| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2000;69:1879
© 2000 The Society of Thoracic Surgeons
DR JAROSLAV STARK (London, England): You mentioned that the proper selection of patients was one of the reasons for your excellent results. Can you give us some indications in how many patients you could not do one of the three procedures and perhaps could do just a shunt or no surgery at all during this time period?
DR BANDO: Well, the patients we excluded had significantly high pulmonary arterial pressure, over 25 mm Hg, or significantly high pulmonary vascular resistance or very poor ventricular function. Those are the patients.
DR STARK: I know, but can you tell us how many patients were not suitable for surgery during this time period?
DR BANDO: I would say only 4 or 5 patients.
DR JOSEPH J. AMATO (Chicago, IL): In our experience what we have done is created a slit 4 mm in length with a dilator going through that slit, and I am just wondering whether the 2.5-mm opening is sufficient enough and wonder whether you had noticed any difference in chest drainage and prolongation of stay of the patient in the hospital with the 2.5-mm versus a 4-mm opening?
DR BANDO: Well, in this study we didn’t specifically analyze how long the patients are going to stay, but certainly the 2.5-mm and smaller shunt would help especially the immediate postoperative course of the postoperative care. And also most recently in conjunction with the other technique of modified ultrafiltration, our stay in the ICU has been down to 5 to 7 days and the total stay in the hospital is approximately 2 weeks.
DR WINFIELD J. WELLS (Los Angeles, CA): Doctor Bando, I noticed in your abstract that over 80% of the patients had spontaneous closure of their fenestration, and yet all these patients are anticoagulated. What is your perception of the mechanism for closure of the fenestration?
DR BANDO: Well, I was puzzled as well in that regard, but 1-year follow-up with the echocardiogram, a 2.5-mm shunt, as I show in here, 90% has been closed. We only give 0.5 to 1 mg of warfarin, which we adjust to the International Normalized Ratio around 1.4 to 1.5. That might be the reason for that. In other words, that was not the systemic significant anticoagulation.
DR WELLS: Just a quick follow-up. Are you planning to anticoagulate these patients indefinitely, and if so, do you have evidence that it is beneficial?
DR BANDO: Yes.
DR WELLS: You do plan indefinite anticoagulation?
DR BANDO: Yes.
DR BABULAL SETHIA (Birmingham, United Kingdom): Thank you for your paper. Your last conclusion about functional outcome being good, satisfactory and so on, do you have any extra data on which to base that, particularly in terms, for instance, of exercise study, the sort of objective measurements of performance? Because there is a wealth of data, as you know, that has been published to show these patients may not necessarily have a particularly good functional outcome depending on what parameters you care to apply.
DR BANDO: That’s a very good point, and most recently we sent letters to the patients’ families on how they are doing at school and how they are doing at the gym class and so forth, and in this particular study that is not our focus to answer. But this upcoming AATS meeting we analyzed more in detail and especially in the patients with hypoplastic left heart syndrome, and I think I can answer your question at that time.
| ||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
