHealth, CA. Tips/Techniques to facilitate heart surgery. All my opinions based on personal experience. Yolopactli/ticitl
Larkspur, CA
Joined August 2012
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PDA endarterectomy through 1cm arteriotomy w "Mills instruments" in spec time. Great job, Dr. Amir Sarkeshik! Mentoring the next gen on complex open maneuvers is more critical than ever. Mastering these skills is what keeps our field safe. #CTO @M_Pompeu_Sa_MD @georgetolisjr
TAVR implanted 7 years ago, now w CHF, sev AS/AI. I've had repeated success finding plane btwn native valve cusps & TAVR skirt, working w elevator instrument in R hand and gentle traction grasping top of frame w L hand to "pop" valve out. @M_Pompeu_Sa_MD @tomcnguyen #TAVR
Rheumatic mitral valve disease persists in the US. In this case, severe MR/mild MS and severe TR. This 49 year old tolerated Coumadin without complications for six years, making mitral replacement with a mechanical heart valve an easy choice.
#inspiris implanted 6 years ago. There is very little clinical data to suggest this valve will be as durable as it's predecessor, Magna or MagnaEase. But certainly more expensive. @tomcnguyen @DrZeigler1 @Abedeanda @APolancoMD
Incredible information gained with modern transesophageal imaging! In this case, a previously repaired valve with long-standing residual regurgitation. Hint hint, the mitral valve doesn't quite look like that.
Redo SAVR via aortic root can be tight. I started by freeing the valve sharply under the RCA, transected the prosthesis, repeated the release/transection until it came apart into 3 pieces, removing each segment carefully to protect the annulus. Simple, practical, worked well.
50 y.o woman treated for “HTN & chronic headaches” for decades. Thought weak legs after walking was normal. Finally got a CT chest; revealed the real problem. Simple surgical fix: 24Fr Ao‑to‑Ao bypass. She feels like a new person. Reminder to keep differential wide.
72 yo w h/o bicuspid AS S/P TAVR 5yrs ago, now severe stenosis of implant. Explant revealed massive calcification & dense pannus. Hard to imagine Tavr in Tavr. Standard root enlargement enabled safe implantation of a 29 mm Epic. @DrZeigler1 @JCoselli_MD @Abedeanda @tomcnguyen
Use of an Intraoperative Head, Neck, and Back Support... : Annals of Surgery journals.lww.com/annalsofsur…
Not all aortic valves come out clean. This one was heavily calcified... had to be cut out in several pieces. Mean gradient 74mmHg. Conduction system intact, annulus fully debrided, and a 29 mm prosthesis seated smoothly in a super athletic man.
Excising an aortic valve as a single piece is a skill set developed when learning to properly detach leaflets at the annular insertion. No need to "tear & pluck" at leaflets & calcium. Almost no annular debridement required. SAVR, w 29mm Abbott Epic valve via mini sternotomy.
Luis J Castro MD retweeted
on my 26th birthday, i wrote I Took A Pill in Ibiza…10 years ago. The song became popular several years after i wrote it. Yesterday i celebrated my 36th birthday. i feel proud to look at the song lyrics and know that NONE of them are true anymore. I’ve grown into a completely new man…one that i’m proud of. check this out… 🧵
85 yo 👱🏼♂️, TAVR 3 years ago, now with endocarditis. Ugly, calcified root with obstructed prosthesis, required SAVR & partial aortic wall endarterectomy. Challenging to say the least. 25 mm tissue valve implanted via mini sternotomy. Clamp time 45 minutes.
